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Ninety-One Osteoporosis Patients Affected with Bisphosphonate-Related Osteonecrosis of the Jaw: A Case Series

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Abstract

Bisphosphonate (BP)-related osteonecrosis of the jaw (BRONJ) presents with necrotic bone in the mouth in the setting of BP exposure. It has been studied in cancer patients taking high-dose BP, but BRONJ has also been noted in patients taking lower-dose BP for osteoporosis. The purpose of this study was to characterize the phenotypes and outcomes in a large series of patients with osteoporosis and BRONJ in the setting of BP exposure. We conducted a retrospective case series. The sample was composed of subjects with BRONJ and osteoporosis. Subjects with a history of BP treatment for myeloma or metastatic cancer to the bones were excluded. Descriptive statistics were computed for the study variables. Ninety-one cases of BRONJ met the inclusion criteria. Subjects had a median age of 71 years and were predominantly female (94.5 %). The median time of BP exposure was 60 months (range 2–120). Most subjects were treated with alendronate (82.4 %). The mandible was involved more frequently (58.2 %) than the maxilla (37.3 %). Subjects commonly (65.9 %), but not universally, reported pain. For subjects with treatment outcome data (n = 0), most reported improvement (80.0 %). Although BRONJ is an uncommon condition, the absolute number of cases is fairly large due to the very large number of patients taking BPs for osteoporosis. The findings of this study confirm that BRONJ primarily affects the mandible, a substantial minority present without pain, and patients typically improve with treatment.

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References

  1. Ruggiero SL, Mehrotra B, Rosenberg TJ, Engroff SL (2004) Osteonecrosis of the jaws associated with the use of bisphosphonates: a review of 63 cases. J Oral Maxillofac Surg 62:527–534

    Article  PubMed  Google Scholar 

  2. Marx RE, Sawatari Y, Fortin M, Broumand V (2005) Bisphosphonate-induced exposed bone (osteonecrosis/osteopetrosis) of the jaws: risk factors, recognition, prevention, and treatment. J Oral Maxillofac Surg 63:1567–1575

    Article  PubMed  Google Scholar 

  3. Woo SB, Kalmar JR (2007) Osteonecrosis of the jaws and bisphosphonates. Alpha Omegan 100:194–202

    Article  PubMed  Google Scholar 

  4. Ruggiero SL, Mehrotra B (2009) Bisphosphonate-related osteonecrosis of the jaw: diagnosis, prevention, and management. Annu Rev Med 60:85–96

    Article  PubMed  CAS  Google Scholar 

  5. Ruggiero SL (2007) Guidelines for the diagnosis of bisphosphonate-related osteonecrosis of the jaw (BRONJ). Clin Cases Miner Bone Metab 4:37–42

    PubMed  Google Scholar 

  6. Ruggiero SL, Dodson TB, Assael LA, Landesberg R, Marx RE, Mehrotra B (2009) American Association of Oral and Maxillofacial Surgeons position paper on bisphosphonate-related osteonecrosis of the jaws: 2009 update. J Oral Maxillofac Surg 67:2–12

    PubMed  Google Scholar 

  7. Jadu F, Lee L, Pharoah M, Reece D, Wang L (2007) A retrospective study assessing the incidence, risk factors and comorbidities of pamidronate-related necrosis of the jaws in multiple myeloma patients. Ann Oncol 18:2015–2019

    Article  PubMed  CAS  Google Scholar 

  8. Solomon DH, Mercer E, Woo SB, Avorn J, Schneeweiss S, Treister N (2013) Defining the epidemiology of bisphosphonate-associated osteonecrosis of the jaw: prior work and current challenges. Osteoporos Int 24:237–244

    Article  PubMed  CAS  Google Scholar 

  9. Fellows JL, Rindal DB, Barasch A, Gullion CM, Rush W, Pihlstrom DJ, Richman J (2011) ONJ in two dental practice-based research network regions. J Dent Res 90:433–438

    Article  PubMed  CAS  Google Scholar 

  10. Sedghizadeh PP, Stanley K, Caligiuri M, Hofkes S, Lowry B, Shuler CF (2009) Oral bisphosphonate use and the prevalence of osteonecrosis of the jaw: an institutional inquiry. J Am Dent Assoc 140:61–66

    PubMed  Google Scholar 

  11. Otto S, Abu-Id MH, Fedele S, Warnke PH, Becker ST, Kolk A, Mucke T, Mast G, Kohnke R, Volkmer E, Haasters F, Lieger O, Iizuka T, Porter S, Campisi G, Colella G, Ploder O, Neff A, Wiltfang J, Ehrenfeld M, Kreusch T, Wolff KD, Sturzenbaum SR, Schieker M, Pautke C (2010) Osteoporosis and bisphosphonates-related osteonecrosis of the jaw: not just a sporadic coincidence: a multi-centre study. J Craniomaxillofac Surg 39:272–277

    Article  PubMed  Google Scholar 

  12. Saussez S, Javadian R, Hupin C, Magremanne M, Chantrain G, Loeb I, Decaestecker C (2009) Bisphosphonate-related osteonecrosis of the jaw and its associated risk factors: a Belgian case series. Laryngoscope 119:323–329

    Article  PubMed  CAS  Google Scholar 

  13. Bagan JV, Murillo J, Jimenez Y, Poveda R, Milian MA, Sanchis JM, Silvestre FJ, Scully C (2005) Avascular jaw osteonecrosis in association with cancer chemotherapy: series of ten cases. J Oral Pathol Med 34:120–123

    Article  PubMed  CAS  Google Scholar 

  14. Hoff AO, Toth BB, Altundag K, Johnson MM, Warneke CL, Hu M, Nooka A, Sayegh G, Guarneri V, Desrouleaux K, Cui J, Adamus A, Gagel RF, Hortobagyi GN (2008) Frequency and risk factors associated with osteonecrosis of the jaw in cancer patients treated with intravenous bisphosphonates. J Bone Miner Res 23:826–836

    Article  PubMed  CAS  Google Scholar 

  15. Ruggiero SL, Carlson ER, Assael LA (2009) Comprehensive review of bisphosphonate therapy: implications for the oral and maxillofacial surgery patient. J Oral Maxillofac Surg 67:1

    Article  PubMed  Google Scholar 

  16. Hess LM, Jeter JM, Benham-Hutchins M, Alberts DS (2008) Factors associated with osteonecrosis of the jaw among bisphosphonate users. Am J Med 121:475–483

    Article  PubMed  CAS  Google Scholar 

  17. Malden N, Lopes V (2012) An epidemiological study of alendronate-related osteonecrosis of the jaws. A case series from the south-east of Scotland with attention given to case definition and prevalence. J Bone Miner Metab 30:171–182

    Article  PubMed  CAS  Google Scholar 

  18. Manfredi M, Merigo E, Guidotti R, Meleti M, Vescovi P (2011) Bisphosphonate-related osteonecrosis of the jaws: a case series of 25 patients affected by osteoporosis. Int J Oral Maxillofac Surg 40:277–284

    Article  PubMed  CAS  Google Scholar 

  19. Yarom N, Yahalom R, Shoshani Y, Hamed W, Regev E, Elad S (2007) Osteonecrosis of the jaw induced by orally administered bisphosphonates: incidence, clinical features, predisposing factors and treatment outcome. Osteoporos Int 18:1363–1370

    Article  PubMed  CAS  Google Scholar 

  20. Solomon DH, Avorn J, Katz JN, Finkelstein JS, Arnold M, Polinski JM, Brookhart MA (2005) Compliance with osteoporosis medications. Arch Intern Med 165:2414–2419

    Article  PubMed  Google Scholar 

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Acknowledgement

This study was supported by NIH Grants DE-R21-018750 and AR-K24-055989 as well as by the Center for Applied Clinical Investigation, Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital. N. Treister receives royalties from Medscape and Up to Date, serves on the Data Safety Committee for Falk Pharmaceuticals, and served on advisory boards for Pfizer and Merck in the past 3 years. T. B. Dodson is a member of the American Association of Oral and Maxillofacial Surgeons’ Task Force on Bisphosphonate-Related Osteonecrosis of the Jaw. D. H. Solomon has received salary support from research grants to his institution in the past 3 years from Amgen, Lilly, and CORRONA, unrelated to the current project. He has served in unpaid roles on two Pfizer-sponsored trials and one Novartis-sponsored trial on unrelated topics. He receives royalties from Up to Date.

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Authors and Affiliations

  1. Division of Rheumatology, Brigham and Women’s Hospital, 75 Francis Street, PBB-B3, Boston, MA, 02115, USA

    E. Mercer, T. Norton & D. H. Solomon

  2. Division of Pharmacoepidemiology, Brigham and Women’s Hospital, Boston, MA, USA

    D. H. Solomon

  3. Division of Oral Medicine and Dentistry, Brigham and Women’s Hospital, Boston, MA, USA

    S. Woo & N. Treister

  4. Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Boston, MA, USA

    T. B. Dodson

Authors
  1. E. Mercer
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  2. T. Norton
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  3. S. Woo
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  4. N. Treister
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  5. T. B. Dodson
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  6. D. H. Solomon
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Corresponding author

Correspondence to D. H. Solomon.

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E. Mercer and T. Norton contributed equally to this work.

D. H. Solomon has received research grants unrelated to this manuscript from Amgen and Eli Lilly. All other authors have stated no conflict of interest.

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Mercer, E., Norton, T., Woo, S. et al. Ninety-One Osteoporosis Patients Affected with Bisphosphonate-Related Osteonecrosis of the Jaw: A Case Series. Calcif Tissue Int 93, 241–248 (2013). https://doi.org/10.1007/s00223-013-9747-1

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  • DOI: https://doi.org/10.1007/s00223-013-9747-1

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