title: Clinical experiences with bisphosphonate-associated osteonecrosis of the jaws: analysis of 21 cases.
abstract: OBJECTIVE
  The aim of the present study was to analyze the clinical presentation, risk factors, radiologic features, histopathologic and microbiological findings, treatment, and evolution of bisphosphonate-associated osteonecrosis of the jaws (BONJ).
  
  
  METHODS
  This study made a retrospective review of 21 patients who underwent treatment and diagnosis of BONJ during 2004 to 2007 in a tertiary health care center reference for 1,100,000 inhabitants.
  
  
  RESULTS
  The mean patient age at the time of presentation was 65.1 years. Of the 21 patients observed, 19 (90.4%) were receiving intravenous zoledronate. Of the 21 patients, 15 were treated with bisphosphonates for bone metastasis (71.4%), 5 for multiple myeloma (23.8%), and 1 for rheumatoid arthritis (4.7%). In 17 patients, the lesions occurred in the mandible. Fifteen patients had previous tooth extractions at the same site of bone necrosis.
  
  
  CONCLUSIONS
  In our series, most patients improved with conservative surgical debridement. Prospective clinical trials would enable clinicians to make accurate judgments about risk, treatment, and outcome for patients with BONJ.
authors.affiliation: Department of Oral and Maxillofacial Surgery, University Central Hospital, Oviedo, Spain. junquera@uniovi.es
authors.forename: Luis
authors.initials: L
authors.lastname: Junquera
authors.forename: Lorena
authors.initials: L
authors.lastname: Gallego
authors.forename: Paz
authors.initials: P
authors.lastname: Cuesta
authors.forename: Alejandro
authors.initials: A
authors.lastname: Pelaz
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: de Vicente
mesh_terms: 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; D001859:Bone Neoplasms / Q000188:drug therapy / Q000556:secondary; D001943:Breast Neoplasms / Q000188:drug therapy / Q000473:pathology; D003646:Debridement; D004164:Diphosphonates / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007093:Imidazoles / Q000009:adverse effects / Q000627:therapeutic use; D007571:Jaw Diseases / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000188:drug therapy / Q000473:pathology; D010020:Osteonecrosis / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000473:pathology; D000077268:Pamidronate; D011471:Prostatic Neoplasms / Q000188:drug therapy / Q000473:pathology; D011859:Radiography; D012189:Retrospective Studies; D012307:Risk Factors; D014081:Tooth Extraction / Q000009:adverse effects; D016896:Treatment Outcome; D000077211:Zoledronic Acid
chemical_list: D000970:Antineoplastic Agents; D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D007093:Imidazoles; D000077211:Zoledronic Acid; D000077268:Pamidronate