Journal of Bone and Mineral Metabolism

, Volume 33, Issue 1, pp 119–124 | Cite as

Prospective, mono-institutional study of the impact of a systematic prevention program on incidence and outcome of osteonecrosis of the jaw in patients treated with bisphosphonates for bone metastases

  • Annalisa Bramati
  • Serena Girelli
  • Gabriella Farina
  • Maria Chiara Dazzani
  • Valter Torri
  • Anna Moretti
  • Sheila Piva
  • Mariastella Dimaiuta
  • Nicla La Verde
Original Article


The aim of our study was to investigate the occurrence of osteonecrosis of the jaw (ONJ) after implementation of dental preventive measures before starting bisphosphonates (BPs) therapy and during treatment. All consecutive patients with bone lesions eligible for BPs treatment were prospectively evaluated. Before starting BPs, each patient underwent a strict dental preventive program with a specialized odontoiatric team. The odontoiatric evaluation identified patients with oral pathologies or inadequate oral hygiene and provided a dental preventive treatment. From April 2007 to April 2012, 254 patients were enrolled. After excluding patients due to previous BPs treatment, 212 patients with a mean age of 74 years (range 37–95) were included. On average, patients received 9.7 treatment cycles (range 1–48). No ONJ was recorded (0.0 %; 95 % confidence interval [CI] 0.0–1.4). Comparing this risk with that observed in a previous cohort who did not receive dental prevention (16/186, 8.6 %; 95 % CI 4.2–15.3 %), we observed clear efficacy in preventing ONJ (relative risk reduction: 100 %, 95 % CI 86–100 %, P < 0.0001). We developed a strict three-step prevention program that is able to decrease ONJ incidence and the need for destructive surgery with permanent sequelae. We demonstrated that ONJ could be effectively prevented. We recommend a mandatory preventive program involving a multidisciplinary team for all patients starting BPs.


Bisphosphonates Bone metastases Oral preventive program Osteonecrosis of the jaw (ONJ) 



This research was not funded by any sponsor.

Conflict of interest

All authors have no conflicts of interest.


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Copyright information

© The Japanese Society for Bone and Mineral Research and Springer Japan 2014

Authors and Affiliations

  • Annalisa Bramati
    • 1
  • Serena Girelli
    • 1
  • Gabriella Farina
    • 1
  • Maria Chiara Dazzani
    • 1
  • Valter Torri
    • 2
  • Anna Moretti
    • 1
  • Sheila Piva
    • 1
  • Mariastella Dimaiuta
    • 1
  • Nicla La Verde
    • 1
  1. 1.Department of OncologyA.O. Fatebenefratelli e OftalmicoMilanItaly
  2. 2.Laboratory of Methodology for Biomedical ResearchIRCCS-Istituto di Ricerche Farmacologiche “Mario Negri”MilanItaly

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