title: Oral bisphosphonate-related osteonecrosis of the jaws: Clinical  characteristics of a series of 20 cases in Spain.
abstract: OBJECTIVE
  The objective of this study was to define the clinical characteristics of osteonecrosis of the jaws (ONJ) induced by oral bisphosphonates in a series of patients from a circumscribed area in northwest Spain.
  
  
  METHODS
  A retrospective multicentre study was undertaken in 3 hospitals in an area with a radius less than 100 km in the Autonomous Community of Galicia (Spain). The medical records were reviewed and an oral examination was performed of patients diagnosed with oral bisphosphonate-related ONJ in the previous 3 years.
  
  
  RESULTS
  We detected 20 cases of ONJ (24 lesions) related to oral bisphosphonates (alendronate [16 patients] and ibandronate [4 patients]), which were mainly administered as treatment for osteoporosis (17 patients). The mean interval between initiation of treatment and confirmation of a diagnosis of ONJ was 66±43 months (range, 6-132 months); in 7 patients (35%) the interval was less than 36 months. The past history revealed hypertension in 13 cases (65%) and diabetes in 4 (20%); 7 patients (35%) were on corticosteroid treatment. Oral surgery had been previously performed in 13 patients (65%) and the remaining 7 patients (35%) had removable dental prostheses. The lesions most frequently affected the posterior mandible (62.5%). The majority of the lesions (75%) were classified as stage 2, although lesions were identified in all established clinical stages (including 2 stage 0 lesions).
  
  
  CONCLUSIONS
  In conclusion, in the present series, ONJ induced by oral bisphosphonates typically develops in women around 70 years of age, taking alendronate, that underwent oral surgery. Most lesions are located in the posterior mandible and are classified as stage 2 at diagnosis. Some patients presented no known risk factors, suggesting that there may be risk factors still to be identified. There are well-defined patterns of clinical presentation that can facilitate early diagnosis of ONJ.
authors.affiliation: Oral Medicine Unit, School of Medicine and Dentistry, University of Santiago de Compostela-Spain, 15782-Santiago de Compostela, Spain. marcio.diniz@usc.es
authors.forename: Márcio
authors.initials: M
authors.lastname: Diniz-Freitas
authors.forename: José-Luis
authors.initials: JL
authors.lastname: López-Cedrún
authors.forename: Jacinto
authors.initials: J
authors.lastname: Fernández-Sanromán
authors.forename: Abel
authors.initials: A
authors.lastname: García-García
authors.forename: Javier
authors.initials: J
authors.lastname: Fernández-Feijoo
authors.forename: Pedro
authors.initials: P
authors.lastname: Diz-Dios
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019386:Alendronate / Q000009:adverse effects*; D059266:Bisphosphonate-Associated Osteonecrosis of the Jaw / Q000175:diagnosis*; D050071:Bone Density Conservation Agents / Q000009:adverse effects*; D004164:Diphosphonates / Q000009:adverse effects*; D005260:Female; D006801:Humans; D000077557:Ibandronic Acid; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013030:Spain
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D000077557:Ibandronic Acid; D019386:Alendronate