title: Osteonecrosis of the Jaw After Bisphosphonates Treatment in Patients with Multiple Myeloma.
abstract: BACKGROUND
  Bone lytic lesion in Multiple myeloma are the most commonly presented symptoms which require treatment with bisphosphonates (BPs). BPs are providing supportive care, reducing the rate of skeletal morbidity but evidently not abolishing it, the criteria for stopping their administration have to be different from those used for classic antineoplastic drugs, and they should not be stopped when metastatic bone disease is progressing. Osteonecrosis of the jaw (ONJ) has been associated recently with the use of BPs.
  
  
  OBJECTIVE
  The aim of these study is to evaluate the incidence of ONJ in patients with MM treated with mixed biphosphonates.
  
  
  METHODS
  We analyzed total 296 myeloma patients (150 male and 146 female). Mostly effected age group with 58,1% is age more than 60 years up to 88 years, diagnosed in our institution in the period 2005-2015. We used intravenous or oral forms of biphosphonates such as pamidronate, ibandronate, clodronate and zolendronic acid. The patients were evaluated for ONJ.
  
  
  RESULTS
  The incidence of ONJ in our group of patients treated with Bps was 4,6% from our group of 260 patients 87,8% received BPs therapy and patients which haven't received BPs 12,2%. From this group, 95,4% (248) didn't show ONJ, and 4,6% (12) showed ONJ. The period of this treatment with BPs is an important risk factor for development of ONJ, average duration of BPs therapy in patients which show adverse effects is 26.8±13.7 months, from the total number of 12 patients that developed ONJ adverse effects, we have 8 patients which received treatment with Zolendronic acid and the remaining 4 patients which were treated with other BPs combinations without Zolendronic acid.
  
  
  CONCLUSIONS
  All patients treated for MM must continue with the therapy with Zolendronic acid and Pamidronate, each patient must be individually treated according to his response of the treatment (dose, frequency and duration of therapy).
authors: University Clinic of Hematology, "Ss Cyril and Methodius University", Skopje, Macedonia.
authors: Svetlana
authors: S
authors: Krstevska
authors: University Clinic of Hematology, "Ss Cyril and Methodius University", Skopje, Macedonia.
authors: Sonja Genadieva
authors: SG
authors: Stavric
authors: University Clinic of Hematology, "Ss Cyril and Methodius University", Skopje, Macedonia.
authors: Lidija
authors: L
authors: Cevrevska
authors: University Clinic of Hematology, "Ss Cyril and Methodius University", Skopje, Macedonia.
authors: Borce
authors: B
authors: Georgjievski
authors: University Clinic of Hematology, "Ss Cyril and Methodius University", Skopje, Macedonia.
authors: Oliver
authors: O
authors: Karanfilski
authors: University Clinic of Hematology, "Ss Cyril and Methodius University", Skopje, Macedonia.
authors: Tatjana
authors: T
authors: Sotirova
authors: Department of Pharmacology, "Ss Cyril and Methodius University", Skopje, Macedonia.
authors: Trajan
authors: T
authors: Balkanov
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D059266:Bisphosphonate-Associated Osteonecrosis of the Jaw / Q000453:epidemiology / Q000209:etiology*; D004164:Diphosphonates / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000188:drug therapy*; D012189:Retrospective Studies
chemical_list: D004164:Diphosphonates
keywords: Multiple myeloma; biphosphonates; osteonecrosis of jaw