[Bisphosphonates and maxillo-mandibular osteo(chemo)necrosis].
BACKGROUND
Maxillo-mandibular osteonecrosis is exceptional outside a context of cervico-facial radiotherapy. Bisphosphonates are non-metabolized pyrophosphate analogues which inhibit osteoclastic activity. Bisphosphonates are prescribed for the treatment of malignant hypercalcemia, osteolysis associated with metastatic bone disease, Paget's disease and osteoporosis. Maxillomandibular osteonecrosis with bisphosphonates can be observed in 1/10000 patients, but is probably underestimated due to lack of dental examination.


METHODS
We describe six cases of mandibular necrosis associated with bisphosphonates: five of them as part of their treatment regimen for a neoplastic condition and one for osteoporosis.


RESULTS
Two patients developed spontaneous bone necrosis. In two others, tooth extraction preceded the onset of osteonecrosis. In the last two patients, we noted a preexisting dental infection. All the histopathological examinations showed necrotic bone colonized by Actinomyces.


CONCLUSIONS
Bisphosphonate-induced osteonecrosis is only found in the maxillomandibular area because the jaws are the only bone in the skeleton exposed to the external environment. The mandible is rendered particularly prone to necrosis even after minor trauma because of its terminal vascularization. Careful oral examination is recommended before prescribing bisphosphonate therapy.
Magremanne
M
M
Service de Stomatologie et Chirurgie Maxillo-faciale, Cliniques Universitaires de Bruxelles, Belgique. michele.magremanne@hap.be
Vervaet
C
C
Dufrasne
L
L
Declercq
I
I
Legrand
W
W
Daelemans
Ph
P
D000197:Actinomycosis, Cervicofacial / Q000150:complications; D000368:Aged; D050071:Bone Density Conservation Agents / Q000009:adverse effects*; D001859:Bone Neoplasms / Q000188:drug therapy* / Q000556:secondary; D001943:Breast Neoplasms / Q000473:pathology; D004164:Diphosphonates / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008336:Mandibular Diseases / Q000139:chemically induced*; D008875:Middle Aged; D009101:Multiple Myeloma / Q000188:drug therapy; D019226:Oral Ulcer / Q000150:complications / Q000188:drug therapy; D010020:Osteonecrosis / Q000139:chemically induced* / Q000150:complications; D010024:Osteoporosis / Q000188:drug therapy; D010482:Periapical Abscess / Q000150:complications / Q000188:drug therapy; D010954:Plasmacytoma / Q000188:drug therapy; D014081:Tooth Extraction / Q000009:adverse effects
D050071:Bone Density Conservation Agents; D004164:Diphosphonates