title: Conservative management of bisphosphonate-related osteonecrosis of the jaws: staging and treatment outcomes.
abstract: OBJECTIVE
  Bisphosphonate-related osteonecrosis of the jaws is a well-established disorder in which patients treated with bisphosphonates develop exposed necrotic bone in the oral cavity. The objective of this study was to report staging and treatment outcomes in a large cohort of patients with bisphosphonate-related osteonecrosis of the jaws managed primarily with non-surgical measures.
  
  
  METHODS
  A retrospective medical record review was conducted from 1998 to 2010 of all patients referred for the management of bisphosphonate-related osteonecrosis of the jaws. Clinical findings and staging were assessed at initial consultation and each follow-up visit. Management was provided to minimize symptoms and/or achieve resolution of lesions. Treatment responses were defined based on symptoms and/or change in staging.
  
  
  RESULTS
  There were 120 records reviewed and 97 patients seen for follow-up (median 12months); 90% were cancer patients. Bisphosphonate-related osteonecrosis of the jaws was managed with observation (16%), antibiotics (55%), non-surgical sequestrectomy±antibiotics (14%), or surgery±antibiotics (14%). There were 14 patients (12%) who presented with stage 0 disease; 41%, 43%, and 5% of patients presented at stages 1, 2, and 3, respectively. Greater than 70% of patients improved, remained asymptomatic, and/or showed complete re-epithelialization when evaluated at 0-3, 3-6, 6-9, 9-12, and/or >12months. Seventeen patients developed non-infectious complications of BONJ including neuropathy (N=9), painful tongue ulcers (N=7), or pathologic fracture (N=1). Twelve patients with multiple myeloma underwent hematopoietic cell transplantation without infectious complications.
  
  
  CONCLUSIONS
  A primarily non-surgical approach appears to be a successful management strategy for bisphosphonate-related osteonecrosis of the jaws. Overall, 71-80% of patients improved or remained asymptomatic with a median follow-up of 12months.
authors.affiliation: Brigham and Women's Hospital, Division of Oral Medicine and Dentistry, One Brigham Circle, Suite 3-028, Boston, MA 02120, United States; Harvard School of Dental Medicine, Department of Oral Medicine, Infection, and Immunity, 188 Longwood Avenue, Boston, MA 02115, United States. Electronic address: Mark_Lerman@hsdm.harvard.edu.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Lerman
authors.affiliation: Dana-Farber Cancer Institute, Department of Medical Oncology, 450 Brookline Avenue, Boston, MA 02215-5450, United States.
authors.forename: Wanling
authors.initials: W
authors.lastname: Xie
authors.affiliation: Brigham and Women's Hospital, Division of Oral Medicine and Dentistry, One Brigham Circle, Suite 3-028, Boston, MA 02120, United States; Harvard School of Dental Medicine, Department of Oral Medicine, Infection, and Immunity, 188 Longwood Avenue, Boston, MA 02115, United States.
authors.forename: Nathaniel S
authors.initials: NS
authors.lastname: Treister
authors.affiliation: Dana-Farber Cancer Institute, Department of Medical Oncology, 450 Brookline Avenue, Boston, MA 02215-5450, United States.
authors.forename: Paul G
authors.initials: PG
authors.lastname: Richardson
authors.affiliation: Dana-Farber Cancer Institute, Department of Medical Oncology, 450 Brookline Avenue, Boston, MA 02215-5450, United States.
authors.forename: Edie A
authors.initials: EA
authors.lastname: Weller
authors.affiliation: Brigham and Women's Hospital, Division of Oral Medicine and Dentistry, One Brigham Circle, Suite 3-028, Boston, MA 02120, United States; Harvard School of Dental Medicine, Department of Oral Medicine, Infection, and Immunity, 188 Longwood Avenue, Boston, MA 02115, United States.
authors.forename: Sook-Bin
authors.initials: SB
authors.lastname: Woo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D059266:Bisphosphonate-Associated Osteonecrosis of the Jaw / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Bisphosphonate-related osteonecrosis of the jaws