Multiple myeloma and chemical maxillary osteonecrosis. Can both occur simultaneously?

Abstract

IntroductionThe aim of the present study was to investigate the number of patients with Multiple Myeloma (MM) treated with intravenous Zoledronic Acid who presented an involvement of the jaws by Myeloma that mimicked an osteonecrosis. Material and methodsA retrospective study was performed in a University Hospital reference for a population of 1.084.000 inhabitants. A ‘case’ Medication-Related Osteonecrosis of the jaw (MRONJ) was considered when the patient met diagnostic criteria established by the American Association of Oral and Maxillofacial Surgeons (AAOMS, 2014). We recorded data on the underlying disease, medications used, mode of Bisphosphonate administration (oral or intravenous), and timing of medication use. ResultsThe sample size was 84 cases. 22 patients had MRONJ associated to MM treatment. Histopathological examination of pathological bone was characterized by the presence of necrotic osteitis in 82 patients. Only 2 patients with MRONJ suspicion were finally diagnosed as MM. These cases represented 9.09% of all patients with multiple myeloma initially labeled MRONJ in our hospital. ConclusionThe present study has shown that MM can be identified in jaw specimens of patients exposed to Bisphosphonates and clinically diagnosed as osteonecrosis. Biopsy examination should be considered in at least selected cases, for example, before surgical treatment in patients with MM and clinical stage 3 osteonecrosis (due to the detection of malignancy would alter the surgical strategy).