Bisphosphonate-Induced Osteonecrosis of the Jaw 32 Months After Interruption of Zoledronate in a Patient With Multiple Myeloma

Abstract

Bisphosphonates prevent, reduce, and delay cancer-related skeletal complications in patients with multiple myeloma or metastatic cancer. 1 Rosen L.S. Gordon D. Kaminski M. et al. Long-term efficacy and safety of zoledronic acid compared with pamidonate disodium in treatment of skeletal complications in patients with advanced multiple myeloma or breast carcinoma: A randomized, double-blind, multicenter, comparative trial. Cancer. 2003; 98: 1735 Crossref PubMed Scopus (756) Google Scholar Thus, the therapy is commonly prescribed to patients with multiple myeloma. 2 Kyle R.A. Yee G.C. Somerfield M.R. et al. American Society of Clinical Oncology 2007 clinical practice guideline update on the role of bisphosphonates in multiple myeloma. J Clin Oncol. 2007; 25: 2464 Crossref PubMed Scopus (356) Google Scholar Bisphosphonates are extremely effective in reducing the symptoms and complications of bone lesions and have been shown to have a profound effect on the quality of life of patients with multiple myeloma. However, in the past few years, several reports and recommendations have been published about bisphosphonate-induced osteonecrosis of the jaw (BRONJ) since the first reports were published in 2003 as a potential adverse effect of Zometa (zoledronic acid; Novartis, East Hanover, NJ). 3 Migliorati C.A. Bisphosphonates and oral cavity avascular bone necrosis. J Clin Oncol. 2003; 21: 4253 Crossref PubMed Scopus (429) Google Scholar , 4 Marx R.E. Pamidronate (Aredia) and zolendronate (Zometa) induced avascular necrosis of the jaws: A growing epidemic. J Oral Maxillofac Surg. 2003; 61: 1115 Abstract Full Text Full Text PDF PubMed Scopus (2095) Google Scholar , 5 Ruggiero S.L. Mehrotra B. Rosenberg T.J. et al. Osteonecrosis of the jaws associated with the use of bisphosphonates: A review of 63 cases. J Oral Maxillofac Surg. 2004; 62: 527 Abstract Full Text Full Text PDF PubMed Scopus (1609) Google Scholar It was observed that the major risk factors are dental extraction and the therapy duration with zoledronic acid. 6 Advisory Task Force on Bisphosphonate-Related Osteonecrosis of the JawsAmerican Association of Oral and Maxillofacial Surgeons' position paper on bisphosphonate-related osteonecrosis of the jaws. J Oral Maxillofac Surg. 2007; 65: 369 Abstract Full Text Full Text PDF PubMed Scopus (740) Google Scholar BRONJ was often diagnosed during or after therapy (range, 1 to 13 months). 7 Ibrahim T. Barbati F. Giorgio-Marrano G. et al. Osteonecrosis of the jaw in patients with bone metastases treated with bisphosphonates: A retrospective study. Oncologist. 2008; 13: 330 Crossref PubMed Scopus (55) Google Scholar We report an extensive case of BRONJ that was clinically evident more than 32 months after the suspension of zoledronic acid.