A follow-up survey of 30 cases of bisphosphonate-related osteomyelitis/osteonecrosis of the jaws: present status after 2 years Expanded Committee of Survey and Planning, Japanese Society of Oral & Maxillofacial Surgeons

Jpn J Oral Maxillofac Surg 2009: 55: 553–561 Bisphosphonates (BPs) were first reported to inhibit bone desorption by Fleisch et al. in1969. BPs are frequently used to treat bone metastatic carcinoma, hypercalcaemia, multiple myeloma, and osteoporosis. However, many cases of BP-related osteonecrosis of the jaws (BRONJ) were reported in the United States since 2003, and similar cases have also been documented in Japan since 2006. The results of the first nationwide survey of BRONJ in Japan were reported in 2007. The present report was a follow-up survey of a previous study in 2007 and described an updated status of the patients after 2 years. Twenty-eight patients were studied because 2 dropped out. This group consisted of 17 patients having had intravenous BPs and 9 patients having had oral BPs. Since the lesions were from additional patients attained complete control during this follow-up survey, this results in 60.8% (a total of 17 patients) achieved totally resolution of their BRONJ. Surgical treatments, such as sequestrectomy, curettage, and resection of the jaw bone, were performed in 15 (88.2%) of the 17 controlled patients and 7 (63.6%) of the 11 uncontrolled patients. Antibiotic therapy was given to 14 (82.4%) of the controlled patients and all of the uncontrolled patients. Drug holidays of BPs were taken in 9 (52.9%) of the controlled patients and 10 (90.9%) of the uncontrolled patients. Surgical treatments appeared to be performed at a higher rate in the controlled patients than in the uncontrolled patients. In contrast, conservative treatments were given to more uncontrolled patients than controlled patients. These results indicate that surgical treatments were useful for BRONJ when given at the appropriate time. In addition, BRONJ was shown to be refractory because only 9 of 17 cases were controlled in these 2 years.

KEN OMURA