Imaging Science in Dentistry

Korean Academy of Oral and Maxillofacial Radiology (대한영상치의학회)
권호 표지
DOI QR코드

DOI QR Code

Risk factors of osteonecrosis of the jaw after tooth extraction in osteoporotic patients on oral bisphosphonates

  • Jeong, Ho-Gul (Department of Oral and Maxillofacial Radiology, Yonsei University, College of Dentistry) ;
  • Hwang, Jae Joon (Department of Oral and Maxillofacial Radiology, Yonsei University, College of Dentistry) ;
  • Lee, Jeong-Hee (Department of Oral and Maxillofacial Radiology, Yonsei University, College of Dentistry) ;
  • Kim, Young Hyun (Department of Oral and Maxillofacial Radiology, Yonsei University, College of Dentistry) ;
  • Na, Ji Yeon (Department of Oral and Maxillofacial Radiology, Yonsei University, College of Dentistry) ;
  • Han, Sang-Sun (Department of Oral and Maxillofacial Radiology, Yonsei University, College of Dentistry)
  • Received : 2016.09.14
  • Accepted : 2016.10.11
  • Published : 2017.03.31
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: The aim of this study was to investigate the incidence of bisphosphonate-related osteonecrosis of the jaw (BRONJ) after tooth extraction in patients with osteoporosis on oral bisphosphonates in Korea and to evaluate local factors affecting the development of BRONJ. Materials and Methods: The clinical records of 320 patients who underwent dental extraction while receiving oral bisphosphonates were reviewed. All patients had a healing period of more than 6 months following the extractions. Each patient's clinical record was used to assess the incidence of BRONJ; if BRONJ occurred, a further radiographic investigation was carried out to obtain a more definitive diagnosis. Various local factors including age, gender, extraction site, drug type, duration of administration, and C-terminal telopeptide (CTx) level were retrieved from the patients' clinical records for evaluating their effect on the incidence of BRONJ. Results: Among the 320 osteoporotic patients who underwent tooth extraction, 11 developed BRONJ, reflecting an incidence rate of 3.44%. Out of the local factors that may affect the incidence of BRONJ, gender, drug type, and CTx level showed no statistically significant effects, while statistically significant associations were found for age, extraction site, and duration of administration. The incidence of BRONJ increased with age, was greater in the mandible than the maxilla, and was associated with a duration of administration of more than 3 years. Conclusion: Tooth extraction in patients on oral bisphosphonates requires careful consideration of their age, the extraction site, and the duration of administration, and close postoperative follow-up should be carried out to facilitate effective early management.

Keywords

References

  1. Pazianas M, Miller P, Blumentals WA, Bernal M, Kothawala P. A review of the literature on osteonecrosis of the jaw in patients with osteoporosis treated with oral bisphosphonates: prevalence, risk factors, and clinical characteristics. Clin Ther 2007; 29: 1548-58. https://doi.org/10.1016/j.clinthera.2007.08.008
  2. Tosteson AN, Gabriel SE, Grove MR, Moncur MM, Kneeland TS, Melton LJ 3rd. Impact of hip and vertebral fractures on quality-adjusted life years. Osteoporos Int 2001; 12: 1042-9. https://doi.org/10.1007/s001980170015
  3. Saia G, Blandamura S, Bettini G, Tronchet A, Totola A, Bedogni G, et al. Occurrence of bisphosphonate-related osteonecrosis of the jaw after surgical tooth extraction. J Oral Maxillofac Surg 2010; 68: 797-804. https://doi.org/10.1016/j.joms.2009.10.026
  4. Cummings SR, Black DM, Thompson DE, Applegate WB, Barrett-Connor E, Musliner TA, et al. Effect of alendronate on risk of fracture in women with low bone density but without vertebral fractures: results from the Fracture Intervention TriaI. JAMA 1998; 280: 2077-82. https://doi.org/10.1001/jama.280.24.2077
  5. Black DM, Cummings SR, Karpf DB, Cauley JA, Thompson DE, Nevitt MC, et al. Randomised trial of effect of alendronate on risk of fracture in women with existing vertebral fractures. Fracture Intervention Trial Research Group. Lancet 1996; 348: 1535-41. https://doi.org/10.1016/S0140-6736(96)07088-2
  6. Delmas PD, Recker RR, Chesnut CH 3rd, Skag A, Stakkestad JA, Emkey R, et al. Daily and intermittent oral ibandronate normalize bone turnover and provide significant reduction in vertebral fracture risk: results from the BONE study. Osteoporos Int 2004; 15: 792-8.
  7. Harris ST, Watts NB, Genant HK, McKeever CD, Hangartner T, Keller M, et al. Effects of risedronate treatment on vertebral and nonvertebral fractures in women with postmenopausal osteoporosis: a randomized controlled trial. Vertebral Efficacy With Risedronate Therapy (VERT) Study Group. JAMA 1999; 282: 1344-52. https://doi.org/10.1001/jama.282.14.1344
  8. Delmas PD, Adami S, Strugala C, Stakkestad JA, Reginster JY, Felsenberg D, et al. Intravenous ibandronate injections in postmenopausal women with osteoporosis: one-year results from the dosing intravenous administration study. Arthritis Rheum 2006; 54: 1838-46. https://doi.org/10.1002/art.21918
  9. Roelofs AJ, Thompson K, Gordon S, Rogers MJ. Molecular mechanisms of action of bisphosphonates: current status. Clin Cancer Res 2006; 12: 6222s-30s. https://doi.org/10.1158/1078-0432.CCR-06-0843
  10. Stepensky D, Kleinberg L, Hoffman A. Bone as an effect compartment: models for uptake and release of drugs. Clin Pharmacokinet 2003; 42: 863-81. https://doi.org/10.2165/00003088-200342100-00001
  11. 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
  12. Ruggiero SL, Dodson TB, Assael LA, Landesberg R, Marx RE, Mehrotra B, et al. American Association of Oral and Maxillofacial Surgeons position paper on bisphosphonate-related osteonecrosis of the jaw - 2009 update. Aust Endod J 2009; 35: 119-30. https://doi.org/10.1111/j.1747-4477.2009.00213.x
  13. Khosla S, Burr D, Cauley J, Dempster DW, Ebeling PR, Felsenberg D, et al. 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
  14. O'Ryan FS, Lo JC. Bisphosphonate-related osteonecrosis of the jaw in patients with oral bisphosphonate exposure: clinical course and outcomes. J Oral Maxillofac Surg 2012; 70: 1844-53. https://doi.org/10.1016/j.joms.2011.08.033
  15. Lazarovici TS, Mesilaty-Gross S, Vered I, Pariente C, Kanety H, Givol N, et al. Serologic bone markers for predicting development of osteonecrosis of the jaw in patients receiving bisphosphonates. J Oral Maxillofac Surg 2010; 68: 2241-7. https://doi.org/10.1016/j.joms.2010.05.043
  16. Mavrokokki T, Cheng A, Stein B, Goss A. Nature and frequency of bisphosphonate-associated osteonecrosis of the jaws in Australia. J Oral Maxillofac Surg 2007; 65: 415-23. https://doi.org/10.1016/j.joms.2006.10.061
  17. Lazarovici TS, Yahalom R, Taicher S, Schwartz-Arad D, Peleg O, Yarom N. Bisphosphonate-related osteonecrosis of the jaw associated with dental implants. J Oral Maxillofac Surg 2010; 68: 790-6. https://doi.org/10.1016/j.joms.2009.09.017
  18. Taylor T, Bryant C, Popat S. A study of 225 patients on bisphosphonates presenting to the bisphosphonate clinic at King's College Hospital. Br Dent J 2013; 214: E18. https://doi.org/10.1038/sj.bdj.2013.327
  19. Sedghizadeh PP, Stanley K, Caligiuri M, Hofkes S, Lowry B, Shuler CF. Oral bisphosphonate use and the prevalence of osteonecrosis of the jaw: an institutional inquiry. J Am Dent Assoc 2009; 140: 61-6. https://doi.org/10.14219/jada.archive.2009.0019
  20. Hansen PJ, Knitschke M, Draenert FG, Irle S, Neff A. Incidence of bisphosphonate-related osteonecrosis of the jaws (BRONJ) in patients taking bisphosphonates for osteoporosis treatment - a grossly underestimated risk? Clin Oral Investig 2013; 17: 1829-37. https://doi.org/10.1007/s00784-012-0873-3
  21. 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

Cited by

  1. Long-term oral bisphosphonates delay healing after tooth extraction: a single institutional prospective study vol.29, pp.10, 2017, https://doi.org/10.1007/s00198-018-4621-7
  2. Detecting the earliest radiological signs of bisphosphonate-related osteonecrosis vol.224, pp.1, 2018, https://doi.org/10.1038/sj.bdj.2017.1001
  3. Osteoporosis therapy in patients with inflammatory rheumatic diseases and osteonecrosis of the jaw vol.79, pp.2, 2017, https://doi.org/10.1007/s00393-019-0606-y
  4. Platelet-Rich Plasma (PRP) in Dental Extraction of Patients at Risk of Bisphosphonate-Related Osteonecrosis of the Jaws: A Two-Year Longitudinal Study vol.10, pp.13, 2020, https://doi.org/10.3390/app10134487