Osteonecrosis of the jaw (ONJ) in cancer patients treated with Bisphosphonates: how the knowledge of a phenomenon can change its evolution.
OBJECTIVE
Osteonecrosis of the jaw (ONJ) is a severe complication of bisphosphonates treatment. Bisphosphonates reduce skeletal adverse events and give a clinical benefit to cancer patients. Therefore, it is necessary to identify appropriate procedures to reduce ONJ injures by using a successful monitoring program. In a retrospective study we analyzed the impact of a prevention program based on clinical oral cavity examination, dentists, and patients' education. The aim of the study was to evaluate if this approach might improve ONJ outcome in patients receiving pamidronate or zoledronate.


METHODS
We analyzed retrospectively two different groups of patients treated at our Institution: patients treated from October 2003 to June 2005 (group A) and patients treated from June 2005 to April 2007 (group B). In June 2005 the prevention program started for all our patients.


RESULTS
One hundred and eighty-six cancer patients with bone involvement, treated with bisphosphonates, were considered. Sixteen of them developed ONJ: eight before and eight after June 2005. We observed a consistent difference in the evolution of the two groups. In the first group, four patients underwent a major surgery (one partial maxillectomy, complicated by septic shock and oronasal communication; two partial mandibulectomies; and one segmental mandibular resection), with an important impairment of their quality of life; while the eight new ONJ cases, diagnosed after June 2005, were successfully treated without aggressive dental interventions, and achieved a good control of symptoms.


CONCLUSIONS
Bisphosphonates-related ONJ is a frequent adverse event (8.6%). The monitoring program proved very efficient to improve the clinical outcome of ONJ, avoiding an aggressive treatment and using a conservative approach and medical therapy.
La Verde
Nicla
N
Oncology Department, Azienda Ospedaliera-Ospedale Fatebenefratelli e Oftalmico, Milan, Italy. nicla.laverde@fbf.milano.it
Bareggi
Claudia
C
Garassino
Marina
M
Borgonovo
Karen
K
Sburlati
Paola
P
Pedretti
Donata
D
Bianchi
Celso
C
Perrone
Silvia
S
Mihali
Dorian
D
Cobelli
Stefano
S
Mantica
Cristina
C
Rizzo
Aurora
A
Farina
Gabriella
G
D000368:Aged; D000970:Antineoplastic Agents / Q000009:adverse effects*; D050071:Bone Density Conservation Agents / Q000008:administration & dosage / Q000009:adverse effects*; D001859:Bone Neoplasms / Q000188:drug therapy* / Q000556:secondary; D004164:Diphosphonates / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007093:Imidazoles / Q000008:administration & dosage / Q000009:adverse effects*; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D007571:Jaw Diseases / Q000139:chemically induced* / Q000175:diagnosis / Q000453:epidemiology / Q000473:pathology; D008297:Male; D010020:Osteonecrosis / Q000139:chemically induced* / Q000175:diagnosis / Q000453:epidemiology / Q000473:pathology; D000077268:Pamidronate; D012189:Retrospective Studies; D012307:Risk Factors; D000077211:Zoledronic Acid
D000970:Antineoplastic Agents; D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D007093:Imidazoles; D000077211:Zoledronic Acid; D000077268:Pamidronate