Bisphosphonate-associated osteonecrosis of the jaws: a therapeutic dilemma.
OBJECTIVE
To describe our experience in prevention and treatment of mandibular and maxillary osteonecrosis, an emerging complication of long-term intravenous administration of bisphosphonates.


METHODS
Between February 2004 and February 2006, 10 patients who had received zoledronic acid intravenously because of multiple bone myelomas or bone metastases were treated for mandibular and maxillary osteonecrosis in the Departments of Otorhinolaryngology and Maxillofacial Surgery of our institution.


RESULTS
All of the patients underwent surgical sequestrectomies. More extensive surgery was necessary in 3 cases. There were no major complications, and the majority of the patients are alive with no signs of infection or bone exposure.


CONCLUSIONS
Our experience confirms that bisphosphonate therapy contributes to the pathogenesis of mandibular and maxillary osteonecrosis. Surgery seems to be necessary in the majority of the patients, although the most adequate procedure is far from being standardized and prevention seems to play a pivotal role.
Diego
Rossi
R
Department of Maxillo-Facial Surgery, Fondazione IRCCS Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, University of Milan, Milan, Italy.
D'Orto
Ornella
O
Pagani
Davide
D
Agazzi
Alessandro
A
Marzano
Umberto
U
Derada Troletti
Giancarlo
G
Fontanella
Walter
W
Pignataro
Lorenzo
L
D000368:Aged; D050071:Bone Density Conservation Agents / Q000008:administration & dosage / Q000009:adverse effects*; D001859:Bone Neoplasms / Q000188:drug therapy / Q000556:secondary; D004164:Diphosphonates / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007093:Imidazoles / Q000008:administration & dosage / Q000009:adverse effects; D007275:Injections, Intravenous; D007571:Jaw Diseases / Q000139:chemically induced* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000188:drug therapy; D010020:Osteonecrosis / Q000139:chemically induced* / Q000601:surgery; D000077211:Zoledronic Acid
D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D007093:Imidazoles; D000077211:Zoledronic Acid