title: Role of intravenous dosage regimens of bisphosphonates in relation to other aetiological factors in the development of osteonecrosis of the jaws in patients with myeloma.
abstract: The aim of this case-control study was to identify possible explanatory risk factors for the development of bisphosphonate-related osteonecrosis of the jaws (BRONJ) by estimating the effects of intravenous dosage regimens of bisphosphonates, coexisting diseases, and other drugs on 201 patients with multiple myeloma, with or without BRONJ. We compared sex, treatment with bisphosphonates, incidence of diabetes, and the taking of drugs such as corticosteroids and chemotherapy in patients who had BRONJ (n=44) and patients who did not (n=157). Among the bisphosphonates given intravenously zoledronic acid showed a stronger correlation with BRONJ than pamidronic acid. The risk of developing BRONJ increased dramatically at cumulative intravenous doses of more than 78 mg of zoledronic acid or 600 mg of pamidronic acid, which corresponds to treatment for 18 months or longer. Diabetes mellitus correlated significantly with the development of BRONJ (p=0.01) while there was no correlation with sex, simultaneous treatment with corticosteroids, or chemotherapy. In conclusion, treatment with zoledronic acid, high doses of pamidronic acid, and the coexistence of diabetes mellitus seem to be associated with the development of BRONJ.
authors.affiliation: Dental Public Service of Medical Dentistry, Danderyd Hospital, Stockholm, Sweden.
authors.forename: Fredrik
authors.initials: F
authors.lastname: Jarnbring
authors.affiliation: Department of Oral and Maxillofacial Surgery, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Ali
authors.initials: A
authors.lastname: Kashani
authors.affiliation: Dental Public Service of Medical Dentistry, Danderyd Hospital, Stockholm, Sweden; Dental Public Service Sickla, Stockholm, Sweden.
authors.forename: Andreas
authors.initials: A
authors.lastname: Björk
authors.affiliation: Dental Public Service Knivsta, Uppsala, Sweden.
authors.forename: Tobias
authors.initials: T
authors.lastname: Hoffman
authors.affiliation: Masteŕs degree of Statistics, Regional Cancer Centre, Stockholm Gotland, Sweden.
authors.forename: Kamilla
authors.initials: K
authors.lastname: Krawiec
authors.affiliation: Department of Hematology, Karolinska University Hospital and Department of Medicine Huddinge, Karolinska Insitutet, Stockholm.
authors.forename: Per
authors.initials: P
authors.lastname: Ljungman
authors.affiliation: Department of Oral and Maxillofacial Surgery, Karolinska University Hospital, Stockholm, Sweden; Section of Oral and Maxillofacial Surgery, Division of Orofacial Diagnostics and Surgery, Department of Oral Medicine, Karolinska Institutet. Electronic address: bodil.lund@ki.se.
authors.forename: Bodil
authors.initials: B
authors.lastname: Lund
mesh_terms: D059266:Bisphosphonate-Associated Osteonecrosis of the Jaw / Q000453:epidemiology; D050071:Bone Density Conservation Agents; D016022:Case-Control Studies; D004164:Diphosphonates; D006801:Humans; D015994:Incidence; D007568:Jaw; D009101:Multiple Myeloma; D010020:Osteonecrosis / Q000139:chemically induced
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates
keywords: Bisphosphonates; Intravenous; Myeloma patients; Osteonecrosis of the jaw; Risk factors.