J Korean Assoc Oral Maxillofac Surg.  2012 Jun;38(3):152-159. 10.5125/jkaoms.2012.38.3.152.

Clinical investigation of bisphosphonate-related osteonecrosis of the jaws in patients with malignant tumors

• Kim SK
• Kwon TG

• KMID: 2043844
• DOI: http://doi.org/10.5125/jkaoms.2012.38.3.152

Abstract

OBJECTIVES
This study evaluated bisphosphonate-related osteonecrosis of the jaws (BRONJ) in patients diagnosed with malignant bone tumors. Demographic findings, laboratory, and radiographic analyses were performed to characterize disease severity and progression.
MATERIALS AND METHODS
Patients who had been diagnosed with BRONJ (2005-2010) at the authors' hospital according to the American Association of Oral and Maxillofacial Surgeons were investigated. Twenty-one patients (12 with multiple myelomas, 7 with breast cancer, and 2 with prostate cancer) who had been treated with bisphosphonates (BPs) for malignant bone tumors were included. Radiographic evaluations with a panorama, computed tomography, whole body bone scan, and laboratory findings were evaluated for erythrocyte sedimentation rate (ESR), c-reactive proteins (CRPs), and c-terminal cross-linked telopeptides (CTXs).
RESULTS
The average age of the patients was 64.3 (range 51-80), and they were treated with BPs for an average of 35+/-19 months before BRONJ was diagnosed. Types of BPs were zolendronic acid (81%, intravenous [IV]), pamidronate (4.8%, IV), zoledronic acid+pamidronate (4.8%, IV), alendronate (4.8%, per os [PO]), and ibadronate (4.75%, PO). Extraction (67%) and persistent irritation of dentures (20%) were the most common triggering factors. BRONJ in the mandible was reported in 62% of the cases, in the maxilla 24%, and both 14%. BRONJ occurred more frequently in patients with multiple myelomas (n=12, 57.1%). Most of the patients revealed an advanced BRONJ stage; Stage I (n=2, 9%), Stage II (n=13, 62%), and Stage III (n=6, 29%).
CONCLUSION
The differences of the ESR, CRP, and CTX values between the BRONJ-recurring and non-recurring patients after the treatment were not evident. Later stage BRONJ patients showed lower CTX levels. A drug holiday after the diagnosis of BRONJ did not remarkably influence the surgical outcomes. However, the limited number of patients in the study should be considered.

Keyword

Bisphosphonates; Jaw; Necrosis; Malignant tumors

MeSH Terms

Alendronate
Bisphosphonate-Associated Osteonecrosis of the Jaw
Blood Sedimentation
Breast Neoplasms
C-Reactive Protein
Dentures
Diphosphonates
Holidays
Humans
Jaw
Mandible
Maxilla
Multiple Myeloma
Necrosis
Prostate
Alendronate
C-Reactive Protein
Diphosphonates

Figure

• 

  Fig. 1 One example of bisphosphonate-related osteonecrosis of the jaw related with Zometa injection for 12 months in patient with breast cancer (patient #14). The patient experienced a large area of exposure (upper panel) and had received surgical curettage and sequestrectomy. Six-month follow up after surgical treatment showed complete healing (lower panel).

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