Bisphosphonate therapy induced osteonecrosis of the jaws in patients with osteoporosis and malignant diseases

Abstract

In patients with osteoporosis more and more low doses of bisphosphonates which is orally given are used in treatment. The risk for this patient group to develop osteonecrosis is not known. Between April 2006 and April 2008, osteonecrosis of the jaw was diagnosed in 8 patients with malignant diseases, and in 8 patients with only oral therapy with bisphosphonates for osteoporosis. In 4 cases with malignant diseases an extended resection of the jaw was necessary. As opposed to these cases, 3 patients with osteoporosis did not show extended necrosis. In all these cases the preferred location was the region of the first and second molar teeth in the left mandible. In one case with alendronic acid therapy for osteoporosis, an extended necrosis of the right posterior maxilla was detected, and extended resection of the posterior maxilla was necessary. 14 patients were treated with success (complete lasting healing, no residual mucosal defect). In half of the cases insufficient teeth with periodontal disease were involved. In 2 cases (one with malignant diseases and one with osteoporosis) after 8 and 12 weeks, respectively once more an intraoral defect was seen, due to which another but not so extended resection had to be performed. It can be concluded that in patients with osteoporosis and malignant diseases before starting a treatment with bisphosphonates a dental treatment is necessary. Further, more information about osteonecrosis in osteoporosis therapy with bisphosphonates must be shared with colleagues of internal medicine.