Hyperbaric oxygen treatment and bisphosphonate-induced osteonecrosis of the jaw: a case series.
OBJECTIVE
Bisphosphonate (BP)-associated osteonecrosis of the jaw (ONJ) is an emerging problem with few therapeutic options. Our pilot study of BP-ONJ investigated a possible role for hyperbaric oxygen (HBO(2)) therapy.


METHODS
A total of 16 patients, ranging in age from 43 to 78 years, with BP-ONJ were treated with adjunctive HBO(2) between July 2003 and April 2006. Staging was based on the size and number of oral lesions. Clinical response after treatment and at distant follow-up; the odds of remission, stabilization, or relapse; and time to failure analysis were calculated.


RESULTS
The median time on BP therapy before appearance of ONJ symptoms was 18 months, and that from symptom onset to HBO(2) therapy was 12 months. Fourteen of 16 patients (87.5%) improved in stage. The size and number of ONJ lesions were decreased after HBO(2) therapy (P < .001 and P = .008, respectively; Wilcoxon signed-rank test). Immediately after HBO(2) therapy, 7 of 16 patients (44%) were in remission and 8 (50%) had stabilized; however, stabilization without remission was sustained in only 2 patients. At follow-up, 10 of the patients (62.5%) were still in remission or had stabilized. The 7 patients who continued on BP treatment during HBO(2) therapy had a shorter time to failure (8.5 months; 95% confidence interval [CI] = 7.1 to 9.8) than those who discontinued the drug (20.1 months; 95% CI = 17.5 to 23.9; P = .006 by the log-rank test). Clinical response was not associated with cancer type or malignancy remission status.


CONCLUSIONS
Adjunctive HBO(2) therapy may benefit patients with BP-ONJ; however, the outcome is improved with cessation of BP administration.
Freiberger
John J
JJ
Center for Hyperbaric Medicine and Environmental Physiology, Duke University Medical Center, Divers Alert Network, Durham, NCfreib002@mc.duke.edu.
Padilla-Burgos
Rebecca
R
Chhoeu
Austin H
AH
Kraft
Kevin H
KH
Boneta
Otto
O
Moon
R E
RE
Piantadosi
C A
CA
D000328:Adult; D000368:Aged; D050071:Bone Density Conservation Agents / Q000009:adverse effects*; D001943:Breast Neoplasms / Q000188:drug therapy; D004164:Diphosphonates / Q000009:adverse effects*; D005260:Female; D006801:Humans; D006931:Hyperbaric Oxygenation; D007571:Jaw Diseases / Q000139:chemically induced / Q000628:therapy*; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000188:drug therapy; D010020:Osteonecrosis / Q000139:chemically induced / Q000628:therapy*; D012074:Remission Induction
D050071:Bone Density Conservation Agents; D004164:Diphosphonates