Osteonecrosis of the jaws and bisphosphonate treatment in cancer patients.
OBJECTIVE
Osteonecrosis of the jaws is described as an intraoral complication after administration of intravenous nitrogen-containing bisphosphonates. In a retrospective study, patients with osteonecrosis of the jaws after bisphosphonate treatment were evaluated with regard to diagnostic investigations and therapeutic management.


METHODS
Seventeen patients with osteonecrosis of the jaws after bisphosphonate treatment who were referred to our department between July 2004 and June 2005 were included in this study. Computer tomography, magnetic resonance imaging, scintigraphy, bacteriology and biopsy were used in diagnostic evaluation. All patients were treated surgically.


RESULTS
The reasons for bisphosphonate treatment were multiple myeloma in 12 patients, breast cancer with bone metastasis in four patients and histiocytosis X in one patient. Five patients had received intravenous pamidronate and 12 patients zoledronic acid. The median number of treatment cycles for pamidronate was 36 times (range 4-100) in 38 months (range 4-100). Zolendric acid was given 23.5 times (range 5-39) in 26 months (range 5-39). Nine patients had a lesion in the mandible, eight in the maxilla. Clinical symptoms were exposed bone, pain and local inflammation of the mucosa. Computer tomography showed sclerotic areas in the osteonecrosis zone. The biopsy did not show a metastatic lesion. Sequestrectomy and decortication was adequate in the follow-up.


CONCLUSIONS
Nitrogen-containing bisphosphonates appear to be associated with the risk of developing osteonecrosis of the jaws. To reduce this risk, patients should be evaluated by a dentist before beginning treatment with intravenous bisphosphonates.
Wutzl
Arno
A
Department of Cranio-Maxillofacial and Oral Surgery, Medical University of Vienna, Austria. arno.wutzl@meduniwien.ac.at
Eisenmenger
Gabriela
G
Hoffmann
Martha
M
Czerny
Christian
C
Moser
Doris
D
Pietschmann
Peter
P
Ewers
Rolf
R
Baumann
Arnulf
A
D000328:Adult; D000368:Aged; D001706:Biopsy; D050071:Bone Density Conservation Agents / Q000008:administration & dosage / Q000009:adverse effects*; D001943:Breast Neoplasms / Q000188:drug therapy*; D004164:Diphosphonates / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006646:Histiocytosis, Langerhans-Cell / Q000188:drug therapy; D006801:Humans; D007093:Imidazoles / Q000008:administration & dosage / Q000009:adverse effects*; D007275:Injections, Intravenous; D007571:Jaw Diseases / Q000139:chemically induced* / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male; D008334:Mandible / Q000473:pathology; D008336:Mandibular Diseases / Q000139:chemically induced / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D008437:Maxilla / Q000473:pathology; D008439:Maxillary Diseases / Q000139:chemically induced / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D008875:Middle Aged; D009101:Multiple Myeloma / Q000188:drug therapy*; D010020:Osteonecrosis / Q000139:chemically induced* / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D000077268:Pamidronate; D011862:Radiography, Panoramic; D011877:Radionuclide Imaging; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D000077211:Zoledronic Acid
D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D007093:Imidazoles; D000077211:Zoledronic Acid; D000077268:Pamidronate