Outcomes of bisphosphonate-related osteonecrosis of the jaw—Importance of staging and management guidelines: A large single institutional update

Abstract

20526 Background: Bisphosphonate (BP) therapy is indicated in the treatment of pts. with symptomatic bony disease secondary to myeloma, solid tumors and in the treatment of osteoporosis. We have previously reported our experience with BP related osteonecrosis of the jaw (ONJ) (J Oral Maxillofac Surg 2004;62:527–34). The reported incidence of this entity in patients receiving IV BP’s is approx. 1–10%. The purpose of our current report is to update our experience and report the clinical outcome of the osteonecrotic lesion, with particular emphasis to clinical stage and after following stage specific management guidelines that we have previously published (Hematology 2006; 356–360). Methods: We performed a retrospective analysis of pts. records that were diagnosed with ONJ at our institution. IRB approval was obtained for this study. Information regarding age, gender, indication for BP treatment, type of BP used, stage of ONJ at time of presentation, outcome of ONJ with appropriate therapy were recorded. Results: Two hundred and seven pts. with ONJ were identified at our institution. Males: n=52; Females: n=155. Underlying frequent diagnoses: Myeloma: n=71; breast ca: n=68; osteoporosis: n=42; prostate ca: n=11; others: n=13. Prior BP therapy included exposure to pamidronate: n=87; zoledronic acid: n=123; oral BP: n=41. Ninety four patients were serially followed for outcome data regarding clinical course of ONJ after cessation of BP therapy. Improvement in ONJ was noted: n=24 (26%), stable disease: n=52 (55%), worsening of ONJ: n=18 (19%). Their initial stage of ONJ was recorded as Stage 1: n=26 (28%), Stage 2: n=45 (48%), Stage 3: n=23 (24%). Outcome by stage: stage 1 pts: improvement 19%; stable disease 73%, worsening 8%; Stage 2 pts: improvement noted in 31%, stable disease 47%, worsening 22%; Stage 3 pts: improvement in 22%, stable disease 52%, worsening 26%. Conclusions: With early detection at a lower stage, and careful conservative management, the large majority (74–92%) of pts. presenting with ONJ will have stabilization or improvement in their clinical presentation after discontinuation of BP therapy. Close coordination of care between oncologists and dental colleagues may optimize treatment outcomes with this entity. Author Disclosure Employment or Leadership Consultant or Advisory Role Stock Ownership Honoraria Research Expert Testimony Other Remuneration Amgen, Novartis Novartis