Experience with the treatment of bisphosphonate-related osteonecrosis of the jaw

Radovan Mottl,Zuzana Janovska,Radovan Slezak

doi:10.5507/bp.2013.069

Abstract

This article covers the authors' experience with the treatment of bisphosphonate-related osteonecrosis of the jaw in 11 individuals. A retrospective study of patients diagnosed and treated for bisphosphonate-related osteonecrosis of the jaw at the Department of Dentistry, University Hospital Hradec Králové during the period January 2006 to October 2012. The treatment protocol consisted of antimicrobial mouth rinses and systemic antibiotic administration according to the stage of the disease. Additional surgical debridement and sequestrectomy in combination with antimicrobial therapy was performed in two cases. Complete healing was achieved in six patients. In two cases, satisfactory healing was noted. Stage of the disease was lowered and only a small area of asymptomatic necrotic bone of up to five mm in diameter persisted. Two patients developed a stable disease without progression. In one patient, the disease progressed to the third stage with osteonecrosis involving all quadrants of both jaws. From these data it was concluded that conservative approach in the treatment of bisphosphonate-related osteonecrosis of the jaw led to symptom regression but was not curative. Surgical intervention, however, bears the risk of further progression of the osteonecrosis and must be carefully planned with respect to the patient's general health status and life expectancy. The treatment of bisphosphonate-related osteonecrosis of the jaw is generally difficult. For this reason, prevention plays a predominant role in the management of the disease.

Highlights

Bisphophonate-related osteonecrosis of the jaw (BRONJ) is a condition first described by Marx in 2003
Patients receiving lower doses of oral bisphopshonates as in the treatment of postmenopausal osteoporosis are at low risk
In addition to antimicrobial mouth rinses combined with systemic antibiotic treatment, minor surgical procedures are often performed as a part of the conservative treatment protocol

Summary

Introduction

Bisphophonate-related osteonecrosis of the jaw (BRONJ) is a condition first described by Marx in 2003 (ref.[1]). BRONJ has become a growing epidemic with several thousands of cases reported. Even though the clinical benefit of bisphosphonate therapy is huge, patients are at risk of developing osteonecrosis as a serious adverse effect. Incidence data for BRONJ vary considerably due to different definitions of the disease. This aside, mild cases of asymptomatic denuded bone very likely remain unidentified[5]. Most incidences of BRONJ have been reported as a result of intravenous administration of high doses of aminobisphosphonates indicated mostly in oncologic patients[6]. The risk of BRONJ development in patients receiving low doses of bisphosphonates orally mainly for the treatment of postmenopausal osteoporosis is relatively low[6,8]

Methods

Results

Conclusion