title: Long-term follow-up of jaw osteomyelitis associated with bisphosphonate use in a tertiary-care center.
abstract: OBJECTIVE
  This study reviews our experience in bisphosphonate-associated jaw osteomyelitis (BJOM), focusing on the incidence, etiology, treatment, and long-term outcome.
  
  
  METHODS
  Retrospective review of the clinical histories adult patients diagnosed with BJOM (1995-2008) in a tertiary hospital.
  
  
  RESULTS
  BJOM was found in 30 of 132 (22.7%) consecutive patients with jaw osteomyelitis. The percentage of BJOM cases increased from 8.7% (4/46) in 1995-2005 to 30.2% (26/86) in 2005-2008. Symptoms appeared in a median of 2.5 years after intravenous use, and 4.5 years after oral exposure. Viridans group streptococci were isolated in 83.3% of cases. Actinomyces spp. was found in 16 (39.0%) of 41 bone histologies. All included patients received a median of 6 months of appropiate antibiotic therapy and a surgical procedure (debridament and/or sequestrectomy). Thirteen of 27 cases (48.1%) with long-term follow-up (median 22 months, IQR 25-75 17-28) failed. Clinical failure defined as, persistent infection or relapse, was more frequent in patients receiving intravenous than oral bisphosphonates (11/16 [68.8%] vs. 2/11 [18.2%]; P < .05) and in cases with Actinomyces spp. (7/10 [70.0%] vs6/17 [35.3%]; P = .08).
  
  
  CONCLUSIONS
  Bisphosphonate therapy is now a frequent cause of JO. BJOM is difficult to cure and relapses are common, particularly in patients exposed to intravenous bisphosphonates.
authors.affiliation: Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain; REIPI (Spanish Network for Research in Infectious Disease), Spain.
authors.forename: Carlos
authors.initials: C
authors.lastname: Pigrau-Serrallach
authors.affiliation: Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain; REIPI (Spanish Network for Research in Infectious Disease), Spain. Electronic address: evelyn.cabral@vhir.org.
authors.forename: Evelyn
authors.initials: E
authors.lastname: Cabral-Galeano
authors.affiliation: Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain; REIPI (Spanish Network for Research in Infectious Disease), Spain.
authors.forename: Benito
authors.initials: B
authors.lastname: Almirante-Gragera
authors.affiliation: Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain; REIPI (Spanish Network for Research in Infectious Disease), Spain.
authors.forename: Roger
authors.initials: R
authors.lastname: Sordé-Masip
authors.affiliation: Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain; REIPI (Spanish Network for Research in Infectious Disease), Spain.
authors.forename: Dolors
authors.initials: D
authors.lastname: Rodriguez-Pardo
authors.affiliation: Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain; REIPI (Spanish Network for Research in Infectious Disease), Spain.
authors.forename: Nuria
authors.initials: N
authors.lastname: Fernandez-Hidalgo
authors.affiliation: Microbiology Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain; REIPI (Spanish Network for Research in Infectious Disease), Spain.
authors.forename: Nieves
authors.initials: N
authors.lastname: Larrosa-Escartín
authors.affiliation: Maxillofacial Surgery Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Socorro
authors.initials: S
authors.lastname: Bescos-Atín
authors.affiliation: Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain; REIPI (Spanish Network for Research in Infectious Disease), Spain.
authors.forename: Albert
authors.initials: A
authors.lastname: Pahissa-Berga
mesh_terms: D000368:Aged; D050071:Bone Density Conservation Agents / Q000009:adverse effects*; D004164:Diphosphonates / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007568:Jaw; D008297:Male; D008875:Middle Aged; D010019:Osteomyelitis / Q000139:chemically induced* / Q000175:diagnosis / Q000382:microbiology* / Q000628:therapy; D012189:Retrospective Studies; D062606:Tertiary Care Centers; D013997:Time Factors
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates
keywords: Bifosfonatos; Bisphosphonate-related jaw osteomyelitis; Bisphosphonate-related osteonecrosis; Bisphosphonates; Jaw osteomyelitis; Jaw osteonecrosis; Osteomielitis maxilar; Osteomielitis maxilar relacionada con bifosfonatos; Osteonecrosis maxilar; Osteonecrosis relacionada con bifosfonatos