Outcome of Treatment and Parameters Influencing Recurrence in Patients with Bisphosphonate-related Osteonecrosis of the Jaws

Overview

Journal J Cancer Res Clin Oncol

Specialty Oncology

Date 2010 Oct 8

PMID 20927569

Citations 42

Authors

Thomas Mucke

Janett Koschinski

Herbert Deppe

Stefan Wagenpfeil

Christoph Pautke

David A Mitchell

Klaus-Dietrich Wolff

Frank Holzle

Affiliations

Soon will be listed here.

Abstract

Purpose: Bisphosphonate-related osteonecrosis of the jaws (BRONJ) is now a well-recognised entity which is difficult to manage and often recurs. The aim of this study was to examine the success of resection of the necrotic bone and identify risk factors for recurrence in these patients.

Methods: One hundred and eight patients were evaluated prospectively and investigated at least twice. Multiple logistic regression analysis was used to determine factors independently associated with the dependent variable of recurrence of BRONJ.

Results: Factors influencing the development of recurrence of BRONJ were the presence of bacterial bone infection of the necrotic area (P = 0.011), type of treatment (either conservative or surgical, P = 0.001) with a lower recurrence rate for surgically treated patients, extent of surgical treatment with better outcome in larger resections (P < 0.0001), number of debridements performed (P < 0.0001), and the extent of radiographic appearance of osteolysis assessed by dental panoramic tomogram (P = 0.028).

Conclusions: An increased risk for recurrence can be found in cases with bacterial bone infection of the necrotic area, type of conservative or surgical treatment, extent of surgical treatment with better outcome in larger resections, and the number of debridements performed. Microvascular tissue transfer should be considered in selected cases if other options have been exhausted.

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References

Ruggiero S, Mehrotra B, Rosenberg T, Engroff S . Osteonecrosis of the jaws associated with the use of bisphosphonates: a review of 63 cases. J Oral Maxillofac Surg. 2004; 62(5):527-34. DOI: 10.1016/j.joms.2004.02.004. View

Vescovi P, Manfredi M, Merigo E, Meleti M . Early surgical approach preferable to medical therapy for bisphosphonate-related osteonecrosis of the jaws. J Oral Maxillofac Surg. 2008; 66(4):831-2. DOI: 10.1016/j.joms.2007.11.025. View

Body J . Breast cancer: bisphosphonate therapy for metastatic bone disease. Clin Cancer Res. 2006; 12(20 Pt 2):6258s-6263s. DOI: 10.1158/1078-0432.CCR-06-0840. View

Vogel F, Scholz H, Al-Nawas B, Elies W, Kresken M, Lode H . [Rational use of oral antibiotics. Findings of an expert commission of the Paul Ehrlich Society for Chemotherapy]. Med Monatsschr Pharm. 2002; 25(6):193-204. View

Woo S, Hellstein J, Kalmar J . Narrative [corrected] review: bisphosphonates and osteonecrosis of the jaws. Ann Intern Med. 2006; 144(10):753-61. DOI: 10.7326/0003-4819-144-10-200605160-00009. View

Bamias A, Kastritis E, Bamia C, Moulopoulos L, Melakopoulos I, Bozas G . Osteonecrosis of the jaw in cancer after treatment with bisphosphonates: incidence and risk factors. J Clin Oncol. 2005; 23(34):8580-7. DOI: 10.1200/JCO.2005.02.8670. View

Migliorati C . Bisphosphanates and oral cavity avascular bone necrosis. J Clin Oncol. 2003; 21(22):4253-4. DOI: 10.1200/JCO.2003.99.132. View

Marx R, Cillo Jr J, Ulloa J . Oral bisphosphonate-induced osteonecrosis: risk factors, prediction of risk using serum CTX testing, prevention, and treatment. J Oral Maxillofac Surg. 2007; 65(12):2397-410. DOI: 10.1016/j.joms.2007.08.003. View

Badros A, Weikel D, Salama A, Goloubeva O, Schneider A, Rapoport A . Osteonecrosis of the jaw in multiple myeloma patients: clinical features and risk factors. J Clin Oncol. 2006; 24(6):945-52. DOI: 10.1200/JCO.2005.04.2465. View

10.

Engroff S, Kim D . Treating bisphosphonate osteonecrosis of the jaws: is there a role for resection and vascularized reconstruction?. J Oral Maxillofac Surg. 2007; 65(11):2374-85. DOI: 10.1016/j.joms.2006.07.012. View

11.

Stockmann P, Hinkmann F, Lell M, Fenner M, Vairaktaris E, Neukam F . Panoramic radiograph, computed tomography or magnetic resonance imaging. Which imaging technique should be preferred in bisphosphonate-associated osteonecrosis of the jaw? A prospective clinical study. Clin Oral Investig. 2009; 14(3):311-7. DOI: 10.1007/s00784-009-0293-1. View

12.

Pautke C, Bauer F, Tischer T, Kreutzer K, Weitz J, Kesting M . Fluorescence-guided bone resection in bisphosphonate-associated osteonecrosis of the jaws. J Oral Maxillofac Surg. 2009; 67(3):471-6. DOI: 10.1016/j.joms.2008.09.037. View

13.

Marx R . Pamidronate (Aredia) and zoledronate (Zometa) induced avascular necrosis of the jaws: a growing epidemic. J Oral Maxillofac Surg. 2003; 61(9):1115-7. DOI: 10.1016/s0278-2391(03)00720-1. View

14.

Marx R, Sawatari Y, Fortin M, Broumand V . Bisphosphonate-induced exposed bone (osteonecrosis/osteopetrosis) of the jaws: risk factors, recognition, prevention, and treatment. J Oral Maxillofac Surg. 2005; 63(11):1567-75. DOI: 10.1016/j.joms.2005.07.010. View

15.

Freiberger J, Padilla-Burgos R, Chhoeu A, Kraft K, Boneta O, Moon R . Hyperbaric oxygen treatment and bisphosphonate-induced osteonecrosis of the jaw: a case series. J Oral Maxillofac Surg. 2007; 65(7):1321-7. DOI: 10.1016/j.joms.2007.03.019. View

16.

Greenberg M . Intravenous bisphosphonates and osteonecrosis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2004; 98(3):259-60. DOI: 10.1016/j.tripleo.2004.08.001. View

17.

Bedogni A, Blandamura S, Lokmic Z, Palumbo C, Ragazzo M, Ferrari F . Bisphosphonate-associated jawbone osteonecrosis: a correlation between imaging techniques and histopathology. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008; 105(3):358-64. DOI: 10.1016/j.tripleo.2007.08.040. View

18.

Vescovi P, Merigo E, Meleti M, Manfredi M . Bisphosphonate-associated osteonecrosis (BON) of the jaws: a possible treatment?. J Oral Maxillofac Surg. 2006; 64(9):1460-2. DOI: 10.1016/j.joms.2006.05.042. View

19.

Conte P, Giannessi P, Latreille J, Mauriac L, Koliren L, Calabresi F . Delayed progression of bone metastases with pamidronate therapy in breast cancer patients: a randomized, multicenter phase III trial. Ann Oncol. 1994; 5 Suppl 7:S41-4. View

20.

Mucke T, Haarmann S, Wolff K, Holzle F . Bisphosphonate related osteonecrosis of the jaws treated by surgical resection and immediate osseous microvascular reconstruction. J Craniomaxillofac Surg. 2009; 37(5):291-7. DOI: 10.1016/j.jcms.2008.12.004. View