title: A different schedule of zoledronic acid can reduce the risk of the osteonecrosis of the jaw in patients with multiple myeloma.
abstract: Osteonecrosis of the jaw (ONJ) is a reported complication of bisphosphonate use. The incidence ranges between 6 and 13% and seems to be higher in people treated with zoledronic acid (ZA) than with pamidronate. We retrospectively evaluated the incidences of ONJ and skeletal-related events (SRE) in 106 patients with multiple myeloma divided in two groups according to the schedule of administration of bisphosphonates: 51 received monthly administrations until tolerated (group A, standard schedule), 55 were treated monthly during the first year and then every 3 months (group B, reduced schedule). The incidence of SRE was similar (15.1 per 100 person years in group A and 17.7 in group B). ONJ occurred in seven patients, six in group A and one in group B (P=0.049). The risk of ONJ was eight-fold lower with the reduced schedule than with the standard schedule. The only significant risk factor for ONJ was the type of bisphosphonate (P=0.006). The incidence of ONJ was significantly higher with ZA than with pamidronate + ZA (9.1 vs 1.6 per 100 person-years). No ONJ was observed in patients treated only with pamidronate. A reduced schedule of ZA may be safer than the standard schedule while maintaining anti-resorptive efficacy.
authors.affiliation: Institute of Hematology, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy. a.corso@smatteo.pv.it
authors.forename: A
authors.initials: A
authors.lastname: Corso
authors.forename: M
authors.initials: M
authors.lastname: Varettoni
authors.forename: P
authors.initials: P
authors.lastname: Zappasodi
authors.forename: C
authors.initials: C
authors.lastname: Klersy
authors.forename: S
authors.initials: S
authors.lastname: Mangiacavalli
authors.forename: G
authors.initials: G
authors.lastname: Pica
authors.forename: M
authors.initials: M
authors.lastname: Lazzarino
mesh_terms: D000368:Aged; D004164:Diphosphonates / Q000008:administration & dosage* / Q000627:therapeutic use; D004334:Drug Administration Schedule; D004341:Drug Evaluation; D005260:Female; D006801:Humans; D007093:Imidazoles / Q000008:administration & dosage*; D015994:Incidence; D007571:Jaw Diseases; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000150:complications*; D010020:Osteonecrosis / Q000188:drug therapy / Q000209:etiology / Q000517:prevention & control*; D000077268:Pamidronate; D012189:Retrospective Studies; D012307:Risk Factors; D000077211:Zoledronic Acid
chemical_list: D004164:Diphosphonates; D007093:Imidazoles; D000077211:Zoledronic Acid; D000077268:Pamidronate