Osteonecrosis of the jaws associated with the use of bisphosphonates: a review of 63 cases
Abstract
Purpose
Bisphosphonates are widely used in the management of metastatic disease to the bone and in the treatment of osteoporosis. We were struck in the past 3 years with a cluster of patients with necrotic lesions in the jaw who shared 1 common clinical feature, that they had all received chronic bisphosphonate therapy. The necrosis that was detected was otherwise typical of osteoradionecrosis, an entity that we rarely encountered at our center, with less than 2 patients presenting with a similar manifestation per year.
Patients and methods
We performed a retrospective chart review of patients who presented to our Oral Surgery service between February 2001 and November 2003 with the diagnosis of refractory osteomyelitis and a history of chronic bisphosphonate therapy.
Results
Sixty-three patients have been identified with such a diagnosis. Fifty-six patients had received intravenous bisphosphonates for at least 1 year and 7 patients were on chronic oral bisphosphonate therapy. The typical presenting lesions were either a nonhealing extraction socket or an exposed jawbone; both were refractory to conservative debridement and antibiotic therapy. Biopsy of these lesions showed no evidence of metastatic disease. The majority of these patients required surgical procedures to remove the involved bone.
Conclusions
In view of the current trend of increasing and widespread use of chronic bisphosphonate therapy, our observation of an associated risk of osteonecrosis of the jaw should alert practitioners to monitor for this previously unrecognized potential complication. An early diagnosis might prevent or reduce the morbidity resulting from advanced destructive lesions of the jaw bone.
∗Chief, Division of Oral and Maxillofacial Surgery, Long Island Jewish Medical Center, New Hyde Park, NY, USA
†Attending, Division of Hematology and Oncology, Long Island Jewish Medical Center, New Hyde Park, NY, USA
‡Former Chief Resident, Division of Oral and Maxillofacial Surgery, Long Island Jewish Medical Center, New Hyde Park, NY, USA
§Fellow, Department of Dentistry and Oral and Maxillofacial Surgery, University of Maryland Medical Systems, Baltimore, MD, USA
Address correspondence and reprint requests to Dr Ruggiero: Division of Oral and Maxillofacial Surgery, Long Island Jewish Medical Center, New Hyde Park, NY 11040 USA
ABSTRACT