title: Multiple myeloma vs. breast cancer patients with bisphosphonates-related osteonecrosis of the jaws: a comparative analysis of response to treatment and predictors of outcome.
abstract: BACKGROUND
  Multiple myeloma (MM) and breast cancer (BC) are the two most common diseases associated with bisphosphonates-related osteonecrosis of the jaws (BRONJ), for which different therapeutical approaches have been proposed. The aim of this study was to compare the clinical behaviour of BRONJ in patients with MM vs. BC and the time of healing in terms of clinical and symptomatological remission, following a standardized therapeutic protocol.
  
  
  METHODS
  Twenty-six BRONJ patients (13 men with MM and 13 women with BC) were prospectively enroled and treated with a specific systemic and topical antibiotic therapy. Several predictors of outcome were also evaluated.
  
  
  RESULTS
  Nine patients (69.2%) with BC and 10 patients (76.9%) with MM progressed towards a complete clinical remission (CR) in a mean healing time of 183.3 days [SD: 113.7; 95% confidence interval (CI): 95.95-207.7] and 372.0 days (SD: 308.0; 95% CI: 151.7-592.3) (P = 0.776), respectively. The clinical improvement was statistically significant (P = 0.0013 and P = 0.0014), as well as the assessment of pain (P = 0.0015 and P = 0.0015), in MM and BC group, respectively. Cox regression analysis revealed that just triggering events (P = 0.036) were found to be significant predictors of outcome of BRONJ healing.
  
  
  CONCLUSIONS
  Both groups of cancer patients experienced clinical and symptomatological remission regardless their malignancy, but BC patients earlier than MM patients.
authors.affiliation: Department of Dermatology, Stanford University School of Medicine, Stanford, CA, USA.
authors.forename: Giulio
authors.initials: G
authors.lastname: Fortuna
authors.forename: Elvira
authors.initials: E
authors.lastname: Ruoppo
authors.forename: Annamaria
authors.initials: A
authors.lastname: Pollio
authors.forename: Massimo
authors.initials: M
authors.lastname: Aria
authors.forename: Daniela
authors.initials: D
authors.lastname: Adamo
authors.forename: Stefania
authors.initials: S
authors.lastname: Leuci
authors.forename: Giovanni Dell'Aversana
authors.initials: GD
authors.lastname: Orabona
authors.forename: Michele D
authors.initials: MD
authors.lastname: Mignogna
mesh_terms: D000368:Aged; D000658:Amoxicillin / Q000627:therapeutic use; D019980:Amoxicillin-Potassium Clavulanate Combination / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D059266:Bisphosphonate-Associated Osteonecrosis of the Jaw / Q000188:drug therapy*; D050071:Bone Density Conservation Agents / Q000009:adverse effects*; D001943:Breast Neoplasms / Q000188:drug therapy*; D004164:Diphosphonates / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D006801:Humans; D007093:Imidazoles / Q000009:adverse effects; D008297:Male; D008336:Mandibular Diseases / Q000188:drug therapy; D008439:Maxillary Diseases / Q000188:drug therapy; D008875:Middle Aged; D009101:Multiple Myeloma / Q000188:drug therapy*; D010147:Pain Measurement; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012074:Remission Induction; D016896:Treatment Outcome; D014945:Wound Healing / Q000187:drug effects; D000077211:Zoledronic Acid
chemical_list: D000900:Anti-Bacterial Agents; D000894:Anti-Inflammatory Agents, Non-Steroidal; D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D007093:Imidazoles; D000077211:Zoledronic Acid; D019980:Amoxicillin-Potassium Clavulanate Combination; D000658:Amoxicillin