Abstract
BackgroundBisphosphonate-associated osteonecrosis of the jaws (BP-ONJ) is an adverse effect of bisphosphonate treatment with varying reported incidence rates.MethodsIn two neighboring German cities, prevalence and additional factors of the development of BP-ONJ in multiple myeloma patients with bisphosphonates therapy were recorded using a retrospective (RS) and cross-sectional study (CSS) design. For the RS, all patients treated from Jan. 2000 - Feb. 2006 were contacted by letter. In the CSS, all patients treated from Oct. 2006 - Mar. 2008 had a physical and dental examination. Additionally, a literature review was conducted to evaluate all articles reporting on BP-ONJ prevalence. PubMed search terms were: bisphosphonat, diphosphonate, osteonecrosis, prevalence and incidence.ResultsIn the RS, data from 81 of 161 patients could be obtained; four patients (4.9%) developed BP-ONJ. In the CSS, 16 of 78 patients (20.5%) developed BP-ONJ. All patients with BP-ONJ had received zoledronate; 12 of these had had additional bisphosphonates. All except one had an additional trigger factor (tooth extraction [n = 14], dental surgical procedure [n = 2], sharp mylohyoid ridge [n = 3]).ConclusionThe prevalence of BP-ONJ may have been underestimated to date. The oral examination of all patients in this CSS might explain the higher prevalence, since even early asymptomatic stages of BP-ONJ and previously unnoticed symptomatic BP-ONJ were recorded. Since nearly all patients with BP-ONJ had an additional trigger factor, oral hygiene and dental care might help to reduce BP-ONJ incidence.
Highlights
Bisphosphonate-associated osteonecrosis of the jaws (BP-ONJ) is an adverse effect of bisphosphonate treatment with varying reported incidence rates
Two studies with two different populations were conducted: one retrospective study and one cross sectional study. Inclusion criteria for both studies were a diagnosis of multiple myeloma and bisphosphonate therapy; the duration of bisphosphonate therapy was not taken into account
Additional diseases, medication and risk factors for osteonecrosis were recorded from patient histories
Summary
Bisphosphonate-associated osteonecrosis of the jaws (BP-ONJ) is an adverse effect of bisphosphonate treatment with varying reported incidence rates. Bisphosphonates are used in the treatment of multiple myeloma because of their inhibitory effect on osteoclastic activity. Bisphosphonates are grouped into nitrogen-containing and non-nitrogen-containing bisphosphonates. The former inhibit the Bisphosphonates have a beneficial effect on pain and can reduce fractures in multiple myeloma patients, [5] thereby increasing quality of life for the patient. In 2003, the fourth adverse effect, bisphosphonate associated osteonecrosis of the jaw (BP-ONJ), was described for the first time [7] and has been subsequently diagnosed with increasing frequency [8]
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