Thirteen cases of jaw osteonecrosis in patients on bisphosphonate therapy.
BACKGROUND
We report on our experience with 13 cases of jaw osteonecrosis in patients treated with amino-bisphosphonates.


METHODS
Data were collected by a regional observatory for jaw osteonecrosis in northern France via letters sent to all physicians likely to manage patients with this condition. All study patients were evaluated at a multidisciplinary jaw osteonecrosis clinic between June and December 2005.


RESULTS
We identified 13 cases, in 12 women and 1 man, with a mean age of 62.6 years. Intravenous amino-bisphosphonate therapy was given for metastatic bone disease from breast cancer in 7 patients and multiple myeloma in 5 patients; the remaining patient was on oral alendronate for osteoporosis. Mean treatment duration was 24 months. A history of dental extraction was found in 11 (84.6%) patients. The mandible was involved in all 13 patients and the maxillary in 3 (23%) patients. Amino-bisphosphonate therapy was discontinued in all 13 patients. We suggest a classification scheme for the clinical and computed-tomography patterns seen in our patients.


CONCLUSIONS
Jaw osteonecrosis is a severe complication of amino-bisphosphonate therapy. In addition to the application of published guidelines, we propose discontinuing bisphosphonate therapy whenever possible. We are evaluating our classification scheme to identify early diagnostic criteria and/or clinical and computed-tomography outcome criteria that would improve the management of patients with jaw osteonecrosis.
Vieillard
Marie-Hélène
MH
Rheumatology Department, Lille Teaching Hospital, Hospital Roger-Salengro, CHRU de Lille, Rue Emile-Laine, 59037 Lille cedex, France. mh-vieillard@chru-lille.fr
Maes
Jean-Michel
JM
Penel
Guillaume
G
Facon
Thierry
T
Magro
Leonardo
L
Bonneterre
Jacques
J
Cortet
Bernard
B
D050071:Bone Density Conservation Agents / Q000009:adverse effects / Q000627:therapeutic use; D001859:Bone Neoplasms / Q000188:drug therapy; D004164:Diphosphonates / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007093:Imidazoles / Q000009:adverse effects / Q000627:therapeutic use; D007568:Jaw; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000188:drug therapy; D056948:Orthognathic Surgical Procedures; D010020:Osteonecrosis / Q000139:chemically induced* / Q000601:surgery; D010024:Osteoporosis / Q000188:drug therapy; D000077268:Pamidronate; D011446:Prospective Studies; D000077211:Zoledronic Acid
D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D007093:Imidazoles; D000077211:Zoledronic Acid; D000077268:Pamidronate