Decreasing Frequency of Osteonecrosis of the Jaw in Cancer and Myeloma Patients Treated with Bisphosphonates: The Experience of the Oncology Network of Piedmont and Aosta Valley (North-Western Italy)

Claudia Galassi,Cinzia Ortega,Vittorio Fusco,Oscar Bertetto,Libero Ciuffreda,Franco Goia,Anna Baraldi,Mario Migliario,Matteo Scoletta,Anastasios Loidoris,Mario Boccadoro,Alfredo Berruti

doi:10.1155/2013/672027

Abstract

Background. Data concerning frequency of Osteonecrosis of Jaws (ONJ) are mostly based on single center experiences. Patients and Methods. Since 2005 a multidisciplinary study group collected data of cases of ONJ in patients treated with Bisphosphonates (BP) and observed in oncology and hematology centers of a regional network. Results. By December 2008, 221 cases were registered. We report details of 200 cases, identified after cross-checking reports from centres of medical oncology, haematology, and oral care. Primary neoplasm was breast cancer (39%), myeloma (32%), prostate cancer (16%), and other types of cancer (8%). In about 50% of the cases a history of dental extraction was present. Zoledronic acid was administered (alone or with other BP) to 178 patients (89%). Median time from first infusion to ONJ diagnosis was 21.0 (zoledronic acid only) and 39.0 months (pamidronate only). The number of ONJ cases per year was 3 in 2003, 21 in 2004, 58 in 2005, 60 in 2006, 37 in 2007, and 21 in 2008. Conclusion. The number of new ONJ cases in cancer and myeloma patients increased until 2006 and then reduced. The possible reasons of this trend (introduction of zoledronic acid; increase of ONJ awareness; diffusion of preventive dental measures; late modifications of BP prescription) are herein discussed.

Highlights

Bisphosphonates (BPs) are widely prescribed at different doses, way of administration and treatment durations, for a range of bone diseases including cancerinduced bone disease, osteoporosis, and Paget’s disease
Ever since a large amount of case reports and case series have been published worldwide [6, 7], quite surprisingly, no cases were reported in previously published randomized controlled trials (RCT) that led to the introduction of BP in the therapy armamentarium
We present here the results of a large series of ONJ cases systematically collected at oncology and hematology units and at referral oral care centers of a regional area in NorthWestern Italy: Piemonte and Valle d’Aosta

Summary

Background

Data concerning frequency of Osteonecrosis of Jaws (ONJ) are mostly based on single center experiences. Since 2005 a multidisciplinary study group collected data of cases of ONJ in patients treated with Bisphosphonates (BP) and observed in oncology and hematology centers of a regional network. Zoledronic acid was administered (alone or with other BP) to 178 patients (89%). Median time from first infusion to ONJ diagnosis was 21.0 (zoledronic acid only) and 39.0 months (pamidronate only). The number of ONJ cases per year was 3 in 2003, 21 in 2004, 58 in 2005, 60 in 2006, 37 in 2007, and 21 in 2008. The number of new ONJ cases in cancer and myeloma patients increased until 2006 and reduced. The possible reasons of this trend (introduction of zoledronic acid; increase of ONJ awareness; diffusion of preventive dental measures; late modifications of BP prescription) are discussed

Introduction

Materials and Methods

Results

Bisphosphonates

Discussion