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Osteonecrosis of the jaw induced by orally administered bisphosphonates: incidence, clinical features, predisposing factors and treatment outcome

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Abstract

Summary

Osteonecrosis of the jaw (ONJ) is a well-known devastating side effect of bisphosphonate therapy for cancer. Several ONJ cases of patients using oral bisphosphonates have been reported in the literature. The present study analyzed the clinical features, predisposing factors, and treatment outcome of 11 patients with oral bisphosphonates-related ONJ.

Introduction and hypothesis

Osteonecrosis of the jaw (ONJ) is a well-known side effect of parenteral bisphosphonates therapy. Although ONJ has been reported in patients using oral bisphosphonates, documentation of this entity is sparse. It was hypothesized that the clinical features, predisposing factors, and treatment outcome of this population are different from those of oncologic patients.

Methods

This retrospective bi-central study involved 98 ONJ patients, 13 of whom were treated with oral bisphosphonates. Two patients were excluded because of previous use of intravenous bisphosphonates. The profiles of 11 patients were analyzed.

Results

The mean duration of alendronate use before developing ONJ was 4.1 years. ONJ was triggered by dental surgery in 9 patients and by ill-fitted dentures in 2. Heavy smokers were the most recalcitrant subjects. Among the nine patients with at least 6 months of follow-up, ONJ healed completely in three, partially in four, and not at all in two.

Conclusions

ONJ is a rare devastating side effect of oral bisphosphonates associated with patient morbidity and high financial burden. Clinicians must be aware of this entity and inform patients of the risks of dental surgery. The synergistic effect of smoking in the pathogenesis of ONJ should be further investigated.

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Acknowledgement

The authors would like to thank Ms. Rita Lazar and Ms. Esther Eshkol for editorial assistance.

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Authors and Affiliations

  1. Department of Oral Pathology and Oral Medicine, The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, P.O. Box 39040, Tel Aviv, 69978, Israel

    N. Yarom

  2. Department of Oral and Maxillofacial Surgery, “Sheba” Medical Center, Tel-Hashomer, Israel

    N. Yarom, R. Yahalom & Y. Shoshani

  3. Department of Oral Medicine, Hebrew University-Hadassah School of Dental Medicine, Jerusalem, Israel

    W. Hamed & S. Elad

  4. Department of Oral and Maxillofacial Surgery, Hebrew University-Hadassah School of Dental Medicine, Jerusalem, Israel

    E. Regev

Authors
  1. N. Yarom
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  2. R. Yahalom
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  3. Y. Shoshani
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  4. W. Hamed
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  5. E. Regev
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  6. S. Elad
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Correspondence to N. Yarom.

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Yarom, N., Yahalom, R., Shoshani, Y. et al. Osteonecrosis of the jaw induced by orally administered bisphosphonates: incidence, clinical features, predisposing factors and treatment outcome. Osteoporos Int 18, 1363–1370 (2007). https://doi.org/10.1007/s00198-007-0384-2

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  • DOI: https://doi.org/10.1007/s00198-007-0384-2

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