Dental disease and myeloma associated bisphosphonate-associated osteonecrosis

Bisphosphonate (BP)-associated osteonecrosis of the jaw (ONJ) is mostly reported in patients receiving intravenous zoledronic acid and pamidronate. The purpose of this study was to develop a cohort of Multiple Myeloma (MM) patients and assess whether demographics, preexisting dental conditions and/or poor overall dental health are associated with ONJ incidence during cancer therapy. We collected a cohort of 230 pre-stem cell transplant MM patients, including 93 females and 137 males. Most were Caucasian (63%) or African American (35%) and 71.3% were using BPs; including 57% taking zometa, 20% taking pamidronate and 6% having taken both. Thirty three patients developed ONJ (14.3%) while under study. All assessments were made using logistic regression. There was a significant correlation between developing ONJ and having used pamidronate or both BPs. Further, a significant correlation was found among those with oral intra-bony myeloma lesions, those who had a dental procedure performed and in those with moderate to severe periodontal disease or in those with moderate to severe activity in their periodontal disease ( p < 0.05). No other disease category or demographic showed significance. Additionally, we present outcome data from this study with follow-up out to three years, looking at the time of dental exam to current MM status (relapse), other co-morbidities or death. We conclude that there are several factors that may increase a patients’ chance to develop ONJ. Namely, the administration of pamidronate alone or with zoledronic acid, presence of oral lesions, periodontal severity and activity, and dental procedures; all significantly increase probability to develop ONJ.

Conflict of interest: None declared.

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Jan 27, 2018 | Posted by in Oral and Maxillofacial Surgery | Comments Off on Dental disease and myeloma associated bisphosphonate-associated osteonecrosis
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