title: Prevalence of bisphosphonate associated osteonecrosis of the jaws in multiple myeloma patients.
abstract: BACKGROUND
  Bisphosphonate-associated osteonecrosis of the jaws (BP-ONJ) is an adverse effect of bisphosphonate treatment with varying reported incidence rates.
  
  
  METHODS
  In two neighboring German cities, prevalence and additional factors of the development of BP-ONJ in multiple myeloma patients with bisphosphonates therapy were recorded using a retrospective (RS) and cross-sectional study (CSS) design. For the RS, all patients treated from Jan. 2000--Feb. 2006 were contacted by letter. In the CSS, all patients treated from Oct. 2006--Mar. 2008 had a physical and dental examination. Additionally, a literature review was conducted to evaluate all articles reporting on BP-ONJ prevalence. PubMed search terms were: bisphosphonat, diphosphonate, osteonecrosis, prevalence and incidence.
  
  
  RESULTS
  In the RS, data from 81 of 161 patients could be obtained; four patients (4.9%) developed BP-ONJ. In the CSS, 16 of 78 patients (20.5%) developed BP-ONJ. All patients with BP-ONJ had received zoledronate; 12 of these had had additional bisphosphonates. All except one had an additional trigger factor (tooth extraction [n = 14], dental surgical procedure [n = 2], sharp mylohyoid ridge [n = 3]).
  
  
  CONCLUSIONS
  The prevalence of BP-ONJ may have been underestimated to date. The oral examination of all patients in this CSS might explain the higher prevalence, since even early asymptomatic stages of BP-ONJ and previously unnoticed symptomatic BP-ONJ were recorded. Since nearly all patients with BP-ONJ had an additional trigger factor, oral hygiene and dental care might help to reduce BP-ONJ incidence.
authors.affiliation: Klinik für Mund-, Kiefer- und Gesichtschirurgie, Johannes Gutenberg-Universität Mainz, Augustusplatz 2, 55131 Mainz, Deutschland. walter@mkg.klinik.uni-mainz.de
authors.forename: Christian
authors.initials: C
authors.lastname: Walter
authors.forename: Bilal
authors.initials: B
authors.lastname: Al-Nawas
authors.forename: Norbert
authors.initials: N
authors.lastname: Frickhofen
authors.forename: Heinold
authors.initials: H
authors.lastname: Gamm
authors.forename: Joachim
authors.initials: J
authors.lastname: Beck
authors.forename: Laura
authors.initials: L
authors.lastname: Reinsch
authors.forename: Christina
authors.initials: C
authors.lastname: Blum
authors.forename: Knut A
authors.initials: KA
authors.lastname: Grötz
authors.forename: Wilfried
authors.initials: W
authors.lastname: Wagner
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D050071:Bone Density Conservation Agents / Q000009:adverse effects* / Q000627:therapeutic use; D003430:Cross-Sectional Studies; D004164:Diphosphonates / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000188:drug therapy*; D010020:Osteonecrosis / Q000139:chemically induced* / Q000453:epidemiology*; D015995:Prevalence; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates