Osteonecrosis of the jaws and bisphosphonates. Report of fifteen cases. Therapeutic recommendations.

Recently there have been reports of osteonecrosis of the jaw (ONJ) in patients with chronic therapy with bisphosphonates (Bps). So far three drugs have been linked: Pamidronate of disodium, Zoledronic acid and Alendronate of sodium. It is due to a non detected side effect in clinical trials before commercialization, and reverberates significantly in the quality of life of these patients. Most of the cases are seen in oncology patients that have received long term concurrent antineoplasic therapy and were treated sporadically with steroids, together with Bps endovenous, for treatment of cancer and its symptoms. Among these cases we find the reported by R.E. Marx (1), S.L. Ruggiero (2) and J. V. Bagán (3). In this report fifteen cases diagnosed, treated and followed up at the author's surgery department are presented and some suggestions are given in order to reduce the incidence in patients with cancer who are going to receive Bps, as well as in patients with established ONJ being treated with these drugs who may need a surgical intervention.

Osteonecrosis of the jaws and bisphosphonates. Report of fifteen cases. Therapeutic recommendations

Recientemente se han descrito casos de osteonecrosis mandibular y maxilar (ONM) en pacientes sometidos a tratamiento crónico con bisfosfonatos (BF). Hasta el momento tres han sido los fármacos implicados: Pamidronato de disodio, Ácido Zoledrónico y Alendronato de sodio. Se trata de un efecto secundario muy poco frecuente, no detectado en ensayos clínicos precomercialización, que repercute de forma significativa en la calidad de vida de estos pacientes.La mayoría de los casos se dan en pacientes oncológicos que reciben tratamiento antineoplásico concomitante a largo plazo y muchos de ellos estaban sometidos a tratamiento intermitente con esteroides a corto plazo, junto a los bisfosfonatos vía endovenosa, para el tratamiento del cáncer y de los síntomas. Entre estos casos se encuentran los publicados por R.E. Marx (1), S.L. Ruggiero (2) y J. V. Bagán (3).Este artículo presenta quince casos clínicos diagnosticados, tratados y seguidos por nuestro servicio y da una serie de recomendaciones para reducir su incidencia en pacientes con cáncer que van a recibir BF, así como en pacientes con ONM establecida en tratamiento con dichos fármacos y que puedan necesitar un tratamiento quirúrgico

Recently there have been reports of osteonecrosis of the jaw (ONJ) in patients with chronic therapy with bisphosphonates (Bps). So far three drugs have been linked: Pamidronate of disodium, Zoledronic acid and Alendronate of sodium. It is due to a non detected side effect in clinical trials before commercialization, and reverberates significantly in the quality of life of these patients.Most of the cases are seen in oncology patients that have received long term concurrent antineoplasic therapy and were treated sporadically with steroids, together with Bps endovenous, for treatment of cancer and its symptoms. Among these cases we find the reported by R.E. Marx (1), S.L. Ruggiero (2) and J. V. Bagán (3).In this report fifteen cases diagnosed, treated and followed up at the author´s surgery department are presented and some suggestions are given in order to reduce the incidence in patients with cancer who are going to receive Bps, as well as in patients with established ONJ being treated with these drugs who may need a surgical intervention