BONE RESORPTION IN OSTEONECROSIS (ON) OF THE JAW AND/OR MANDIBLE IN PATIENTS UNDER CHRONIC BISPHOSPHONATE THERAPY.

PICARDO S; PELLEGRINI G; REY E; ZENI SN

Glasgow, Escocia

Simposio; 37th European Symposium on Calcified Tissues; 2010

IBMS

BONE RESORPTION IN OSTEONECROSIS (ON) OF THE JAW AND/OR MANDIBLE IN PATIENTS UNDER CHRONIC BISPHOSPHONATE THERAPY. Bisphosphonates (BPs) induce marked inhibition of bone resorption, particularly when administered by intravenous infusion. They have been utilized clinically for the treatment of osteoporosis and to manage of patients with advance-stage cancer involving skeletal metastasis and hypercalcemia of malignancy. Although the pathogenesis of the ON of the jaw is not understood, several papers suggest that BPs may play a role in its development.  In the present report we describe our experience in patients who received treatment with BPs and who subsequently developed ON of the jaw and/or mandible. Since 2007, one man and twenty-four women (65±9 years old) with ON diagnosis under BPs treatment (mean±SD: 64.5±9.0 month) were referred to the Oral-maxillofacial Department. School of Dentistry. UBA by Bs.As. Suburban Hospitals.  Patients were treated with BPs for osteoporosis (67%) and for oncologic treatments (33%) that included multiple mieloma; metastatatic breast cancer, and metastatic ovary cancer.  A total of 25 patients had ON signs (bone exposed; inflammation; osteomyelitis; delay healing; oral mucosal changes; sequester) which were manifested in the maxilla 42% and in the jaw 58%.  Two patients were discarded for lacking inflammatory signs post-invasive dental procedures. The most number of cases occurred after an invasive dental procedure such as: extractions; implants; endodontic treatments) but approximately a 20% occurred spontaneously. A total of 18 patients were treated with only one BPs that in decreasing order were: Alendronate (AL); Zolendronate (ZOL); Pamidronate (PAM) and Risendronate (RIS):  the remaining patients were treated with two BPs: PAM/ZOL 3; ALE/ZOL 1;  ALE/PAM 1 and ALE/Ibandronate 1. Serum C-terminal of telopeptide type I collagen (CTX) (ELISA, Nordic Bioscience Diag. A/S) was in the lowest level of reference (251-761): (mean±SD) 258.3±62.4 ug/L Conclusion: These findings, according to literature reports, suggested that BPs and a very low bony renewal capacity may contribute to the pathogenesis of ON. Although the most cases developed in oncological patients, as demonstrated in the present presentation, it could be also identified in osteoporosis patients. This last group of patients should also be carefully followed by preventive oral care before beginning BPs treatment.  This paper is part of the S Picardo PhD.