Clinical investigation of bisphosphonate-related osteonecrosis of the jaws in patients with malignant tumors.
10.5125/jkaoms.2012.38.3.152
- Author:
Sei Kyoung KIM
1
;
Tae Geon KWON
Author Information
1. Department of Oral and Maxillofacial Surgery, School of Dentistry, Kyungpook National University, Daegu, Korea. kwondk@knu.ac.kr
- Publication Type:Original Article
- Keywords:
Bisphosphonates;
Jaw;
Necrosis;
Malignant tumors
- MeSH:
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
- From:Journal of the Korean Association of Oral and Maxillofacial Surgeons
2012;38(3):152-159
- CountryRepublic of Korea
- Language:English
-
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.
