Jaw osteonecrosis in patients receiving bisphosphonate therapy: results from a single institution

ABSTRACT

A growing number of reported cases of jaw osteonecrosis in patients receiving bisphosphonate have been published in the last several years. The clinical features of this condition include pain, paresthesia, bone exposure and fistula. Risk factors have been recognized and classified as local and/or systemic. Objective: The aim of this study was to demonstrate the clinical data of the patients with osteonecrosis assisted at a single institution. Patients and Methods: A total of 42 patients presenting 49 areas of jaw osteonecrosis were evaluated. Medical records were analyzed in order to collect information on underlying disease, bisphosphonate information, clinical features related to bisphosphonate-induced osteonecrosis of the jaw, as well as precipitating events related to its occurrence. Results: Most patients were female (71%) and the mean age was 64.7 years old. Breast cancer was the most frequent underlying disease (40.5%) followed by multiple myeloma, prostate cancer, lung and osteoporosis. In addition, the average use of bisphosphonate was 36.8 months and most patients had received zoledronic acid. The posterior region of the mandible was the main affected site. Among the possible triggering factors, exodontias was associated with 73.8% of the cases. The treatment modalities consisted of surgical, local irrigation with clorexidin and antibiotics and a majority of cases presented complete or partial remission. Conclusion: Most cases of jaw osteonecrosis were related to tooth extraction and surgical interventions showed a good control of the osteonecrosis cases.