Clinical profile of individuals with bisphosphonate-related osteonecrosis of the jaw: an integrative review.

Aloizio Premoli Maciel,Lázara Joyce Oliveira Martins,Rogério Jardim Caldas,Paulo Sérgio Da Silva Santos,Reyna Aguilar Quispe

doi:10.1590/1516-3180.2019.0352.r2.15052020

Abstract

Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is still the most prevalent type of osteonecrosis with clinical relevance. In Brazil, bisphosphonate use is high but there is a lack of epidemiological studies on BRONJ. To determine the clinical profile of BRONJ in a Brazilian population through an integrative review. Integrative review of BRONJ in a Brazilian population. Cases and clinical research on Brazilians with BRONJ between 2010 and 2019, indexed in PubMed/MEDLINE, Scopus, Web of Science and LILACS were reviewed. Age, sex, type and time of bisphosphonate intake, administration route, related diseases, region of the BRONJ, diagnostic criteria, staging, triggering factor and type of treatment were analyzed. Fifteen articles on 128 subjects were included. Most patients were women (82.03%); the mean age was 63 years. Intravenous zoledronic acid was mostly used (62.50%), for breast cancer treatment (46.87%). The main localization of BRONJ was the mandible (54.68%), associated mainly with tooth extractions (45.98%). The diagnostic criteria were clinical (100%) and radiographic (89.06%), mostly in stage II (68.08%). The surgical treatments were sequestrectomy (37.50%) and platelet-rich plasma (PRP) (36.71%). Microbial control was done using chlorhexidine (93.75%) and infection control using clindamycin (53.90%). BRONJ had higher prevalence in Brazilian women receiving treatment for breast cancer and osteoporosis. The mandible was the region most affected with a moderate stage of BRONJ, particularly when there were histories of tooth extraction and peri-implant surgery. Sequestrectomy with additional drugs and surgical therapy was the treatment most accomplished.

Highlights

Bisphosphonates (BPs) are drugs with oncological indication that have been used since 1960.1 They are currently indicated as therapy for multiple myeloma, malignant hypercalcemia, prevention of bone metastases and pathological fractures.[2]
The variables selected were the following: age, sex, type of bisphosphonate used, duration of use of bisphosphonates until disease manifestation, route of administration, underlying disease that led to indication for drug use, oral region affected by bisphosphonate-related osteonecrosis of the jaw (BRONJ), clinical criteria for diagnosis of BRONJ, clinical staging according to the American Association of Oral and Maxillofacial Surgeons (AAOMS),[8] local triggering factor and type of treatment
The commonest diagnoses relating to BRONJ were: breast cancer, in 60 individuals[9,10,12,16,17,19,21] (46.87%); osteoporosis,[10,17,18,19,23,24,25,26] in 25 (19.53%); multiple myeloma,[5,9,16,17,20] in 16 (12.50%); and prostate cancer,[9,10,16,18,19] in 16 (12.50%) (Table 1).[4,5,9,10,12,16,17,18,19,20,21,23,24,25,26]

Summary

Introduction

Bisphosphonates (BPs) are drugs with oncological indication that have been used since 1960.1 They are currently indicated as therapy for multiple myeloma, malignant hypercalcemia, prevention of bone metastases and pathological fractures.[2]. Bone remodeling and deposition of physiological bone matrix are affected.[6,7] These effects on bone metabolism associated with local triggering factors, such as infection and tissue inflammation in the mouth, are named bisphosphonate-related osteonecrosis of the jaw (BRONJ).[8] Among the main triggering factors of BRONJ are the following: exodontia, peri-implant surgery and traumas in the buccal mucosa.[1,9,10,11] The clinical characteristics of BRONJ can include asymptomatic manifestations, severe pain, presence of infections and bone exposure.[6]. Sex, type and time of bisphosphonate intake, administration route, related diseases, region of the BRONJ, diagnostic criteria, staging, triggering factor and type of treatment were analyzed. CONCLUSIONS: BRONJ had higher prevalence in Brazilian women receiving treatment for breast cancer and osteoporosis. Sequestrectomy with additional drugs and surgical therapy was the treatment most accomplished

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