title: Reduction of osteonecrosis of the jaw (ONJ) after implementation of preventive measures in patients with multiple myeloma treated with zoledronic acid.
abstract: BACKGROUND
  Osteonecrosis of the jaw (ONJ) is a well-described complication of bisphosphonates use in patients with multiple myeloma (MM). We investigated whether the occurrence of ONJ decreased after the implementation of preventive measures in 128 patients with MM who received zoledronic acid.
  
  
  METHODS
  Patients with MM who received zoledronic acid were included in this analysis. Patients with a previous use of other bisphosphonates were excluded; patients were stratified into group A (n=38) and group B (n=90) if treatment was started before or after the implementation of preventive measures.
  
  
  RESULTS
  One hundred and twenty-eight patients were included in this analysis. Sixteen patients (12.5%) developed ONJ--group A: 8 (26.3%), group B: 2 (6.7%) (P=0.002). The incidence rate (IR) was 0.671/100 person-months for group A and 0.230/100 person-months for group B [IR ratio 2.92, P=0.029, 95% confidence interval 1.06-8.03]. No patient in group B developed stage III ONJ.
  
  
  CONCLUSIONS
  In conclusion, the risk of developing ONJ after treatment of zoledronic acid is reduced (but not deleted) by the implementation of preventive measures.
authors.affiliation: Department of Clinical Therapeutics, Medical School, University of Athens, Greece. mdimop@med.uoa.gr
authors.forename: M A
authors.initials: MA
authors.lastname: Dimopoulos
authors.forename: E
authors.initials: E
authors.lastname: Kastritis
authors.forename: C
authors.initials: C
authors.lastname: Bamia
authors.forename: I
authors.initials: I
authors.lastname: Melakopoulos
authors.forename: D
authors.initials: D
authors.lastname: Gika
authors.forename: M
authors.initials: M
authors.lastname: Roussou
authors.forename: M
authors.initials: M
authors.lastname: Migkou
authors.forename: E
authors.initials: E
authors.lastname: Eleftherakis-Papaiakovou
authors.forename: D
authors.initials: D
authors.lastname: Christoulas
authors.forename: E
authors.initials: E
authors.lastname: Terpos
authors.forename: A
authors.initials: A
authors.lastname: Bamias
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use; D050071:Bone Density Conservation Agents / Q000009:adverse effects / Q000627:therapeutic use; D001897:Boronic Acids / Q000627:therapeutic use; D000069286:Bortezomib; D003777:Dental Prophylaxis / Q000379:methods; D004164:Diphosphonates / Q000009:adverse effects* / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007093:Imidazoles / Q000009:adverse effects* / Q000627:therapeutic use*; D015994:Incidence; D007571:Jaw Diseases / Q000139:chemically induced / Q000453:epidemiology / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000188:drug therapy*; D010020:Osteonecrosis / Q000139:chemically induced / Q000453:epidemiology / Q000517:prevention & control*; D011719:Pyrazines / Q000627:therapeutic use; D012189:Retrospective Studies; D013792:Thalidomide / Q000627:therapeutic use; D055815:Young Adult; D000077211:Zoledronic Acid
chemical_list: D000970:Antineoplastic Agents; D050071:Bone Density Conservation Agents; D001897:Boronic Acids; D004164:Diphosphonates; D007093:Imidazoles; D011719:Pyrazines; D013792:Thalidomide; D000069286:Bortezomib; D000077211:Zoledronic Acid