Analysis of reasons for osteonecrosis of the jaws
Osteonecroses of the jaws are caused by several reasons. Bisphosphonate-associated osteonecrosis of the jaws (BP-ONJ) is known since 2003 with an increasing incidence in the first years. Along with more knowledge about the pathophysiology, preventive strategies were implemented trying to reduce the incidence. The aim of this retrospective study was to analyze the frequency and overall proportion of BP-ONJ within the field of osteonecrosis. The data was compared to a similar study performed in 2005.
All patients with osteonecrosis or osteomyelitis treated in the period from April 2005 to July 2012 in the Oral and Maxillofacial Surgery at the University of Mainz, Germany, were analyzed.
The reasons for osteonecrosis were bisphosphonates in 45 %, odontogenic or surgically induced osteonecrosis in 32 %, osteoradionecrosis in 17 %, traumas in 1 %, and in 4 % the reason remained unclear. The BP-ONJ became the most important factor for osteonecrosis. Its fraction in the years 2000–2005 was 10 % only.
Although preventive strategies are implemented, the number of new cases got bigger. The implemented prevention strategies did not manage to reduce the overall number of new cases. Furthermore, the launch of other medications with a similar side effect on the jawbone as the BP-ONJ for bisphosphonates might influence the overall distribution of osteonecroses.
KeywordsOsteonecrosis Osteomyelitis Bisphosphonate Bisphosphonate-associated osteonecrosis of the jaws Osteoradionecrosis Prevalence
- 5.Walter C, Al-Nawas B, Grotz KA, Thomas C, Thuroff JW, Zinser V, Gamm H, Beck J, Wagner W (2008) Prevalence and risk factors of bisphosphonate-associated osteonecrosis of the jaw in prostate cancer patients with advanced disease treated with zoledronate. Eur Urol 54(5):1066–1072PubMedCrossRefGoogle Scholar
- 8.Ziebart T, Pabst A, Klein MO, Kammerer P, Gauss L, Brullmann D, Al-Nawas B, Walter C (2011) Bisphosphonates: restrictions for vasculogenesis and angiogenesis: inhibition of cell function of endothelial progenitor cells and mature endothelial cells in vitro. Clin Oral Investig 15(1):105–111. doi:10.1007/s00784-009-0365-2 PubMedCrossRefGoogle Scholar
- 13.Blus C, Szmukler-Moncler S, Giannelli G, Denotti G, Orru G (2013) Use of ultrasonic bone surgery (Piezosurgery) to surgically treat bisphosphonate-related osteonecrosis of the jaws (BRONJ). A case series report with at least 1 year of follow-up. Open Dent J 7:94–101. doi:10.2174/1874210601307010094 PubMedCentralPubMedCrossRefGoogle Scholar
- 14.Assaf AT, Zrnc TA, Riecke B, Wikner J, Zustin J, Friedrich RE, Heiland M, Smeets R, Grobe A (2013) Intraoperative efficiency of fluorescence imaging by Visually Enhanced Lesion Scope (VELscope) in patients with bisphosphonate related osteonecrosis of the jaw (BRONJ). J Craniomaxillofac Surg. doi:10.1016/j.jcms.2013.07.014 Google Scholar
- 15.Grötz KA, Kreusch T (2006) Zahnärztliche Betreuung von Patienten unter/nach Bisphosphonat-Medikation. DZZ 60:10Google Scholar
- 17.Grötz KA, Piesold JU, Al-Nawas B (2012) AWMF Leitlinie Bisphosphonat-assoziierte Kiefernekrose (BP-ONJ) und andere Medikamenten-assoziierte Kiefernekrosen. AWMFGoogle Scholar
- 18.Montefusco V, Gay F, Spina F, Miceli R, Maniezzo M, Teresa Ambrosini M, Farina L, Piva S, Palumbo A, Boccadoro M, Corradini P (2008) Antibiotic prophylaxis before dental procedures may reduce the incidence of osteonecrosis of the jaw in patients with multiple myeloma treated with bisphosphonates. Leuk Lymphoma 49(11):2156–2162PubMedCrossRefGoogle Scholar
- 25.Henry DH, Costa L, Goldwasser F, Hirsh V, Hungria V, Prausova J, Scagliotti GV, Sleeboom H, Spencer A, Vadhan-Raj S, von Moos R, Willenbacher W, Woll PJ, Wang J, Jiang Q, Jun S, Dansey R, Yeh H (2011) Randomized, double-blind study of denosumab versus zoledronic acid in the treatment of bone metastases in patients with advanced cancer (excluding breast and prostate cancer) or multiple myeloma. J Clin Oncol 29(9):1125–1132. doi:10.1200/JCO.2010.31.3304 PubMedCrossRefGoogle Scholar
- 26.Guarneri V, Miles D, Robert N, Dieras V, Glaspy J, Smith I, Thomssen C, Biganzoli L, Taran T, Conte P (2010) Bevacizumab and osteonecrosis of the jaw: incidence and association with bisphosphonate therapy in three large prospective trials in advanced breast cancer. Breast Cancer Res Treat 122(1):181–188PubMedCrossRefGoogle Scholar