No osteonecrosis in jaws of young patients with osteogenesis imperfecta treated with bisphosphonates.
BACKGROUND
Recent reports of osteonecrosis of the jaw (ONJ) after dental surgery in patients treated with second- and third-generation nitrogen-containing bisphosphonates instigated this retrospective study. As treatment with bisphosphonates in patients with osteogenesis imperfecta (OI) has become an important symptomatic therapy, especially for severe forms of the disease, we found it important to investigate whether healing after surgical exposure of jaw bone was influenced by the bisphosponate treatment in our group of children, adolescents and young adults with OI.


METHODS
Disodiumpamidronate was given as monthly intravenous infusion to 64 patients with OI aged 3 months to 20.9 years at the start of treatment (mean 8.1, median 7.7). During 0.5-12.5 years of treatment (mean 4.5, median 4.0), a total individual dose of 140-4020 mg/m(2) disodiumpamidronate was given (mean 1623 and median 1460). Ten patients continued with oral alendronate and two with zoledronic acid therapy. In 22 of these patients, 38 dental surgery procedures were performed at the age of 3.4-31.9 years (mean 12.2, median 12.3) after 0.03-7.9 years of treatment (mean 3.6, median 3.4).


RESULTS
Despite long-term intravenous monthly disodiumpamidronate treatment, none of the 64 patients had any clinical signs of ONJ.


CONCLUSIONS
The risk of ONJ in these patients must be considered so low that the patients with indications for treatment should be treated and get the chance to experience the well-documented beneficial effect for children with severe OI.
Malmgren
Barbro
B
Department of Paediatrics, Karolinska University Hospital Huddinge, Stockholm, Sweden. barbro.malmgren@telia.com
Aström
Eva
E
Söderhäll
Stefan
S
D000293:Adolescent; D000328:Adult; D050071:Bone Density Conservation Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D004164:Diphosphonates / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D007223:Infant; D007262:Infusions, Intravenous; D007571:Jaw Diseases / Q000139:chemically induced*; D019647:Oral Surgical Procedures; D010013:Osteogenesis Imperfecta / Q000188:drug therapy*; D010020:Osteonecrosis / Q000139:chemically induced*; D012189:Retrospective Studies
D050071:Bone Density Conservation Agents; D004164:Diphosphonates