ABSTRACT
BACKGROUND: Bisphosphonates (BP) decrease the incidence of skeletal related events among cancer patients with bone metastases from solid tumors and multiple myeloma. Renal safety and osteonecrosis of the jaws (ONJ) are two major concerns of toxicity. Information about safety of using BP beyond 2 years is scarce. MATERIALS AND METHODS: Patients receiving zoledronic acid (ZA) at the time of the study were reviewed. Serum creatinine levels (SCL) were collected at three different moments: before the start of BP (baseline), at the time of analysis (final), and the highest SCL during the treatment (highest). Oral examination was carried out in every patient. Separated analysis was made for patients on BP for >2 years. Concomitant risk factors for both renal toxicity and ONJ were evaluated. RESULTS: Sixty-seven patients were included. Median time of BP was 22 months, with 22 patients receiving BP for >2 years. Median baseline and final values of SCL were 0.71 mg/dl and 0.70 mg/dl, respectively (P = 0.121). Median highest SCL during treatment was 0.82 mg/dl (P <0.0001). A notable increase in the SCL was observed in six of the 67 patients (9%), four of them receiving BP for >2 years (P = 0.085). ONJ was also diagnosed in six patients, four of them in the group of prolonged BP treatment. CONCLUSION: ZA showed to be safe with a low rate of reversible renal toxicity. Patients receiving BP should be monitored carefully for renal toxicity and ONJ, especially those with exposure to BP beyond 2 years.
Subject(s)
Antineoplastic Agents/adverse effects , Bone Density Conservation Agents/adverse effects , Bone Neoplasms/drug therapy , Diphosphonates/adverse effects , Imidazoles/adverse effects , Jaw Diseases/chemically induced , Kidney Diseases/chemically induced , Osteonecrosis/chemically induced , Adult , Aged , Aged, 80 and over , Bone Neoplasms/secondary , Creatinine/blood , Drug Monitoring , Female , Follow-Up Studies , Humans , Jaw Diseases/pathology , Kidney Diseases/blood , Male , Middle Aged , Osteonecrosis/pathology , Retrospective Studies , Risk Assessment , Risk Factors , Time Factors , Treatment Outcome , Zoledronic AcidABSTRACT
Osteonecrosis of the jaws (ONJ) is a recognized complication of bisphosphonates (BP) therapy in cancer patients with bone metastasis. We report 2 additional cases of ONJ in women with breast cancer after long-term exposure to BP, discussing some considerations about the presentation and management of this rare and new complication.
Subject(s)
Bone Density Conservation Agents/adverse effects , Bone Neoplasms/secondary , Diphosphonates/adverse effects , Imidazoles/adverse effects , Jaw Diseases/chemically induced , Osteonecrosis/chemically induced , Aged , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Bone Neoplasms/drug therapy , Breast Neoplasms/pathology , Breast Neoplasms/therapy , Combined Modality Therapy , Female , Humans , Mastectomy , Middle Aged , Radiotherapy , Zoledronic AcidABSTRACT
Osteonecrosis of the jaws (ONJ) is a recognized complication of bisphosphonates (BP) therapy in cancer patients with bone metastasis. We report 2 additional cases of ONJ in women with breast cancer after long-term exposure to BP, discussing some considerations about the presentation and management of this rare and new complication (AU)
