Osteonecrosis of the jaw associated with bisphosphonate use: Presentation of seven cases and literature review.
OBJECTIVE
Bisphosphonates, pyrophosphate analogs, are strong osteoclast inhibitors that are used for osteoporosis and in the treatment of solid tumors with bony metastasis. There are growing reports of osteonecrosis associated with the nitrogen containing bisphosphonates, Pamindronate and Zolendronic acid therapy. Theses cases have been most commonly seen and treated by oral surgeons. An untreated maxillary osteonecrosis can lead to pansinusitis, involving the otolaryngologist in these patients' care. To the authors' knowledge, this is the first case series reported in the otolaryngology literature.


METHODS
A retrospective chart review was conducted on patients presenting to the Mount Sinai Hospital Center and at Elmhurst General Hospital between October 2003 and November 2004 with a history of refractory osteomyelitis of the jaws and chronic bisphosphonate therapy.


RESULTS
Seven patients were identified with both of these conditions. These patients presented with nonhealing ulcers of the mandible or maxilla. Four of the patients were on bisphosphonate therapy, and the other three had been treated with bisphosphonates. Three of the patients required extensive operations to remove the involved bone. One patient required endoscopic sinus surgery.


CONCLUSIONS
Increasing reports of bisphosphonate associated osteomyelitis and the difficulty in treating these patients requires further investigation to identify the subset of patients who are at increased risk for this process. The optimal and safe duration of treatment with bisphosphonates needs to be determined.
Mortensen
Melissa
M
Department of Otolaryngology-Head and Neck Surgery, Mount Sinai School of Medicine, New York, New York, USA. melissa.mortensen@mssm.edu
Lawson
William
W
Montazem
Andre
A
D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D050071:Bone Density Conservation Agents / Q000009:adverse effects*; D001943:Breast Neoplasms / Q000188:drug therapy; D004164:Diphosphonates / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007571:Jaw Diseases / Q000139:chemically induced* / Q000188:drug therapy / Q000473:pathology; D008297:Male; D008334:Mandible / Q000187:drug effects; D008437:Maxilla / Q000187:drug effects; D008875:Middle Aged; D009101:Multiple Myeloma / Q000188:drug therapy; D010020:Osteonecrosis / Q000139:chemically induced* / Q000188:drug therapy; D012189:Retrospective Studies; D014081:Tooth Extraction / Q000009:adverse effects
D000900:Anti-Bacterial Agents; D050071:Bone Density Conservation Agents; D004164:Diphosphonates