Bisphosphonates-Osteonecrosis of Jaw (original) (raw)
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Journal of Oral Pathology and Medicine, 2005
Jaw bone necrosis is a clinical condition associated with defects in vascularization of the maxilla or the mandibular bone, usually present following head and neck radiotherapy and/or oral surgical interventions. Bisphosphonates are synthetic analogues of pyrophosphate used in the treatment of patients with hypercalcemia as a result of malignancy, bone metastasis and for the treatment of other disorders such as metabolic bone diseases, Paget's disease and osteoporosis. Over last 10 years, cases of jaw bone necrosis have been associated with the use of bisphosphonate therapy. In particular, Ruggiero et al. (J Oral Maxillofac Surg 2004; 62: 527-534) in 2004 described a large group of patients (63) with jaw bone necrosis probably related to the use of these drugs. It should be noted that all the patients in the group described either underwent head and neck radiotherapy or had a dental extraction while taking bisphosphonates. In the present study, we reported four cases of jawbone necrosis in patients taking pamidronate (Aredia) and zoledronate (Zometa) without having undergone any kind of radiotherapy or dental surgery. All the patients were females between the ages of 56 and 71 years; three were treated with bisphosphonates for bone metastasis and one for multiple myeloma. All the patients received surgical treatment with bone curettage, with partial and/or temporary improvement of the lesions. Although a treatment for bisphosphonate-induced bone lesions has not yet been established, we suggest careful evaluation of the patients' oral health before prescribing bisphosphonate treatment.
Bisphosphonates and Osteonecrosis of the Jaw
Annals of Internal Medicine, 2006
Osteonecrosis of the jaw (ONJ) is an important but uncommon side effect of bisphosphonate therapy. ONJ may result in disabling and sometimes disfiguring complications that may affect the quality of life of patients. ONJ occurs more frequently in patients on intravenous nitrogen-containing forms of bisphosphonates and is thought to be time and dose dependent. Currently, there is no recognized effective treatment apart from controlling pain and accompanied infection. Prevention of this complication is therefore important. In this article, some of the key issues of bisphosphonate-associated ONJ are being reviewed.
Osteonecrosis of the Jaw and the Role of Bisphosphonates: A Critical Review
The American Journal of Medicine, 2009
Osteonecrosis of the jaw (ONJ), a condition characterized by necrotic exposed bone in the maxillofacial region, has been reported in patients with cancer receiving bisphosphonate therapy, and rarely in patients with postmenopausal osteoporosis or Paget disease of bone receiving such therapy. In the absence of a uniform definition, the American Academy of Oral and Maxillofacial Surgeons (AAOMS), the American Society for Bone and Mineral Research (ASBMR), and other groups have established similar diagnostic criteria for bisphosphonate-related ONJ, which is more commonly reported in patients with advanced malignancies with skeletal metastases who receive higher doses, and is more rarely reported in patients with osteoporosis and Paget disease who receive lower doses. However, a critical review of the literature reveals that the etiology of ONJ remains unknown, and to date no direct causal link to bisphosphonates has been established. Despite an increased awareness of ONJ and recent improvements in preventive strategies, patients and physicians alike continue to express concern about the potential risks of bisphosphonate treatment in both oncologic and nononcologic settings. Although much remains to be learned about this condition, including its true incidence in various patient populations, its pathophysiology, and optimal clinical management, evidence to date suggests that the positive benefits of bisphosphonates in patients with malignant bone disease, osteoporosis, or Paget disease outweigh the relatively small risk of ONJ.
Osteonecrosis of the jaws and bisphosphonates
Current Osteoporosis Reports, 2008
Osteonecrosis of the jaws associated with bisphosphonate therapy was first identified in 2003 as a condition typified by exposed bone that does not heal after 8 weeks. Other signs and symptoms, such as pain and infection, may or may not be present. There is a strong need for consensus on a case definition for this condition. This condition has occurred primarily among cancer patients treated with the aminobisphosphonates zoledronic acid and pamidronate. The etiology of this condition remains unknown; however, oral disease and trauma appear to be important risk factors. This condition appears to be rare in metabolic bone disease and Paget's disease, with an estimated prevalence of approximately 1 per 100,000 person-years. Thus, the benefits of bisphosphonate therapy appear to outweigh the risks. Recommendations have been established for the oral health management of patients with a history of bisphosphonate therapy.
Bisphosphonate complications including osteonecrosis of the jaw
Hematology / the Education Program of the American Society of Hematology. American Society of Hematology. Education Program, 2006
Bisphosphonate therapy has been incorporated in the standard management of patients with multiple myeloma-related bony disease. Although their efficacy in reducing skeletal related events is important in the supportive management of the myeloma patient, post-marketing experience with this class of agents, particularly the more potent intravenous agents pamidronate and zoledronic acid, have raised cautionary notes regarding the potential side effects of these agents. The focus of this session is to review the risk factors, incidence, prevention strategies and management of bisphosphonate-related osteonecrosis of the jaw. In addition, pathophysiology, incidence and monitoring for renal dysfunction during chronic therapy with these agents are reviewed.
Bisphosphonate Induced Osteonecrosis of the Jaw
Annals of International medical and Dental Research, 2018
Osteonecrosis of the jaw is an important but uncommon side effect of bisphosphonate therapy. It may result in disabling and sometimes disfiguring complications that may affect the quality of life of patients. It occurs more frequently in patients on intravenous nitrogen-containing forms of bisphosphonates and is thought to be time and dose dependent. Currently, there is no recognized effective treatment apart from controlling pain and accompanied infection. Prevention of this complication is therefore important. In this article, some of the key issues of bisphosphonate-associated osteonecrosis of jaw are being reviewed.