Osteonecrosis of the jaw induced by orally administered bisphosphonates: incidence, clinical features, predisposing factors and treatment outcome.
Osteonecrosis of the jaw (ONJ) is a well-known devastating side effect of bisphosphonate therapy for cancer. Several ONJ cases of patients using oral bisphosphonates have been reported in the literature. The present study analyzed the clinical features, predisposing factors, and treatment outcome of 11 patients with oral bisphosphonates-related ONJ.


OBJECTIVE
Osteonecrosis of the jaw (ONJ) is a well-known side effect of parenteral bisphosphonates therapy. Although ONJ has been reported in patients using oral bisphosphonates, documentation of this entity is sparse. It was hypothesized that the clinical features, predisposing factors, and treatment outcome of this population are different from those of oncologic patients.


METHODS
This retrospective bi-central study involved 98 ONJ patients, 13 of whom were treated with oral bisphosphonates. Two patients were excluded because of previous use of intravenous bisphosphonates. The profiles of 11 patients were analyzed.


RESULTS
The mean duration of alendronate use before developing ONJ was 4.1 years. ONJ was triggered by dental surgery in 9 patients and by ill-fitted dentures in 2. Heavy smokers were the most recalcitrant subjects. Among the nine patients with at least 6 months of follow-up, ONJ healed completely in three, partially in four, and not at all in two.


CONCLUSIONS
ONJ is a rare devastating side effect of oral bisphosphonates associated with patient morbidity and high financial burden. Clinicians must be aware of this entity and inform patients of the risks of dental surgery. The synergistic effect of smoking in the pathogenesis of ONJ should be further investigated.
Yarom
N
N
Department of Oral Pathology and Oral Medicine, The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University,Tel Aviv 69978, Israel. noamyar@post.tau.ac.il
Yahalom
R
R
Shoshani
Y
Y
Hamed
W
W
Regev
E
E
Elad
S
S
D000368:Aged; D050071:Bone Density Conservation Agents / Q000009:adverse effects* / Q000378:metabolism; D003729:Dental Care / Q000009:adverse effects*; D004164:Diphosphonates / Q000009:adverse effects* / Q000378:metabolism; D005260:Female; D006801:Humans; D007571:Jaw Diseases / Q000139:chemically induced* / Q000175:diagnosis / Q000188:drug therapy; D008875:Middle Aged; D010020:Osteonecrosis / Q000139:chemically induced* / Q000175:diagnosis / Q000188:drug therapy; D010024:Osteoporosis / Q000188:drug therapy*; D011788:Quality of Life / Q000523:psychology; D012189:Retrospective Studies; D012907:Smoking / Q000009:adverse effects*; D016896:Treatment Outcome
D050071:Bone Density Conservation Agents; D004164:Diphosphonates