Factors predicting the prognosis of oral alendronate-related osteonecrosis of the jaws: a 4-year cohort study.

BACKGROUND Studies concerning prognostic factors specific for alendronate-related osteonecrosis of the jaws (ONJ) are rare. METHODS We surveyed a cohort of 100 osteoporotic patients with 111 alendronate-related ONJ lesions treated during a 4-year period. Prognostic values of clinical variables and serum markers of bone turnover were assessed by univariate and multivariate analyses. RESULTS The cumulative complete response rate at 6 months was 48.65%. Serum bone-specific alkaline phosphatase (BSAP) level >10 μg/L, lesion depth ≦ 10 mm, and lesions in anterior regions denoted a better chance of healing within 6 months and the adjusted hazard ratios were 2.48 (95% confidence interval [CI], 1.41-4.37), 2.71 (95% CI, 1.57-4.70), and 3.94 (95% CI, 1.87-8.30), respectively. CONCLUSIONS Early discovery of lesions and prevention of their deeper extension are crucial for improving the prognosis of alendronate-related ONJ. A higher pretreatment level of BSAP indicates a better prognosis.