Osteonecrosis of the jaw (ONJ) in cancer patients treated with Bisphosphonates: how the knowledge of a phenomenon can change its evolution
Purchase on Springer.com
$39.95 / €34.95 / £29.95*
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.
Goals of the work
Osteonecrosis of the jaw (ONJ) is a severe complication of bisphosphonates treatment. Bisphosphonates reduce skeletal adverse events and give a clinical benefit to cancer patients. Therefore, it is necessary to identify appropriate procedures to reduce ONJ injures by using a successful monitoring program. In a retrospective study we analyzed the impact of a prevention program based on clinical oral cavity examination, dentists, and patients’ education. The aim of the study was to evaluate if this approach might improve ONJ outcome in patients receiving pamidronate or zoledronate.
Materials and methods
We analyzed retrospectively two different groups of patients treated at our Institution: patients treated from October 2003 to June 2005 (group A) and patients treated from June 2005 to April 2007 (group B). In June 2005 the prevention program started for all our patients.
One hundred and eighty-six cancer patients with bone involvement, treated with bisphosphonates, were considered. Sixteen of them developed ONJ: eight before and eight after June 2005. We observed a consistent difference in the evolution of the two groups. In the first group, four patients underwent a major surgery (one partial maxillectomy, complicated by septic shock and oronasal communication; two partial mandibulectomies; and one segmental mandibular resection), with an important impairment of their quality of life; while the eight new ONJ cases, diagnosed after June 2005, were successfully treated without aggressive dental interventions, and achieved a good control of symptoms.
Bisphosphonates-related ONJ is a frequent adverse event (8.6%). The monitoring program proved very efficient to improve the clinical outcome of ONJ, avoiding an aggressive treatment and using a conservative approach and medical therapy.
- Badros A, Weikel D, Salama A, Goloubeva O, Schneider A, Rapoport A et al (2006) Osteonecrosis of the jaw in multiple myeloma patients: clinical features and risk factors. J Clin Oncol 24(6):945–952 doi:10.1200/JCO.2005.04.2465 CrossRef
- Bamias A, Kastritis E, Bamia C, Moulopoulos LA, Melakopoulos I, Bozas G et al (2005) Osteonecrosis of the jaw in cancer after treatment with bisphosphonates: incidence and risk factors. J Clin Oncol 23:8580–8587 doi:10.1200/JCO.2005.02.8670 CrossRef
- Coleman RE (2001) Metastatic bone disease: clinical features, pathophysiology and treatment strategies. Cancer Treat Rev 27(3):165–176 doi:10.1053/ctrv.2000.0210 CrossRef
- Durie B, Katz M, Crowley J (2005) Osteonecrosis of the jaw and bisphosphonates. N Engl J Med 351:99–102 doi:10.1056/NEJM200507073530120 CrossRef
- Farrugia MC, Summerlin DJ, Krowiak E, Huntley T, Freeman S, Borrowdale R et al (2006) Osteonecrosis of the mandible or maxilla associated with the use of new generation bisphosphonates. Laryngoscope 116(1):115–120 doi:10.1097/01.mlg.0000187398.51857.3c CrossRef
- Hellstein JW, Marek CL (2005) Bisphosphonate osteochemonecrosis (bis-phossy jaw): is this phossy jaw of the 21st century? J Oral Maxillofac Surg 63(5):682–689 doi:10.1016/j.joms.2005.01.010 CrossRef
- Iguchi T, Miyakawa Y, Saito K, Nakabayashi C, Nakanishi M, Saya H et al (2007) Zoledronate-induced S phase arrest and apoptosis accompanied by DNA damage and activation of the ATM/Chk1/cdc25 pathway in human osteosarcoma cells. Int J Oncol 31(2):285–291
- Marx RE (2003) Related pamidronate and zoledronate induced avascular necrosis of the jaws: a growing epidemic. J Oral Maxillofac Surg 61:1115–1117 doi:10.1016/S0278-2391(03)00720-1 CrossRef
- Migliorati CA, Schubert MM, Peterson DE, Seneda LM (2005) Bisphosphonate-associated osteonecrosis of mandibular and maxillary bone: an emerging oral complication of supportive cancer therapy. Cancer 104(1):83–93 doi:10.1002/cncr.21130 CrossRef
- Rogers MJ (2003) New insights into the molecular mechanisms of action of bisphosphonates. Curr Pharm Des 9(32):2643–2658, Review doi:10.2174/1381612033453640 CrossRef
- Ruggiero SL, Mehrotra B, Rosenberg TJ, Engroff SL (2004) Osteonecrosis of the jaws associated with the use of bisphosphonates: a review of 63 cases. J Oral Maxillofac Surg 62:527–534 doi:10.1016/j.joms.2004.02.004 CrossRef
- Strampel W, Emkey R, Civitelli R (2007) Safety considerations with bisphosphonates for the treatment of osteoporosis. Drug Safety 30(9):755–763 doi:10.2165/00002018-200730090-00003 CrossRef
- Takeyama S, Shinoda H (2003) Pharmacological actions and pharmacokinetics of bisphosphonates. Clin Calcium 13:115–121
- Weitzman R, Sauter N, Eriksen EF, Tarassoff PG, Lacerna LV, Dias R et al (2007) Critical review: updated recommendations for the prevention, diagnosis, and treatment of osteonecrosis of the jaw in cancer patients-May 2006. Crit Rev Oncol Hematol 62(2):148–152 doi:10.1016/j.critrevonc.2006.12.005 CrossRef
- Woo SK, Hellstein JW, Kalmar JR (2006) Systematic review: bisphosphonates and osteonecrosis of the jaws. Ann Intern Med 144:753–761
- Osteonecrosis of the jaw (ONJ) in cancer patients treated with Bisphosphonates: how the knowledge of a phenomenon can change its evolution
Supportive Care in Cancer
Volume 16, Issue 11 , pp 1311-1315
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- Bone metastases
- Industry Sectors
- Author Affiliations
- 1. Oncology Department, Azienda Ospedaliera–Ospedale Fatebenefratelli e Oftalmico, Corso di Porta Nuova, 23, 20121, Milan, Italy