Skip to main content

Advertisement

SpringerLink
Log in

Incidence of bisphosphonate-related osteonecrosis of the jaws (BRONJ) in patients taking bisphosphonates for osteoporosis treatment—a grossly underestimated risk?

  • Original Article
  • Published:
Clinical Oral Investigations Aims and scope Submit manuscript

Abstract

Purpose

The aim of this study was to detect the incidence of bisphosphonate-related osteonecrosis of the jaws (BRONJ) in association with osteoporosis in 2009 in the rural district of Marburg-Biedenkopf, Germany. In addition, the therapeutic regimen of dentists in this area was compared to the treatment guidelines of established international associations.

Methodology

A postal survey including 129 dental offices within the named investigation area was conducted. Additionally, the dentists were asked to contribute to this study during a course of retraining. Ultimately, 107 colleagues participated in this study.

Results

A total of 37 BRONJ cases were revealed, 37.4 % of those were linked to malignant diseases, 62.6 % to osteoporosis. Noticeably, 30.1 % of the BRONJ cases linked to osteoporosis were connected with intravenous application. In total, 62.6 % of all cases were associated with intravenous and 37.4 % with oral application. Considering the estimated number of 1.014 patients using bisphosphonates for osteoporosis treatment in Marburg-Biedenkopf in 2009, the specific incidence of BRONJ could be narrowed down to about 2.27 %. In proportion to the increasing risk potential of the three patient groups, participants conducted fewer surgical interventions themselves but tended to refer patients to colleagues.

Conclusion

This study reveals the incidence of BRONJ in association with osteoporosis as being grossly underrated so far, especially in connection with intravenous bisphosphonate treatment. The therapeutic regimen of the dentists who participated correlated with the established guidelines.

Clinical relevance

The interface between dentistry and medicine may profit from our study’s results which will help to improve interdisciplinary communication. With regard to this, we wish to contribute to an informative discussion since a main focus was to ensure colleagues in their decision making, especially in case of complications after elective dentoalveolar surgery—like implantations. Besides medical there are also economic and political aspects, i.e. the financial responsibility in case of unexpected or inevitable complications, possibly leading to BRONJ, that may become part of future discussions based on this study.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Marx RE (2003) Pamidronate (Aredia) and zoledronate (Zometa) induced avascular necrosis of the jaws: a growing epidemic. J Oral Maxillofac Surg 61(9):1115–1117

    Article  PubMed  Google Scholar 

  2. Schwabe U, Ziegler R (2011) Osteoporosemittel. In: Arzneimittelverordnungsreport 2010. Springer, Berlin, pp 739–752

    Google Scholar 

  3. Durie BG, Katz M, Crowley J (2005) Osteonecrosis of the jaw and bisphosphonates. N Engl J Med 353(1):99–102

    Article  PubMed  Google Scholar 

  4. Dimopoulos MA et al (2006) Osteonecrosis of the jaw in patients with multiple myeloma treated with bisphosphonates: evidence of increased risk after treatment with zoledronic acid. Haematologica 91(7):968–971

    PubMed  Google Scholar 

  5. Bamias A et al (2005) Osteonecrosis of the jaw in cancer after treatment with bisphosphonates: incidence and risk factors. J Clin Oncol 23(34):8580–8587

    Article  PubMed  Google Scholar 

  6. Assael LA (2009) Oral bisphosphonates as a cause of bisphosphonate-related osteonecrosis of the jaws: clinical findings, assessment of risks, and preventive strategies. J Oral Maxillofac Surg 67(5 Suppl):35–43

    Article  PubMed  Google Scholar 

  7. Felsenberg D (2006) Osteonecrosis of the jaw—a potential adverse effect of bisphosphonate treatment. Nat Clin Pract Endocrinol Metab 2(12):662–663

    Article  PubMed  Google Scholar 

  8. Mavrokokki T et al (2007) Nature and frequency of bisphosphonate-associated osteonecrosis of the jaws in Australia. J Oral Maxillofac Surg 65(3):415–423

    Article  PubMed  Google Scholar 

  9. Migliorati CA (2008) Intravenous bisphosphonate therapy may lead to osteonecrosis of the jaw in multiple myeloma, breast, and prostate cancer patients. J Evid Based Dent Pract 8(2):93–94

    Article  PubMed  Google Scholar 

  10. Marx R (2007) Oral & intravenous bisphosphonate-induced osteonecrosis of the jaws (history, prevention, and treatment). Quintessence Publishing Co, Inc., Hanover Park

    Google Scholar 

  11. Bock O, Felsenberg D (2008) Bisphosphonates in the management of postmenopausal osteoporosis—optimizing efficacy in clinical practice. Clin Interv Aging 3(2):279–297

    PubMed  Google Scholar 

  12. Sewerynek E, Stuss M (2011) The role of i.v. ibandronate administration in osteoporosis therapy. Endokrynol Pol 62(1):51–60

    PubMed  Google Scholar 

  13. Sedghizadeh PP et al (2009) Oral bisphosphonate use and the prevalence of osteonecrosis of the jaw: an institutional inquiry. J Am Dent Assoc 140(1):61–66

    PubMed  Google Scholar 

  14. Grbic JT et al (2008) Incidence of osteonecrosis of the jaw in women with postmenopausal osteoporosis in the health outcomes and reduced incidence with zoledronic acid once yearly pivotal fracture trial. J Am Dent Assoc 139(1):32–40

    PubMed  Google Scholar 

  15. US Food and Drug Administration 2011. http://www.accessdata.fda.gov/scripts/cder/drugsatfda/index.cfm?fuseaction=Search.Overview&DrugName=BONIVA. Accessed 3 Sept 2012.

  16. Rustemeyer J, Bremerich A (2010) Bisphosphonate-associated osteonecrosis of the jaw: what do we currently know? A survey of knowledge given in the recent literature. Clin Oral Investig 14(1):59–64

    Article  PubMed  Google Scholar 

  17. Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF) (2012) Bisphosphonat-assoziierte Kiefernekrosen. http://www.awmf.org/uploads/tx_szleitlinien/007-091l_S3_Bisphosphonat-assoziierte_Kiefernekrose_2012-04.pdf. Accessed 3 Sept 2012.

  18. Ruggiero SL et al (2009) American Association of Oral and Maxillofacial Surgeons position paper on bisphosphonate-related osteonecrosis of the jaws—2009 update. J Oral Maxillofac Surg 67(5 Suppl):2–12

    PubMed  Google Scholar 

  19. Stockmann P et al (2010) Panoramic radiograph, computed tomography or magnetic resonance imaging. Which imaging technique should be preferred in bisphosphonate-associated osteonecrosis of the jaw? A prospective clinical study. Clin Oral Investig 14(3):311–317

    Article  PubMed  Google Scholar 

  20. Hoff AO et al (2008) Frequency and risk factors associated with osteonecrosis of the jaw in cancer patients treated with intravenous bisphosphonates. J Bone Miner Res 23(6):826–836

    Article  PubMed  Google Scholar 

  21. Lemound J et al (2012) Bisphosphonate-associated osteonecrosis of the mandible: reliable soft tissue reconstruction using a local myofascial flap. Clin Oral Investig 16(4):1143–1152

    Article  PubMed  Google Scholar 

  22. Vescovi P et al (2010) Surgical approach with Er:YAG laser on osteonecrosis of the jaws (ONJ) in patients under bisphosphonate therapy (BPT). Lasers Med Sci 25(1):101–113

    Article  PubMed  Google Scholar 

  23. Pautke C et al (2011) Fluorescence-guided bone resection in bisphosphonate-related osteonecrosis of the jaws: first clinical results of a prospective pilot study. J Oral Maxillofac Surg 69(1):84–91

    Article  PubMed  Google Scholar 

  24. Gesundheisberichterstattung des Bundes (2009) Prävalenz von Osteoporose. http://www.gbe-bund.de/gbe10/owards.prc_show_pdf?p_id=13742&p_sprache=d&p_uid=&p_aid=&p_lfd_nr=1. Accessed 3 Sept 2012

  25. Hessisches Landesamt für Statistik (2009) Bevölkerung Hessens nach Altersgruppen und Geschlecht. http://www.statistik-hessen.de/themenauswahl/bevoelkerung-gebiet/landesdaten/bevoelkerung-allgemein/bevoelkerung-nach-altersgruppen-und-geschlecht/index.html. Accessed 3 Sept 2012

  26. Haussler B et al (2007) Epidemiology, treatment and costs of osteoporosis in Germany—the BoneEVA Study. Osteoporos Int 18(1):77–84

    Article  PubMed  Google Scholar 

  27. Filleul O, Crompot E, Saussez S (2010) Bisphosphonate-induced osteonecrosis of the jaw: a review of 2,400 patient cases. J Cancer Res Clin Oncol 136(8):1117–1124

    Article  PubMed  Google Scholar 

  28. Otto S et al (2011) Osteoporosis and bisphosphonates-related osteonecrosis of the jaw: not just a sporadic coincidence—a multi-centre study. J Craniomaxillofac Surg 39(4):272–277

    Article  PubMed  Google Scholar 

  29. Marx RE et al (2005) Bisphosphonate-induced exposed bone (osteonecrosis/osteopetrosis) of the jaws: risk factors, recognition, prevention, and treatment. J Oral Maxillofac Surg 63(11):1567–1575

    Article  PubMed  Google Scholar 

  30. Hoff AO et al (2011) Epidemiology and risk factors for osteonecrosis of the jaw in cancer patients. Ann N Y Acad Sci 1218:47–54

    Article  PubMed  Google Scholar 

  31. Ferlito S, Liardo C, Puzzo S (2010) Dental extractions in patient treated with intravenous bisphosphonates and risk of osteonecrosis of jaws: presentation of a preventive protocol and case series. Minerva Stomatol 59(11–12):593–601

    PubMed  Google Scholar 

  32. Ferlito S, Liardo C, Puzzo S (2011) Bisphosponates and dental implants: a case report and a brief review of literature. Minerva Stomatol 60(1–2):75–81

    PubMed  Google Scholar 

  33. Madrid C, Sanz M (2009) What impact do systemically administrated bisphosphonates have on oral implant therapy? A systematic review. Clin Oral Implants Res 20(Suppl 4):87–95

    Article  PubMed  Google Scholar 

  34. Mellado-Valero A et al (2010) Implant treatment in patients with osteoporosis. Med Oral Patol Oral Cir Bucal 15(1):e52–e57

    PubMed  Google Scholar 

  35. Favia G et al (2011) Osteonecrosis of the posterior mandible after implant insertion: a clinical and histological case report. Clin Implant Dent Relat Res 13(1):58–63

    Article  PubMed  Google Scholar 

  36. Shin EY et al (2010) Implant failure associated with oral bisphosphonate-related osteonecrosis of the jaw. J Periodontal Implant Sci 40(2):90–95

    Article  PubMed  Google Scholar 

  37. Groetz K et al (2010) Bei welchen Bisphosphonat-Patienten darf ich eigentlich implantieren? Ein systematisches Review. Z Zahnärztl Impl 26(2):153–161

    Google Scholar 

  38. Jadu F et al (2007) A retrospective study assessing the incidence, risk factors and comorbidities of pamidronate-related necrosis of the jaws in multiple myeloma patients. Ann Oncol 18(12):2015–2019

    Article  PubMed  Google Scholar 

  39. Borromeo GL et al (2011) A review of the clinical implications of bisphosphonates in dentistry. Aust Dent J 56(1):2–9

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

The authors declare no conflict of interest

Author information

Authors and Affiliations

  1. Department of Oral and Maxillofacial Surgery, Philipps-University Marburg, Baldingerstraße, D-35033, Marburg, Germany

    Peter Johannes Hansen, Michael Knitschke, Florian Guy Draenert & Andreas Neff

  2. Institute for Medical Biometry and Epidemiology, Philipps-University Marburg, Bunsenstr. 3, D-35037, Marburg, Germany

    Sebastian Irle

Authors
  1. Peter Johannes Hansen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Michael Knitschke
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Florian Guy Draenert
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sebastian Irle
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Andreas Neff
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Peter Johannes Hansen.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hansen, P.J., Knitschke, M., Draenert, F.G. et al. Incidence of bisphosphonate-related osteonecrosis of the jaws (BRONJ) in patients taking bisphosphonates for osteoporosis treatment—a grossly underestimated risk?. Clin Oral Invest 17, 1829–1837 (2013). https://doi.org/10.1007/s00784-012-0873-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00784-012-0873-3

Keywords

Search

Navigation