Osteonecrosis of the jaws associated with the use of bisphosphonates. Discussion over 52 cases.

BACKGROUND Osteonecrosis of the jaws is increasing worldwide in patients treated with bisphosphonates. STUDY DESIGN A retrospective review of 52 patients who were treated during 2007-2010 for bisphosphonate related maxillofacial symptoms of the jaws was conducted. Patient characteristics and other factors that influenced the disease process were studied. RESULTS Thirteen patients received bisphosphonates for the prevention or treatment of osteoporosis; 39 for preventing bone metastases from malignant tumors. Thirty-six patients were females (age range 32-87 years, median 64 years); 16 were males (age range 30-81 years, median 73.5 years). Bisphosphonate used was ibandronic acid in four cases, alendronate sodium in 14 cases, and zoledronic acid in 34 cases. Mean bisphosphonate treatment period was 22.44 months (95%CI 19.33-25.55). Thirty patients received intravenous, 22 received oral bisphosphonate. The average period until occurrence of maxillofacial symptoms was 6 months (range 0.5-24 months) in subjects with intravenous bisphosphonate and 12.26 months (range 0.25-36 months) in subjects with oral bisphosphonates (p=0.011). CONCLUSIONS The risk of bisphosphonate related osteonecrosis of the jaws is very high twelve months after oral administration and six months after intravenous administration in patients who have a trigger point in the jaws area. A proper monitoring of patients receiving bisphosphonates can reduce the risk of osteonecrosis and can prevent complications.