Bisphosphonates (BPs) are non-metabolized analogues of pyrophosphate used to treat metabolic bone diseases, such as osteoporosis, a common condition that affects 10 million individuals aged over 50 . During the past two decades, BP therapy has become the leading clinical intervention for postmenopausal osteoporosis thanks to selective suppression of osteoclast activity and retardation of bone resorption. Oral BP was prescribed at 73% of 6.3 million visits for osteoporosis in 2003 and it is estimated that over 190 million prescriptions for oral BP have been dispensed worldwide .

Osteoporosis is a chronic disease that requires long-term administration of BP: the benefits of prolonged use of these drugs must be evaluated and compared with the possible side effects. Based on literature and clinical evidence, BPs have a safety profile in the treatment of osteoporosis , but an initial report in 2003 , subsequently confirmed by several studies, reported that osteonecrosis of the jaws (ONJ) may occur as an adverse side effect of intravenous BP therapy (BRONJ) . In addition, a low-grade risk of BRONJ is also connected with oral administration of BP . BRONJ is defined as the presence of necrotic bone in the oral cavity for at least 8 weeks in a patient who is taking (or has taken) BP and who has not received radiation to the head and neck . Patients affected by BRONJ may have swelling of oral and perioral tissues, pain, bleeding, persistent purulent discharge and draining fistulas, severe halitosis, lower lip paresthesia, mobility and loosening of teeth.

Owing to the higher risk of developing the disease in onco-haematological patients treated with intravenous (i.v.) BP, the majority of reviews and reports have concentrated on cancer patients. Few studies have investigated the development of BRONJ in patients receiving BP for the treatment of osteoporosis.

In this study, the authors report the occurrence of BRONJ in 25 female patients who received BP therapy for the treatment of osteoporosis with different drug schedules.

Materials and methods

From June 2005 to May 2009, 135 consecutive patients affected by BRONJ were observed. 25 of these patients (females, mean age 70.4 years, range 52–89 years) had been treated with BP therapy for osteoporosis. In particular, 4 of the 25 patients (16%) had received BP therapy for osteoporosis and were also affected by rheumatoid arthritis (RA) ( Table 1 ). The remaining 110 patients, who had been treated for oncological reasons (52 affected by multiple myeloma and 58 by bone cancer metastasis) were not included in this study. Patients were classified as affected by BRONJ according to American Association of Oral and Maxillofacial Surgeons (AAOMS) guidelines .

Table 1

Non-oncological patients affected by BRONJ: clinical features and medical history.

Patient	Smoking	Age, years	Disease	Max/Mand	Trigger event	Mobile prosthesis	Stage	BP	Duration BPT months	BPT discontinuation	Co-morbidities	BRONJ therapy	Stage	Follow up (months)
ALF	–	68	OP	Mand	–	Yes	III	Ale	51	+	RA–Diabetes–Hypertension	–	–	–
BG	–	62	OP	Mand	Extr	No	II	Ale + Clo	84	–	–	G4	0	25
CF	–	65	OP	Mand	–	Yes	II	Ale	60	+	RA–Hypertension	G2	I	29
CLE	–	77	OP	Mand	–	No	I	Clo	60	+	–	G3	0	20
CM	+	65	OP	Mand	Extr	No	II	Ale + Iba	72	+	Hypertension–Breast cancer*	G2	I	6
CB	–	63	OP	Mand	Extr	Yes	II	Ner	36	–	Hyperthyroidism	G1	II	8
CI	–	79	OP	Mand	–	Yes	II	Ale	48	–	RA	G2	I	26
DK	–	52	OP	Max	Surg	No	I	Ale	24	–	–	G3	0	8
FA	–	77	OP	Max	–	Yes	I	Clo	96	–	Hypertension	G4	0	6
FP	–	70	OP	Mand	Extr	Yes	II	Ale + Clo	36	–	Hypertension–Parkinson’s disease	G2	0	24
GL	–	57	OP	Mand	Extr	No	II	Ale	>36	–	RA–Hypertension–Diabetes–Hypercholesterolemia	G1	I	9
LA	–	63	OP	Mand	Impl	No	II	Ale	36	–	Hypertension	G1	0	7
MC	+	74	OP	Max	Extr–Impl	Yes	II	Ale + Iba	42	+	–	G4	0	6
MA	–	61	OP	Max	Extr	No	II	Ale	12	–	–	G2	0	36
MBA	–	85	OP	Mand	–	Yes	II	Ale	96	–	RA–Heart disease	G4	0	7
MP	–	65	OP	Max	Extr	No	II	Ale	48	+	Hypertension	G4	0	7
PI	–	75	OP	Max	Extr	Yes	II	Ale + Ris	>180	–	–	G3	0	7
PE	–	87	OP	Mand	–	No	III	Ale	>84	–	Hypertension–Breast cancer*	G1	III	10
PI	Past	48	OP	Max	Extr	No	II	Zol	3	+	Diabetes	G1	0	7
PC	–	60	OP	Mand	Extr	No	I	Zol + Ale + Clo	30	+	Crohn’s disease	–	–	–
SI	–	78	OP	Mand	Extr	Yes	II	Ale	84	–	Diabetes–Hypertension–Parkinson’s disease	G4	0	28
SBI	+	61	OP	Mand	Impl	No	II	Ale	48	–	COPD	G2	0	24
TC	–	89	OP	Max	Extr	Yes	II	Iba	48	–	Gastritis	–	–	–
TS	–	57	OP	Mand	Extr	Yes	II	Ale + Ris	24	+	Kidney transplant	G3	0	20
USE	–	68	OP	Max	Extr	No	II	Ale + Iba	60	–	Breast cancer*	G2	0	12

Only gold members can continue reading. Log In or Register to continue

Share this:

• Click to share on Twitter (Opens in new window)
• Click to share on Facebook (Opens in new window)

Related

Related posts:

1. Prevalence of human cytomegalovirus and Epstein-Barr virus in subgingival plaque at peri-implantitis, mucositis and healthy sites. A pilot study
2. Soft tissue cephalometric norms for a North Indian population group using Legan and Burstone analysis
3. Closure of palatal fistula with buccal fat pad flap
4. Bisphosphonate-related osteonecrosis of the maxilla and sinusitis maxillaris
5. Evaluation of in vitroresistance of titanium and resorbable (poly- l- dl-lactic acid) fixation systems on the mandibular angle fracture
6. Cyclooxygenase-2 activity is important in craniofacial fracture repair

Stay updated, free dental videos. Join our Telegram channel

Join