Journal of the Korean Association of Oral and Maxillofacial Surgeons

The Korean Association of Oral and Maxillofacial Surgeons (대한구강악안면외과학회)
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Retrospective study on the bisphosphonate-related osteonecrosis of jaw

비스포스포네이트 관련 악골괴사에 대한 후향적 연구

  • Han, Yoon-Sic (Department of Oral and Maxillofacial Surgery, School of Dentistry, Seoul National University) ;
  • Lee, In-Woo (Department of Oral and Maxillofacial Surgery, School of Dentistry, Seoul National University) ;
  • Lee, Ho (Department of Oral and Maxillofacial Surgery, School of Dentistry, Seoul National University) ;
  • Suh, Jin-Won (Department of Oral and Maxillofacial Surgery, School of Dentistry, Seoul National University) ;
  • Kim, Soung-Min (Department of Oral and Maxillofacial Surgery, School of Dentistry, Seoul National University) ;
  • Myoung, Hoon (Department of Oral and Maxillofacial Surgery, School of Dentistry, Seoul National University) ;
  • Hwang, Soon-Jung (Department of Oral and Maxillofacial Surgery, School of Dentistry, Seoul National University) ;
  • Choi, Jin-Young (Department of Oral and Maxillofacial Surgery, School of Dentistry, Seoul National University) ;
  • Lee, Jong-Ho (Department of Oral and Maxillofacial Surgery, School of Dentistry, Seoul National University) ;
  • Choung, Pill-Hoon (Department of Oral and Maxillofacial Surgery, School of Dentistry, Seoul National University) ;
  • Kim, Myung-Jin (Department of Oral and Maxillofacial Surgery, School of Dentistry, Seoul National University) ;
  • Seo, Byoung-Moo (Department of Oral and Maxillofacial Surgery, School of Dentistry, Seoul National University)
  • 한윤식 (서울대학교 치의학대학원 구강악안면외과학교실) ;
  • 이인우 (서울대학교 치의학대학원 구강악안면외과학교실) ;
  • 이호 (서울대학교 치의학대학원 구강악안면외과학교실) ;
  • 서진원 (서울대학교 치의학대학원 구강악안면외과학교실) ;
  • 김성민 (서울대학교 치의학대학원 구강악안면외과학교실) ;
  • 명훈 (서울대학교 치의학대학원 구강악안면외과학교실) ;
  • 황순정 (서울대학교 치의학대학원 구강악안면외과학교실) ;
  • 최진영 (서울대학교 치의학대학원 구강악안면외과학교실) ;
  • 이종호 (서울대학교 치의학대학원 구강악안면외과학교실) ;
  • 정필훈 (서울대학교 치의학대학원 구강악안면외과학교실) ;
  • 김명진 (서울대학교 치의학대학원 구강악안면외과학교실) ;
  • 서병무 (서울대학교 치의학대학원 구강악안면외과학교실)
  • Received : 2011.08.23
  • Accepted : 2011.11.01
  • Published : 2011.12.31
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Abstract

Introduction: The incidence of bisphosphonate-related osteonecrosis of the jaw (BRONJ) has increased gradually in patients who have undergone surgical treatment for osteomyelitis. In this study, a retrospective analysis of BRONJ patients was carried out using the data of osteomyelitis patients treated surgically. Materials and Methods: Osteomyelitis patients, who underwent curettage, sequestrectomy, saucerization or decortications, and partial mandibulectomy at Seoul National University Dental Hospital from 2004 to 2010 were enrolled in this study. The patients were classified and categorized into two groups based on the surgical records and progress notes. One group comprised of patients with osteomyelitis and osteoporosis, and the other group included patients with osteomyelitis only. The epidemiological data of the BRONJ patients was analyzed to identify any trend in the incidence of BRONJ in osteomyelitis patients. Results: Among 200 patients who underwent surgical intervention for osteomyelitis, 64 (32.0%) were identified as having osteoporosis as the underlying disease. In these 64 patients, more than 81.3% had been prescribed bisphosphonates. Females were far more affected by BRONJ than males. The incidence of BRONJ also increased with age. The posterior part of the mandible was affected more frequently by BRONJ. Conclusion: Although the availability of potent antibiotics and increased oral hygiene care can reduce the overall incidence of osteomyelitis, BRONJ can increase the total incidence. To prevent BRONJ, it is recommended that an oral examination be performed before prescribing bisphosphonates. Moreover, the patients should be educated about the potential risks of dental procedures that might be causal factors for BRONJ. Furthermore, patient swho take bisphosphonates for the treatment of osteoporosis should undergo periodic follow up oral examinations to prevent BRONJ.

Keywords

References

  1. Marx RE. Pamidronate (Aredia) and zoledronate (Zometa) induced avascular necrosis of the jaws: a growing epidemic. J Oral Maxillofac Surg 2003;61:1115-7. https://doi.org/10.1016/S0278-2391(03)00720-1
  2. Rogers MJ. New insights into the molecular mechanisms of action of bisphosphonates. Curr Pharm Des 2003;9:2643-58. https://doi.org/10.2174/1381612033453640
  3. Otto S, Abu-Id MH, Fedele S, Warnke PH, Becker ST, Kolk A, et al. Osteoporosis and bisphosphonates-related osteonecrosis of the jaw: not just a sporadic coincidence--a multi-centre study. J Craniomaxillofac Surg 2011;39:272-7. https://doi.org/10.1016/j.jcms.2010.05.009
  4. The Korean Endocrine Society, the Korean Society of Bone Metabolism, the Korean Society of Osteoporosis, the Korean Association of Oral and Maxillofacial Surgeons. Bisphosphonate related osteonecrosis of the jaw (BRONJ)-position statement of Korea. J Korean Endocr Soc 2009;24:227-30. https://doi.org/10.3803/jkes.2009.24.4.227
  5. Advisory Task Force on Bisphosphonate-Related Ostenonecrosis of the Jaws, American Association of Oral and Maxillofacial Surgeons. American Association of Oral and Maxillofacial Surgeons position paper on bisphosphonate-related osteonecrosis of the jaws. J Oral Maxillofac Surg 2007;65:369-76. https://doi.org/10.1016/j.joms.2006.11.003
  6. Ruggiero SL, Dodson TB, Assael LA, Landesberg R, Marx RE, Mehrotra B; American Association of Oral and Maxillofacial Surgeons. American Association of Oral and Maxillofacial Surgeons position paper on bisphosphonate-related osteonecrosis of the jaws--2009 update. J Oral Maxillofac Surg 2009;67(5 Suppl):2-12.
  7. Ruggiero SL, Drew SJ. Osteonecrosis of the jaws and bisphosphonate therapy. J Dent Res 2007;86:1013-21. https://doi.org/10.1177/154405910708601101
  8. Saussez S, Javadian R, Hupin C, Magremanne M, Chantrain G, Loeb I, et al. Bisphosphonate-related osteonecrosis of the jaw and its associated risk factors: a Belgian case series. Laryngoscope 2009;119:323-9. https://doi.org/10.1002/lary.20076
  9. Hoefert S, Eufinger H. Relevance of a prolonged preoperative antibiotic regime in the treatment of bisphosphonate-related osteonecrosis of the jaw. J Oral Maxillofac Surg 2011;69:362-80. https://doi.org/10.1016/j.joms.2010.06.200
  10. Khosla S, Burr D, Cauley J, Dempster DW, Ebeling PR, Felsenberg D, et al; American Society for Bone and Mineral Research. Bisphosphonate-associated osteonecrosis of the jaw: report of a task force of the American Society for Bone and Mineral Research. J Bone Miner Res 2007;22:1479-91. https://doi.org/10.1359/jbmr.0707onj
  11. Migliorati CA, Schubert MM, Peterson DE, Seneda LM. Bisphosphonate- associated osteonecrosis of mandibular and maxillary bone: an emerging oral complication of supportive cancer therapy. Cancer 2005;104:83-93. https://doi.org/10.1002/cncr.21130
  12. Rizzoli R, Burlet N, Cahall D, Delmas PD, Eriksen EF, Felsenberg D, et al. Osteonecrosis of the jaw and bisphosphonate treatment for osteoporosis. Bone 2008;42:841-7. https://doi.org/10.1016/j.bone.2008.01.003
  13. Adamo V, Caristi N, Saccà MM, Ferraro G, Arcanà C, Maisano R, et al. Current knowledge and future directions on bisphosphonaterelated osteonecrosis of the jaw in cancer patients. Expert Opin Pharmacother 2008;9:1351-61. https://doi.org/10.1517/14656566.9.8.1351
  14. Sarin J, DeRossi SS, Akintoye SO. Updates on bisphosphonates and potential pathobiology of bisphosphonate-induced jaw osteonecrosis. Oral Dis 2008;14:277-85. https://doi.org/10.1111/j.1601-0825.2007.01381.x
  15. Marx RE, Cillo JE Jr, Ulloa JJ. Oral bisphosphonate-induced osteonecrosis: risk factors, prediction of risk using serum CTX testing, prevention, and treatment. J Oral Maxillofac Surg 2007;65:2397-410. https://doi.org/10.1016/j.joms.2007.08.003
  16. Allen MR, Ruggiero SL. Higher bone matrix density exists in only a subset of patients with bisphosphonate-related osteonecrosis of the jaw. J Oral Maxillofac Surg 2009;67:1373-7. https://doi.org/10.1016/j.joms.2009.03.048
  17. Magopoulos C, Karakinaris G, Telioudis Z, Vahtsevanos K, Dimitrakopoulos I, Antoniadis K, et al. Osteonecrosis of the jaws due to bisphosphonate use. A review of 60 cases and treatment proposals. Am J Otolaryngol 2007;28:158-63. https://doi.org/10.1016/j.amjoto.2006.08.004
  18. Vescovi P, Manfredi M, Merigo E, Meleti M. Early surgical approach preferable to medical therapy for bisphosphonate-related osteonecrosis of the jaws. J Oral Maxillofac Surg 2008;66:831-2. https://doi.org/10.1016/j.joms.2007.11.025
  19. Carlson ER, Basile JD. The role of surgical resection in the management of bisphosphonate-related osteonecrosis of the jaws. J Oral Maxillofac Surg 2009;67(5 Suppl):85-95.
  20. Shimura K, Shimazaki C, Taniguchi K, Akamatsu S, Okamoto M, Uchida R, et al. Hyperbaric oxygen in addition to antibiotic therapy is effective for bisphosphonate-induced osteonecrosis of the jaw in a patient with multiple myeloma. Int J Hematol 2006;84:343-5. https://doi.org/10.1532/IJH97.06110

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