title: Osteonecrosis of the maxilla and mandible in patients with advanced cancer treated with bisphosphonate therapy.
abstract: Cases of osteonecrosis of the jaw (ONJ) have been reported with an increasing frequency over the past 5 years. ONJ is most often identified in patients with cancer who are receiving intravenous bisphosphonate (IVBP) therapy, but it has also been diagnosed in patients receiving oral bisphosphonates for nonmalignant conditions. To further categorize risk factors associated with ONJ and potential clinical outcomes of this condition, we performed a retrospective study of patients with metastatic bone disease treated with intravenous bisphosphonates who have been evaluated by the Memorial Sloan-Kettering Cancer Center Dental Service between January 1, 1996 and January 31, 2006. We identified 310 patients who met these criteria. Twenty-eight patients were identified as having ONJ at presentation to the Dental Service and an additional 7 patients were subsequently diagnosed with ONJ. Statistically significant factors associated with increased likelihood of ONJ included type of cancer, duration of bisphosphonate therapy, sequential IVBP treatment with pamidronate followed by zoledronic acid, comorbid osteoarthritis or rheumatoid arthritis, and benign hematologic conditions. Our data do not support corticosteroid use or oral health as a predictor of risk for ONJ. Clinical outcomes of patients with ONJ were variable with 11 patients demonstrating improvement or healing with conservative management. Our ONJ experience is presented here.
authors.affiliation: D. Dental Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, New York 10021, USA. estiloc@mskcc.org
authors.forename: Cherry L
authors.initials: CL
authors.lastname: Estilo
authors.forename: Catherine H
authors.initials: CH
authors.lastname: Van Poznak
authors.forename: Tijaana
authors.initials: T
authors.lastname: Wiliams
authors.forename: George C
authors.initials: GC
authors.lastname: Bohle
authors.forename: Phyu T
authors.initials: PT
authors.lastname: Lwin
authors.forename: Qin
authors.initials: Q
authors.lastname: Zhou
authors.forename: Elyn R
authors.initials: ER
authors.lastname: Riedel
authors.forename: Diane L
authors.initials: DL
authors.lastname: Carlson
authors.forename: Heiko
authors.initials: H
authors.lastname: Schoder
authors.forename: Azeez
authors.initials: A
authors.lastname: Farooki
authors.forename: Monica
authors.initials: M
authors.lastname: Fornier
authors.forename: Jerry L
authors.initials: JL
authors.lastname: Halpern
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Tunick
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Huryn
mesh_terms: 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; D007262:Infusions, Intravenous; D007568:Jaw; D007573:Jaw Neoplasms / Q000188:drug therapy*; D008297:Male; D008334:Mandible; D008437:Maxilla; D010020:Osteonecrosis / Q000139:chemically induced* / Q000473:pathology*; D000077268:Pamidronate; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D000077211:Zoledronic Acid
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D007093:Imidazoles; D000077211:Zoledronic Acid; D000077268:Pamidronate