Bisphosphonate-induced osteonecrosis of the jaw: a review of 2,400 patient cases.
OBJECTIVE
Bisphosphonates (BPs) are bone-remodeling inhibitors that are used to manage bone metastases and osteoporosis. Osteonecrosis of the jaw, however, can occur during treatment. This complication is poorly understood and is called "bisphosphonate-induced osteonecrosis of the jaw" (BIOJ).


METHODS
We performed a PubMed-based review of all of the described cases of BIOJ from January 2003 (the year of the first description) to September 2009. Issues of clinical relevance, such as the primary diagnosis and type of treatment, were evaluated for each patient case.


RESULTS
We retrieved 2,408 cases, 88% of which were associated with intravenous therapy, primarily with zoledronate. Of the total number of cases, 89% were associated with the treatment of a malignant condition, particularly multiple myeloma (43% of the cases). Of all the BIOJ cases, 67% were preceded by tooth extraction and only 35% of patients were cured.


CONCLUSIONS
Prevention is better than treatment, and the establishment of meticulous oral hygiene and surgical procedures prior to commencing BP treatment is important for preventing BIOJ. Our review summarizes the current knowledge about this severe complication. Future studies, especially basic research studies, are needed to better understand this devastating disease.
Faculty of Medicine and Pharmacy, Department of Anatomy and Cellular Biology, University of Mons, Pentagone 2C-Avenue du Champ de Mars, 6, B-7000, Mons, Belgium.
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Filleul
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Crompot
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Saussez
D016723:Bone Remodeling / Q000187:drug effects*; D004164:Diphosphonates / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007571:Jaw Diseases / Q000139:chemically induced* / Q000473:pathology; D008297:Male; D008336:Mandibular Diseases / Q000139:chemically induced / Q000473:pathology / Q000601:surgery; D008437:Maxilla / Q000473:pathology / Q000601:surgery; D008439:Maxillary Diseases / Q000139:chemically induced / Q000473:pathology / Q000601:surgery; D010001:Osteitis Deformans / Q000139:chemically induced; D010020:Osteonecrosis / Q000139:chemically induced* / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D012189:Retrospective Studies; D012744:Sex Ratio
D004164:Diphosphonates