Bisphosphonate Induced Osteonecrosis of the Jaws: Our Clinical Experience at King Hussein Medical Center, Amman, Jordan

Abstract

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. 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. 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. 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. 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.