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

PICARDO S; PELLEGRINI GG; REY E; ZENI SN

Glascow, Scotland

Congreso; ECTS 2010; 2010

ECTS

Abstract: Bisphosphonates (BPs) induce marked inhibition of bone resorption, particularly by intravenous infusion. They are used to treat osteoporosis (OP) or advance-stage cancer involving skeletal metastasis and hypercalcemia of malignancy. Although the pathogenesis of ON of the jaw is not understood yet, 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 subsequently developed ON in the jaw and/or mandible. Since 2007, a man and 26 women (65±9 years) with ON diagnosis under BPs treatment (mean±SD: 64.5±9.0 month) were referred to Oral-maxillofacial Dep, Fac. Dentistry. UBA, by Bs.As. Suburban Hospitals. BPs were received for OP (67%) or oncologic treatments (33%): multiple mieloma; metastatatic breast cancer, metastatic ovary cancer. 25 patients had ON signs (bone exposed; inflammation; osteomyelitis; delay healing; oral mucosal changes; sequester):maxilla 42% and jaw 58%. Two patients were discarded for not presenting inflammatory signs post-invasive dental procedures. Most of the cases occurred after an invasive dental procedure such as: dental extractions; implants; endodontic treatments) but approximately a 20% occurred spontaneously. A total of 18 patients were treated only whit one BPs, in decreasing order: 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/LBisphosphonates (BPs) induce marked inhibition of bone resorption, particularly by intravenous infusion. They are used to treat osteoporosis (OP) or advance-stage cancer involving skeletal metastasis and hypercalcemia of malignancy. Although the pathogenesis of ON of the jaw is not understood yet, 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 subsequently developed ON in the jaw and/or mandible. Since 2007, a man and 26 women (65±9 years) with ON diagnosis under BPs treatment (mean±SD: 64.5±9.0 month) were referred to Oral-maxillofacial Dep, Fac. Dentistry. UBA, by Bs.As. Suburban Hospitals. BPs were received for OP (67%) or oncologic treatments (33%): multiple mieloma; metastatatic breast cancer, metastatic ovary cancer. 25 patients had ON signs (bone exposed; inflammation; osteomyelitis; delay healing; oral mucosal changes; sequester):maxilla 42% and jaw 58%. Two patients were discarded for not presenting inflammatory signs post-invasive dental procedures. Most of the cases occurred after an invasive dental procedure such as: dental extractions; implants; endodontic treatments) but approximately a 20% occurred spontaneously. A total of 18 patients were treated only whit one BPs, in decreasing order: 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, suggest that BPs and the very low bony renewal capacity may contribute to pathogenesis of ON. Although most of the cases develope in oncological patients, as demonstrated in the present study, it could be also identified in osteoporotic patients who should also be carefully followed by preventive oral care before beginning BPs treatment. This paper is part of the S Picardo PhD.These findings, according to literature reports, suggest that BPs and the very low bony renewal capacity may contribute to pathogenesis of ON. Although most of the cases develope in oncological patients, as demonstrated in the present study, it could be also identified in osteoporotic patients who should also be carefully followed by preventive oral care before beginning BPs treatment. This paper is part of the S Picardo PhD. Disclosure of Interest: None Declared: None Declared Keywords: osteonecrosis - Jaw - mandible - bone turnover: osteonecrosis - Jaw - mandible - bone turnover