title: [Osteonecrosis of the jaw in patients with multiple myeloma during and after treatment with zoledronic acid].
abstract: OBJECTIVE
  To analyze the incidence, the clinical features, and the factors associated with the development of osteonecrosis of the jaw (ONJ) in patients with multiple myeloma (MM) treated with zoledronic acid.
  
  
  METHODS
  Sixty-four patients diagnosed with MM and treated with zoledronic acid between August 1996 and March 2006 were included. Demographic data, predisposing factors, the type of antineoplastic therapy received and the infusions of biophosphonate were recorded. The main characteristics of the seven patients with ONJ, including clinical and physical examinations data, diagnostic methods and treatment established were reported.
  
  
  RESULTS
  The overall incidence of ONJ was 7 out of 64 patients (10.93%). A recent oral surgical procedure has been associated with the ONJ (p < 0.0001). The mean of infusions of zoledronic acid before onset of osteonecrosis (standard deviation) was 30 (7.04) in contrast to 19.5 (11.8) cycles (p = 0.03) in the patients who did not present this complication. The cumulative risk increased from 6.7% after 20 treatments with zoledronic acid up to 31.7% at 36 infusions. Three patients exhibited ONJ after discounting zoledronic acid.
  
  
  CONCLUSIONS
  The ONJ in patients with MM who underwent dental or oral surgery appears to be associated with long term exposure to zoledronic acid. The long-lasting bone effect of biophosphonate could explain the appearance of osteonecrotic lesions after discontinuing treatment with biphosphonate.
authors.affiliation: Servico de Hematología. Hospital General de Lanzarote. Arrecife de Lanzarote. Las Palmas. España. jmcvillas@hotmail.com
authors.forename: José Manuel
authors.initials: JM
authors.lastname: Calvo-Villas
authors.forename: Maria
authors.initials: M
authors.lastname: Tapia Torres
authors.forename: José
authors.initials: J
authors.lastname: Govantes Rodríguez
authors.forename: Elena
authors.initials: E
authors.lastname: Carreter de Granda
authors.forename: Francisco
authors.initials: F
authors.lastname: Sicilia Guillén
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D050071:Bone Density Conservation Agents / Q000009:adverse effects*; D004164:Diphosphonates / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007093:Imidazoles / Q000009:adverse effects*; D015994:Incidence; D007571:Jaw Diseases / Q000139:chemically induced* / Q000453:epidemiology; D008297:Male; D009101:Multiple Myeloma / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology; D010020:Osteonecrosis / Q000139:chemically induced* / Q000453:epidemiology; D012307:Risk Factors; D000077211:Zoledronic Acid
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D007093:Imidazoles; D000077211:Zoledronic Acid