Bisphosphonate Induced Osteonecrosis of the Jaws: Our Clinical Experience at King Hussein Medical Center, Amman, Jordan
Hytham Al-Rabadi, Luai K Daklalah, Mashoor Alwreikat, Mohammad Alqudah, Moath Momani, Hind F Nsour
Bisphosphonates, Mandible, Osteonecrosis, Retrospective study
Citation Information :
Al-Rabadi H, Daklalah LK, Alwreikat M, Alqudah M, Momani M, Nsour HF. Bisphosphonate Induced Osteonecrosis of the Jaws: Our Clinical Experience at King Hussein Medical Center, Amman, Jordan. J Contemp Dent Pract 2018; 19 (11):1401-1404.
Aim: To describe and analyze the clinical characteristics of bisphosphonate induced osteonecrosis of the jaws (BIONJ) patients diagnosed and treated at King Hussein Medical Center (KHMC), Amman, Jordan.
Patients and methods: A series of 12 patients with BIONJ was studied and analyzed retrospectively regarding age, gender, underlying disease, type, route and duration of bisphosphonate (BP) administered, site of osteonecrosis, initiating factor and treatment outcome were recorded. Follow-up period ranged from 6 months to 3 years.
Results: Patient's age ranged from 45 to 76 year old. Female to male ratio was 2:1. Most patients received IV BP as a part of the therapeutic protocol of their malignant disease; only two patients received oral BP. Mandible was more commonly involved compared to maxilla with a ratio of 5:1. In most patients the exposed necrotic bone was subsequent to an oral surgical intervention; However, in two cases the disease was initiated spontaneously. Complete wound healing was achieved in most of cases within a period ranged from 4 to 8 weeks. Two patients needed a second surgical intervention; However one patient was refractory to treatment and no wound healing achieved.
Conclusion: Bisphosphonate (BP) induced osteonecrosis of the jaws is a rare complication of bisphosphonates (BP) therapy. Oral surgical intervention and female gender increase the risk of the disease. Early diagnosis and cessation of BP are essential to achieve success.
Clinical significance: It seems that some cases of BIONJ are refractory to the known treatment modalities. However, evaluation of treatment protocols may be needed in the future.
Ribeiroa GH, Chruna ES, Dutraa KL, Danielb FI, Grandob LJ. Osteonecrosis of the jaws: a review and update inetiology and treatment. Braz J Otorhinolaryngol. 2017 Jun 24
Dimitrakopoulos I, Magopoulos C, Karakasis D. Bisphosphonate- induced avascular osteonecrosis of the jaws: a clinical report of 11 cases. Int. J. Oral Maxillofac. Surg. 2006;35:588-593
Lee LW, Hsiao SH, Chen LK. Clinical treatment outcomes for 40 patients with bisphosphonates-related osteonecrosis of the jaws. Journal of the Formosan Medical Association 2014;113(3):166-172.
Kuijpers SCC, van Merkesteyn JPR: Bisphosphonate-related osteonecrosis of the jaws: Cohort study of surgical treatment results in seventy-four stage II/III patients. Journal of Cranio-Maxillofacial Surgery 2016.
American Association Oral Maxillofacial Surgeons. Position Paper on bisphosphonate- related osteonecrosis of the jaws. J Oral Maxillofac Surg 2007;65(3):369-376
Marx RE: Pamidronate (Aredia) and zoledronate (Zometa) induced avascular necrosis of the jaws: a growing epidemic. J Oral Maxillofac Surg 2003;61:1115-1117.
Sawatari Y, Marx RE. Bisphosphonates and bisphosphonate induced osteonecrosis. Oral Maxillofac Surg Clin North Am. 2007 Nov;19(4):487-498.
Cariolatto FA, Carelli J, de Campos Moreira T, Pietrobon R, Rodrigues C, Bonilauri Ferreira AP. Recommendations for the prevention of bisphosphonate-related osteonecrosis of the jaw: a systematic review, The Journal of Evidence-Based Dental Practice (2018), doi: 10.1016/ j.jebdp.2017.11.002.
Black DM, Schwartz AV. Effects of continuing or stopping alendronate after 5 years of treatment: the Fracture Intervention Trial Long-term Extension (FLEX): a randomized trial. JAMA. 2006 Dec 27;296(24):2927-2938.
Kos M, Kuebler JF, Luczak K, Engelke W. Bisphosphonaterelated osteonecrosis of the jaws: A review of 34 cases and evaluation of risk. Journal of Cranio-Maxillo-Facial Surgery 2010;38:255e-259.
Jacobsen C, Metzler P, Rossle M, Obwegeser J, Zemann W, Gratz KW. Osteopathology induced by bisphosphonates and dental implants: clinical observations. Clin Oral Investig 2013;7:167-175.
Marx RE, Sawatari Y, Fortin M, Broumand V. Bisphosphonate- induced exposed bone (osteonecrosis/osteopetrosis) of the jaws: risk factors, recognition, prevention, and treatment. J Oral Maxillofac Surg. 2005 Nov;63(11):1567-1575.
Antonio Chi-Kit Tong, George Kam-Hop Li, Wing-Yan Au. Bisphosphonate-induced Osteonecrosis of the Jaws:Report of 4 Patients. Asian J Oral Maxillofac Surg. 2009;21:59-63.
López-Cedrún JL, Sanromán JF, GarcíaA, Penarrocha M, Feijoo JF, Limeres J, Diz P. Oral bisphosphonate-related osteonecrosis of the jaws in dental implant patients: a case series. British Journal of Oral and Maxillofacial Surgery 51 2013;874-87.
Pichardo SEC, Kuijpers SCC, van Merkesteyn JPR, Bisphosphonate-related osteonecrosis of the jaws: Cohort study of surgical treatment results in seventy-four stage II/III patients. Journal of Cranio-Maxillofacial Surgery 2016;44(9):1216-1220.