A systematic review of bisphosphonate osteonecrosis (BON) in cancer.
OBJECTIVE
This systematic review aims to examine the prevalence of bisphosphonate osteonecrosis (BON) in the cancer population, prevention and treatment protocols, and quality of life issues.


METHODS
A search of MEDLINE/PubMed and EMBASE form October 2003 to December 31, 2008 was conducted with the objective of identifying publications that contained original data regarding BON.


RESULTS
A total of 28 publications fulfilled inclusion criteria, but only 22 were used for prevalence analysis. No randomized controlled clinical trials, meta-analysis, or quality of life papers were found that contained information regarding either prevalence or treatment protocols for the management of BON. The overall weighted prevalence of BON included a sample of 39,124 patients with a mean weighted prevalence of 6.1%. The weighted prevalence was 13.3% for studies with documented follow-up with a sample size of 927 individuals. The weighted prevalence in studies with undocumented follow-up was 0.7% in a sample of 8,829 chart reviews. Epidemiological studies evaluated a total of 29,368 individual records, and the weighted BON prevalence was 1.2%.


CONCLUSIONS
High-quality studies are needed to accurately characterize the prevalence of BON, and to determine effective treatment protocols.
Migliorati
Cesar Augusto
CA
Department of Biologic and Diagnostic Sciences, University of Tennessee Health Science Center, Memphis, TN 38163, USA. migliorati@uthsc.edu
Woo
Sook-Bin
SB
Hewson
Ian
I
Barasch
Andrei
A
Elting
Linda S
LS
Spijkervet
Fred K L
FK
Brennan
Michael T
MT
D050071:Bone Density Conservation Agents / Q000009:adverse effects* / Q000627:therapeutic use; D004164:Diphosphonates / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D009369:Neoplasms / Q000150:complications / Q000188:drug therapy; D010020:Osteonecrosis / Q000139:chemically induced* / Q000453:epidemiology / Q000628:therapy; D015995:Prevalence; D011788:Quality of Life
D050071:Bone Density Conservation Agents; D004164:Diphosphonates
J Oral Maxillofac Surg. 2004 May;62(5):527-34
15122554
Clin Cancer Res. 2008 Apr 15;14(8):2387-95
18413829
J Oral Maxillofac Surg. 2008 May;66(5):839-47
18423269
Laryngoscope. 2006 Jan;116(1):115-20
16481822
Leuk Lymphoma. 2007 Jan;48(1):56-64
17325848
J Natl Cancer Inst. 2007 Jul 4;99(13):1016-24
17596574
Ann Oncol. 2008 Dec;19(12):2091-2
18977851
Eur Urol. 2008 Nov;54(5):1066-72
18602738
Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006 Oct;102(4):433-41
16997108
Lancet Oncol. 2008 Dec;9(12):1166-72
19038763
J Am Dent Assoc. 2009 Oct;140(10):1259-65
19797556
Ann Intern Med. 2006 May 16;144(10):753-61
16702591
J Clin Oncol. 2008 Aug 20;26(24):4037-8
18711196
Oncology. 2009;76(3):209-11
19212145
J Bone Miner Res. 2008 Jun;23(6):826-36
18558816
J Clin Oncol. 2003 Nov 15;21(22):4253-4
14615459
J Clin Oncol. 2006 Feb 20;24(6):945-52
16484704
Am J Otolaryngol. 2007 May-Jun;28(3):158-63
17499130
J Oral Maxillofac Surg. 2009 Mar;67(3):593-601
19231786
Ann Oncol. 2007 Dec;18(12):2015-9
17804475
J Oral Maxillofac Surg. 2003 Sep;61(9):1115-7
12966493
Cancer Invest. 2009 Feb;27(2):221-6
19235596
J Oral Maxillofac Surg. 2005 Nov;63(11):1567-75
16243172
Br J Haematol. 2006 Sep;134(6):620-3
16889620
J Oral Maxillofac Surg. 2006 Jun;64(6):917-23
16713806
Oncologist. 2008 Aug;13(8):911-20
18695259
J Clin Endocrinol Metab. 2007 Mar;92(3):1172-5
17179196
Haematologica. 2006 Jul;91(7):968-71
16757414
JAMA. 2006 Dec 27;296(24):2927-38
17190893
J Am Dent Assoc. 2008 Jan;139(1):23-30
18167381
NCI Monogr. 1990;(9):1-184
2188147
J Oral Maxillofac Surg. 2007 Jul;65(7):1328-31
17577497
J Craniomaxillofac Surg. 2008 Mar;36(2):95-103
18234504
Support Care Cancer. 2008 Nov;16(11):1311-5
18663482
Ann Oncol. 2009 Jan;20(1):117-20
18689864
Oral Oncol. 2008 Sep;44(9):857-69
18282788
J Oral Maxillofac Surg. 2008 Apr;66(4):625-31
18355585
Cancer. 2005 Jul 1;104(1):83-93
15929121
Bone. 2009 Jan;44(1):4-10
18948230
J Tenn Dent Assoc. 2009 Fall;89(4):36-8; quiz 38-9
20102031
Support Care Cancer. 2010 Aug;18(8):979-84
20306090
J Oral Maxillofac Surg. 2008 Apr;66(4):767-75
18355603
Cancer. 2009 Apr 15;115(8):1631-7
19156913
Dentomaxillofac Radiol. 2006 Jul;35(4):236-43
16798918
J Clin Oncol. 2008 Dec 20;26(36):5904-9
19018084
J Oral Maxillofac Surg. 2007 Mar;65(3):415-23
17307586
Br J Oral Maxillofac Surg. 2009 Jan;47(1):67-8
18639371
J Oral Maxillofac Surg. 2009 May;67(5 Suppl):2-12
19371809
J Clin Oncol. 2005 Dec 1;23(34):8580-7
16314620
J Am Dent Assoc. 2005 Dec;136(12):1658-68
16383047
Ann Oncol. 2007 Jun;18 Suppl 6:vi168-72
17591816
Lancet Oncol. 2006 Jun;7(6):508-14
16750501
N Engl J Med. 2005 Jul 7;353(1):99-102; discussion 99-102
16000365