Journal of the Korean Association of Oral and Maxillofacial Surgeons

The Korean Association of Oral and Maxillofacial Surgeons (대한구강악안면외과학회)
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Evaluation of the predisposing factors and involved outcome of surgical treatment in bisphosphonate-related osteonecrosis of the jaw cases including bone biopsies

  • Kim, Tae-Hwan (Department of Oral and Maxillofacial Surgery, College of Dentistry, Dankook University) ;
  • Seo, Won-Gyo (Department of Oral and Maxillofacial Surgery, College of Dentistry, Dankook University) ;
  • Koo, Chul-Hong (Department of Oral and Maxillofacial Surgery, College of Dentistry, Dankook University) ;
  • Lee, Jae-Hoon (Department of Oral and Maxillofacial Surgery, College of Dentistry, Dankook University)
  • Received : 2016.04.14
  • Accepted : 2016.07.22
  • Published : 2016.08.31
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Abstract

Objectives: This study examined the statistical relevance of whether the systemic predisposing factors affect the prognosis of surgical treatment of bisphosphonate-related osteonecrosis of the jaw (BRONJ). All cases had undergone bone biopsies to determine the characteristics of the mechanisms of BRONJ by optical microscopy. Materials and Methods: The data included 54 BRONJ cases who underwent surgery and in whom bone biopsies were performed. The results of surgery were evaluated and the results were classified into 3 categories: normal recovery, delayed recovery, and recurrence after surgery. The medical history, such as diabetes mellitus, medication of steroids, malignancies on other sites was investigated for an evaluation of the systemic predisposing factors in relation to the prognosis. The three factors involved with the medication of bisphosphonate (BP) were the medication route, medication period, and drug holiday of BP before surgery. The serum C-terminal cross-linking telopeptide (CTX) value and presence of microorganism colony in bone biopsy specimens were also checked. Statistical analysis was then carried out to determine the relationship between these factors and the results of surgery. Results: The group of patients suffering from diabetes and on steroids tended to show poorer results after surgery. Parenteral medication of BP made the patients have a poorer prognosis after surgery than oral medication. In contrast, the medication period and drug holiday of BP before surgery did not have significance with the results of surgery nor did the serum CTX value and presence of microorganism colony. Necrotic bone specimens in this study typically showed disappearing new bone formation around the osteocytic lacunae and destroyed Howship's lacunae. Conclusion: Although many variables exist, this study could in part, predict the prognosis of surgical treatment of BRONJ by taking the patient's medical history.

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References

  1. McClung MR. Bisphosphonates. Endocrinol Metab Clin North Am 2003;32:253-71. https://doi.org/10.1016/S0889-8529(02)00079-8
  2. Stanton DC, Balasanian E. Outcome of surgical management of bisphosphonate-related osteonecrosis of the jaws: review of 33 surgical cases. J Oral Maxillofac Surg 2009;67:943-50. https://doi.org/10.1016/j.joms.2008.12.057
  3. 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
  4. Ruggiero SL, Mehrotra B, Rosenberg TJ, Engroff SL. Osteonecrosis of the jaws associated with the use of bisphosphonates: a review of 63 cases. J Oral Maxillofac Surg 2004;62:527-34. https://doi.org/10.1016/j.joms.2004.02.004
  5. Hinson AM, Smith CW, Siegel ER, Stack BC Jr. Is bisphosphonate-related osteonecrosis of the jaw an infection? A histological and microbiological ten-year summary. Int J Dent 2014. doi:10.1155/2014/452737.
  6. Ohe JY, Kwon YD, Lee HW. Bisphosphonates modulate the expression of OPG and M-CSF in hMSC-derived osteoblasts. Clin Oral Investig 2012;16:1153-9. https://doi.org/10.1007/s00784-011-0614-z
  7. Kim RH, Lee RS, Williams D, Bae S, Woo J, Lieberman M, et al. Bisphosphonates induce senescence in normal human oral keratinocytes. J Dent Res 2011;90:810-6. https://doi.org/10.1177/0022034511402995
  8. Kos M, Brusco D, Kuebler J, Engelke W. Clinical comparison of patients with osteonecrosis of the jaws, with and without a history of bisphosphonates administration. Int J Oral Maxillofac Surg 2010;39:1097-102. https://doi.org/10.1016/j.ijom.2010.04.054
  9. Lee SH, Chang SS, Lee M, Chan RC, Lee CC. Risk of osteonecrosis in patients taking bisphosphonates for prevention of osteoporosis: a systematic review and meta-analysis. Osteoporos Int 2014;25:1131-9. https://doi.org/10.1007/s00198-013-2575-3
  10. Khamaisi M, Regev E, Yarom N, Avni B, Leitersdorf E, Raz I, et al. Possible association between diabetes and bisphosphonate-related jaw osteonecrosis. J Clin Endocrinol Metab 2007;92:1172-5. https://doi.org/10.1210/jc.2006-2036
  11. Sung EC, Chan SM, Sakurai K, Chung E. Osteonecrosis of the maxilla as a complication to chemotherapy: a case report. Spec Care Dentist 2002;22:142-6. https://doi.org/10.1111/j.1754-4505.2002.tb01178.x
  12. Tarassoff P, Csermak K. Avascular necrosis of the jaws: risk factors in metastatic cancer patients. J Oral Maxillofac Surg 2003;61:1238-9.
  13. 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
  14. Hewitt C, Farah CS. Bisphosphonate-related osteonecrosis of the jaws: a comprehensive review. J Oral Pathol Med 2007;36:319-28. https://doi.org/10.1111/j.1600-0714.2007.00540.x
  15. Leite AF, Figueiredo PT, Melo NS, Acevedo AC, Cavalcanti MG, Paula LM, et al. Bisphosphonate-associated osteonecrosis of the jaws. Report of a case and literature review. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006;102:14-21. https://doi.org/10.1016/j.tripleo.2005.10.045
  16. 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
  17. Freiberger JJ, Padilla-Burgos R, Chhoeu AH, Kraft KH, Boneta O, Moon RE, et al. Hyperbaric oxygen treatment and bisphosphonate-induced osteonecrosis of the jaw: a case series. J Oral Maxillofac Surg 2007;65:1321-7. https://doi.org/10.1016/j.joms.2007.03.019
  18. Vescovi P, Merigo E, Meleti M, Manfredi M. Bisphosphonate-associated osteonecrosis (BON) of the jaws: a possible treatment? J Oral Maxillofac Surg 2006;64:1460-2.
  19. Lopes RN, Rabelo GD, Rocha AC, Carvalho PA, Alves FA. Surgical therapy for bisphosphonate-related osteonecrosis of the jaw: six-year experience of a single institution. J Oral Maxillofac Surg 2015;73:1288-95. https://doi.org/10.1016/j.joms.2015.01.008
  20. Stockmann P, Burger M, von Wilmowsky C, Ebker T, Lutz R, Bauersachs A, et al. The outcome after surgical therapy of bisphosphonate-associated osteonecrosis of the jaw--results of a clinical case series with an average follow-up of 20 months. Clin Oral Investig 2014;18:1299-304.
  21. 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.
  22. Reich W, Bilkenroth U, Schubert J, Wickenhauser C, Eckert AW. Surgical treatment of bisphosphonate-associated osteonecrosis: Prognostic score and long-term results. J Craniomaxillofac Surg 2015;43:1809-22. https://doi.org/10.1016/j.jcms.2015.07.035
  23. Kim KW, Kim BJ, Lee CH. Clinical study of diagnosis and treatment of bisphosphonate-related osteonecrosis of the jaws. J Korean Assoc Oral Maxillofac Surg 2011;37:54-61. https://doi.org/10.5125/jkaoms.2011.37.1.54
  24. Lehenkari PP, Kellinsalmi M, Napankangas JP, Ylitalo KV, Monkkonen J, Rogers MJ, et al. Further insight into mechanism of action of clodronate: inhibition of mitochondrial ADP/ATP translocase by a nonhydrolyzable, adenine-containing metabolite. Mol Pharmacol 2002;61:1255-62. https://doi.org/10.1124/mol.61.5.1255
  25. Molcho S, Peer A, Berg T, Futerman B, Khamaisi M. Diabetes microvascular disease and the risk for bisphosphonate-related osteonecrosis of the jaw: a single center study. J Clin Endocrinol Metab 2013;98:E1807-12. https://doi.org/10.1210/jc.2013-2434
  26. Watters AL, Hansen HJ, Williams T, Chou JF, Riedel E, Halpern J, et al. Intravenous bisphosphonate-related osteonecrosis of the jaw: long-term follow-up of 109 patients. Oral Surg Oral Med Oral Pathol Oral Radiol 2013;115:192-200. https://doi.org/10.1016/j.oooo.2012.05.017
  27. Favus MJ. Diabetes and the risk of osteonecrosis of the jaw. J Clin Endocrinol Metab 2007;92:817-8. https://doi.org/10.1210/jc.2007-0098
  28. Ichiseki T, Ueda Y, Katsuda S, Kitamura K, Kaneuji A, Matsumoto T. Oxidative stress by glutathione depletion induces osteonecrosis in rats. Rheumatology (Oxford) 2006;45:287-90. https://doi.org/10.1093/rheumatology/kei149
  29. Ortega C, Montemurro F, Faggiuolo R, Vormola R, Nanni D, Goia F, et al. Osteonecrosis of the jaw in prostate cancer patients with bone metastases treated with zoledronate: a retrospective analysis. Acta Oncol 2007;46:664-8. https://doi.org/10.1080/02841860601185917
  30. Vieillard MH, Maes JM, Penel G, Facon T, Magro L, Bonneterre J, et al. Thirteen cases of jaw osteonecrosis in patients on bisphosphonate therapy. Joint Bone Spine 2008;75:34-40. https://doi.org/10.1016/j.jbspin.2007.05.003
  31. Kos M, Kuebler JF, Luczak K, Engelke W. Bisphosphonate-related osteonecrosis of the jaws: a review of 34 cases and evaluation of risk. J Craniomaxillofac Surg 2010;38:255-9. https://doi.org/10.1016/j.jcms.2009.06.005
  32. Brown JE, Cook RJ, Major P, Lipton A, Saad F, Smith M, et al. Bone turnover markers as predictors of skeletal complications in prostate cancer, lung cancer, and other solid tumors. J Natl Cancer Inst 2005;97:59-69. https://doi.org/10.1093/jnci/dji002
  33. Garnero P, Delmas PD. Noninvasive techniques for assessing skeletal changes in inflammatory arthritis: bone biomarkers. Curr Opin Rheumatol 2004;16:428-34. https://doi.org/10.1097/01.moo.0000127830.72761.00
  34. Fleisher KE, Welch G, Kottal S, Craig RG, Saxena D, Glickman RS. Predicting risk for bisphosphonate-related osteonecrosis of the jaws: CTX versus radiographic markers. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010;110:509-16. https://doi.org/10.1016/j.tripleo.2010.04.023
  35. Kunchur R, Need A, Hughes T, Goss A. Clinical investigation of C-terminal cross-linking telopeptide test in prevention and management of bisphosphonate-associated osteonecrosis of the jaws. J Oral Maxillofac Surg 2009;67:1167-73. https://doi.org/10.1016/j.joms.2009.02.004
  36. American Society for Bone and Mineral Research Task Force on Osteonecrosis of the Jaw, Khosla S, Burr D, Cauley J, Dempster DW, Ebeling PR, et al. Oral bisphosphonate-induced osteonecrosis: risk factors, prediction of risk using serum CTX testing, prevention, and treatment. J Oral Maxillofac Surg 2008;66:1320-1; author reply 1321-2.
  37. Berger CE, Kroner A, Kristen KH, Minai-Pour M, Leitha T, Engel A. Spontaneous osteonecrosis of the knee: biochemical markers of bone turnover and pathohistology. Osteoarthritis Cartilage 2005;13:716-21. https://doi.org/10.1016/j.joca.2005.04.003
  38. Ganguli A, Steward C, Butler SL, Philips GJ, Meikle ST, Lloyd AW, et al. Bacterial adhesion to bisphosphonate coated hydroxyapatite. J Mater Sci Mater Med 2005;16:283-7. https://doi.org/10.1007/s10856-005-0625-x
  39. Kos M, Junka A, Smutnicka D, Bartoszewicz M, Kurzynowski T, Gluza K. Pamidronate enhances bacterial adhesion to bone hydroxyapatite. Another puzzle in the pathology of bisphosphonate-related osteonecrosis of the jaw? J Oral Maxillofac Surg 2013;71:1010-6. https://doi.org/10.1016/j.joms.2012.12.005
  40. Anavi-Lev K, Anavi Y, Chaushu G, Alon DM, Gal G, Kaplan I. Bisphosphonate related osteonecrosis of the jaws: clinico-pathological investigation and histomorphometric analysis. Oral Surg Oral Med Oral Pathol Oral Radiol 2013;115:660-6. https://doi.org/10.1016/j.oooo.2013.03.001
  41. Hansen T, Kunkel M, Springer E, Walter C, Weber A, Siegel E, et al. Actinomycosis of the jaws--histopathological study of 45 patients shows significant involvement in bisphosphonate-associated osteonecrosis and infected osteoradionecrosis. Virchows Arch 2007;451:1009-17. https://doi.org/10.1007/s00428-007-0516-2
  42. Naik NH, Russo TA. Bisphosphonate-related osteonecrosis of the jaw: the role of actinomyces. Clin Infect Dis 2009;49:1729-32. https://doi.org/10.1086/648075
  43. Kumar SK, Gorur A, Schaudinn C, Shuler CF, Costerton JW, Sedghizadeh PP. The role of microbial biofilms in osteonecrosis of the jaw associated with bisphosphonate therapy. Curr Osteoporos Rep 2010;8:40-8. https://doi.org/10.1007/s11914-010-0008-1
  44. Sedghizadeh PP, Yooseph S, Fadrosh DW, Zeigler-Allen L, Thiagarajan M, Salek H, et al. Metagenomic investigation of microbes and viruses in patients with jaw osteonecrosis associated with bisphosphonate therapy. Oral Surg Oral Med Oral Pathol Oral Radiol 2012;114:764-70. https://doi.org/10.1016/j.oooo.2012.08.444
  45. Marx RE, Tursun R. Suppurative osteomyelitis, bisphosphonate induced osteonecrosis, osteoradionecrosis: a blinded histopathologic comparison and its implications for the mechanism of each disease. Int J Oral Maxillofac Surg 2012;41:283-9. https://doi.org/10.1016/j.ijom.2011.12.016

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