"Bis-phossy jaws" - high and low risk factors for bisphosphonate-induced osteonecrosis of the jaw.
BACKGROUND
Bisphosphonates (BPs) have transformed our ability to treat certain malignancies, osteoporosis and hypercalcaemia. This class of drug is assumed to be well tolerated by most. There are some important caveats to this assumption, however, one of the significances being the risk of osteonecrosis of the jaw (ONJ).


METHODS
This multi-centre retrospective study examined the role of different BPs on the development of ONJ, its clinical presentation and the efficacy of various treatment modalities, comparing these findings with the available literature.


RESULTS
A total of 78 patients from 17 centres were identified with ONJ. A majority of patients identified with ONJ had used Pamidronate or Zoledronate (93.6%) intravenously. 94.9% of patients had received BP in the course of treatment for malignancies and a majority had also received prior chemotherapy or exogenous steroids. 82.1% of patients had received BP for more than 1 year. The mean time from the introduction of BP to the development of ONJ in 24 patients from our department was 31.8 months.


CONCLUSIONS
The most common intraoral manifestation was exposed necrotic jawbone. Tooth extractions and oral surgical intervention appear to place patients on BP therapy at risk of ONJ, especially after intravenous BP treatments. ONJ proved in this study to be remarkably refractory to treatment, with radical resection being the only curative approach. We recommend that all patients receive necessary dental treatment prior to commencing BP therapy.
Abu-Id
Mario H
MH
Department of Oral and Maxillofacial Surgery and Plastic Surgery, Asklepios Klinik Nord, Hamburg, Germany.
Warnke
Patrick H
PH
Gottschalk
Joachim
J
Springer
Ingo
I
Wiltfang
Jörg
J
Acil
Yahya
Y
Russo
Paul A J
PA
Kreusch
Thomas
T
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use; D050071:Bone Density Conservation Agents / Q000008:administration & dosage / Q000009:adverse effects*; D004164:Diphosphonates / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007093:Imidazoles / Q000008:administration & dosage / Q000009:adverse effects; D007275:Injections, Intravenous; D007571:Jaw Diseases / Q000139:chemically induced* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy; D019647:Oral Surgical Procedures / Q000009:adverse effects; D010020:Osteonecrosis / Q000139:chemically induced* / Q000601:surgery; D000077268:Pamidronate; D012189:Retrospective Studies; D012307:Risk Factors; D011795:Surveys and Questionnaires; D000077211:Zoledronic Acid
D000970:Antineoplastic Agents; D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D007093:Imidazoles; D000077211:Zoledronic Acid; D000077268:Pamidronate