Author: Woo SB, Hellstein JW, Kalmar JR.
Source: Annals of Internal Medicine.
Year: 2006
Comment:
The authors conclude, "Osteonecrosis of the jaws is a newly recognized condition reported in patients treated with bisphosphonates, in particular potent aminobisphosphonates. Most cases have developed in patients with multiple myeloma or metastatic cancer, but the condition has also been identified in patients with osteoporosis."
Abstract / Excerpt:
“Osteonecrosis of the jaws is a recently described adverse side effect of bisphosphonate therapy. Patients with multiple myeloma and metastatic carcinoma to the skeleton who are receiving intravenous, nitrogen-containing bisphosphonates are at greatest risk for osteonecrosis of the jaws; these patients represent 94% of published cases. The mandible is more commonly affected than the maxilla (2:1 ratio), and 60% of cases are preceded by a dental surgical procedure. Oversuppression of bone turnover is probably the primary mechanism for the development of this condition, although there may be contributing comorbid factors. All sites of potential jaw infection should be eliminated before bisphosphonate therapy is initiated in these patients to reduce the necessity of subsequent dentoalveolar surgery. Conservative de´bridement of necrotic bone, pain control, infection management, use of antimicrobial oral rinses, and withdrawal of bisphosphonates are preferable to aggressive surgical measures for treating this condition. The degree of risk for osteonecrosis in patients taking oral bisphosphonates, such as alendronate, for osteoporosis is uncertain and warrants careful monitoring.”
Citation:
Woo SB, Hellstein JW, Kalmar JR. Systematic review: bisphosphonates and osteonecrosis of the jaws. Annals of Internal Medicine. 2006; 144(10), 753-761.