title: Bisphosphonate (zoledronic acid)-induced osteonecrosis of the jaw.
abstract: OBJECTIVE
  The use of bisphosphonates (zoledronic acid) in the treatment of metastatic bone disease has been raised during recent years. The purpose of this treatment is mainly to reduce skeletal-related events, e.g. pain and pathological fractures. The aim of this study was to report the incidence of bisphosphonate-related osteonecrosis of the jaw (ONJ).
  
  
  METHODS
  All patients treated with bisphosphonates during a 5-year period (2003-2007) were reviewed.
  
  
  RESULTS
  Fifty-three patients, median age 69 years (range 56-81 years) were treated with bisphosphonates during the period. Fifty-one patients had hormone-refractory metastatic prostate cancer and two women had metastatic renal cell carcinoma. During this 5-year period, 686 treatments with bisphosphonates were administrated. The average treatment duration was 14 months (range 1-40 months) with administration of 4 mg of bisphosphonates every 4 weeks. Two cases of ONJ were registered. In the first case, the patient developed spontaneous osteonecrosis, whereas the second patient developed symptoms after a dental procedure. Since the initiation of a routine maxillofacial examination before treatment with bisphosphonates, no ONJ has been seen.
  
  
  CONCLUSIONS
  ONJ is a rare but a very serious complication in relation to treatment with bisphosphonates. To decrease the incidence of ONJ, a maxillofacial examination could be performed in all patients before treatment with bisphosphonates.
authors.affiliation: Department of Urology, Viborg County Hospital, Viborg, Denmark.
authors.forename: Ali
authors.initials: A
authors.lastname: Haidar
authors.forename: Morten
authors.initials: M
authors.lastname: Jønler
authors.forename: Troels B
authors.initials: TB
authors.lastname: Folkmar
authors.forename: Lars
authors.initials: L
authors.lastname: Lund
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D050071:Bone Density Conservation Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001859:Bone Neoplasms / Q000188:drug therapy / Q000556:secondary; D002292:Carcinoma, Renal Cell / Q000473:pathology; D004164:Diphosphonates / Q000009:adverse effects* / Q000627:therapeutic use; D005147:Facial Bones / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D015994:Incidence; D007571:Jaw Diseases / Q000139:chemically induced* / Q000453:epidemiology*; D007680:Kidney Neoplasms / Q000473:pathology; D008297:Male; D008437:Maxilla / Q000000981:diagnostic imaging; D008875:Middle Aged; D010020:Osteonecrosis / Q000139:chemically induced* / Q000453:epidemiology*; D011471:Prostatic Neoplasms / Q000473:pathology; D011859:Radiography; D012189:Retrospective Studies
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates