Hyperbaric Oxygen Treatment and Bisphosphonate-Induced Osteonecrosis of the Jaw: A Case Series

Freiberger, John J.; Padilla-Burgos, Rebecca; Chhoeu, Austin H.; Kraft, Kevin H.; Boneta, Otto; Moon, R.E.; Piantadosi, C.A.

doi:10.1016/j.joms.2007.03.019

« Previous Next »Journal of Oral and Maxillofacial Surgery
Volume 65, Issue 7 , Pages 1321-1327, July 2007

Hyperbaric Oxygen Treatment and Bisphosphonate-Induced Osteonecrosis of the Jaw: A Case Series

John J. Freiberger, MD, MPH
- Assistant Professor of Anesthesiology, Center for Hyperbaric Medicine and Environmental Physiology, Duke University Medical Center, Divers Alert Network, Durham, NC.
- Address correspondence and reprint requests to Dr Freiberger: Department of Anesthesiology, Center for Hyperbaric Medicine and Environmental Physiology, Box 3823, Duke University Medical Center, Durham, NC 27710
Rebecca Padilla-Burgos, RN
- Staff Nurse, Center for Hyperbaric Medicine and Environmental Physiology, Duke University Medical Center, Durham, NC.
Austin H. Chhoeu, DO
- Chief, Wound Care and Hyperbaric Medicine, Department of Surgery, Dwight D. Eisenhower Army Medical Center, Ft Gordon, GA.
Kevin H. Kraft, RN
- Head Nurse, Center for Hyperbaric Medicine and Environmental Physiology, Duke University Medical Center, Durham, NC.
Otto Boneta, MD, MPH
- Attending Physician, Hyperbaric Medicine Division, US Air Force School of Aerospace Medicine, Brooks City Base, San Antonio, TX.
R.E. Moon, MD
- Professor of Anesthesiology and Associate Professor of Medicine, Center for Hyperbaric Medicine and Environmental Physiology, Duke University Medical Center, Divers Alert Network, Durham, NC.
C.A. Piantadosi, MD
- Professor of Medicine, Center for Hyperbaric Medicine and Environmental Physiology, Duke University Medical Center, Durham, NC.

Purpose

Bisphosphonate (BP)-associated osteonecrosis of the jaw (ONJ) is an emerging problem with few therapeutic options. Our pilot study of BP-ONJ investigated a possible role for hyperbaric oxygen (HBO₂) therapy.

Patients and Methods

A total of 16 patients, ranging in age from 43 to 78 years, with BP-ONJ were treated with adjunctive HBO₂ between July 2003 and April 2006. Staging was based on the size and number of oral lesions. Clinical response after treatment and at distant follow-up; the odds of remission, stabilization, or relapse; and time to failure analysis were calculated.

Results

The median time on BP therapy before appearance of ONJ symptoms was 18 months, and that from symptom onset to HBO₂ therapy was 12 months. Fourteen of 16 patients (87.5%) improved in stage. The size and number of ONJ lesions were decreased after HBO₂ therapy (P < .001 and P = .008, respectively; Wilcoxon signed-rank test). Immediately after HBO₂ therapy, 7 of 16 patients (44%) were in remission and 8 (50%) had stabilized; however, stabilization without remission was sustained in only 2 patients. At follow-up, 10 of the patients (62.5%) were still in remission or had stabilized. The 7 patients who continued on BP treatment during HBO₂ therapy had a shorter time to failure (8.5 months; 95% confidence interval [CI] = 7.1 to 9.8) than those who discontinued the drug (20.1 months; 95% CI = 17.5 to 23.9; P = .006 by the log-rank test). Clinical response was not associated with cancer type or malignancy remission status.