Resolution of oral bisphosphonate and steroid-related osteonecrosis of the jaw--a serial case analysis.
OBJECTIVE
To offer recommendations of risk factors, prevention, and treatment of oral bisphosphonate and steroid-related osteonecrosis of the jaw (BSRONJ) in Taiwan.


METHODS
Twelve patients were clinicopathologically proved to have bisphosphonate-related osteonecrosis of the jaw (BRONJ). All of the patients were taking oral bisphosphonates and were concurrently administered long-term steroids. Of the 12 patients, 3 patients were assigned to the first stage of BRONJ; 5 patients were assigned to the second stage, and 4 patients were assigned to the third stage. The patients' symptoms, localization of necrosis, presence of a fistula, and association with possible triggering factors for onset of the lesion were recorded.


RESULTS
The radiologic investigations revealed osteolytic areas and scintigraphy demonstrated increased bone metabolism. Microbiologic analysis showed pathogenic actinomycosis organisms in a majority of patients (91.6%). Antibiotic therapy, minor debridement surgery, and combined hyperbaric oxygen therapy were useful in obtaining short-term symptomatic relief.


CONCLUSIONS
Comorbidities of steroid use along with bisphosphonates may cause osteonecrosis of the jaw to occur sooner, be more severe, and respond more slowly to a drug discontinuation. The clinical disease of BSRONJ is more severe and more unpredictable to treat than BRONJ. From the data gained from other published studies of BRONJ and our clinical experience with the series of cases of BSRONJ, we offer recommendations of risk factors, prevention, and treatment of BSRONJ in southern Taiwan.
Chiu
Chang-Ta
CT
Department of Oral and Maxillofacial Surgery, Chang Gung Memorial Hospital, Kaohsiung Memorial Center, Kaohsiung City, and Chang Gung University, College of Medicine, Taiwan.
Chiang
Wei-Fan
WF
Chuang
Ching-Ya
CY
Chang
Sung-Wen
SW
D000196:Actinomycosis / Q000150:complications; D000284:Administration, Oral; D000368:Aged; D000369:Aged, 80 and over; D019386:Alendronate / Q000008:administration & dosage / Q000009:adverse effects; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D050071:Bone Density Conservation Agents / Q000008:administration & dosage / Q000009:adverse effects*; D003646:Debridement; D004164:Diphosphonates / Q000008:administration & dosage / Q000009:adverse effects*; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D006931:Hyperbaric Oxygenation; D007571:Jaw Diseases / Q000139:chemically induced* / Q000145:classification / Q000382:microbiology / Q000628:therapy; D008336:Mandibular Diseases / Q000139:chemically induced / Q000628:therapy; D008439:Maxillary Diseases / Q000139:chemically induced / Q000628:therapy; D008875:Middle Aged; D010014:Osteolysis / Q000139:chemically induced / Q000628:therapy; D010020:Osteonecrosis / Q000139:chemically induced* / Q000145:classification / Q000382:microbiology / Q000628:therapy; D010026:Osteosclerosis / Q000139:chemically induced / Q000628:therapy; D012307:Risk Factors; D013624:Taiwan; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D005938:Glucocorticoids; D019386:Alendronate