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Osteonecrosis of the Jaw in Patients undergoing Long-Term Treatment with Bisphosphonates: Incidence and Associated Characteristics

Abstract

Introduction: Bisphosphonates (BPs) provide a well-known, favorable therapeutic action on the bony tissue of patients receiving these drugs. Aim: The aim of this study is to link long-term treatment with nitrogenous bisphosphonates to ONJBPs (osteonecrosis of the jaw caused by bisphosphonates), the most frequently encountered side effect in jaws. In 2007 the AAOMS defined the concept of ONJBP as "an exposed necrotic bone area in the mouth present for over eight weeks in patients who have undergone longterm treatment with bisphosphonates and who have not received radiation therapy to the head and neck." Subsequently in 2009 the AAOMS defined 4 clinical stages (0 to 3) of ONJBPs. Subjects and methods: Between January 2007 and December 2013 25,538 patients were referred to the Department of Maxillo-facial Surgery and Traumatology II of the School of Dentistry, University of Buenos Aires Argentina. All these patients underwent surgical dental treatment and the 1097 patients found to have healing dyscrasias were subsequently divided into three groups. All 1097 patients included in this study underwent semiological systemic clinical, dental, biochemical, histopathological studies as well as densitometry and X-ray imaging. Results: Of the 25,538 patients evaluated, 0.33% were found to have ONJBP. Of the 1097 patients with healing dyscrasias, the incidence of ONJBP was 7.75%. Among the 270 patients who took BPs the incidence of ONJBPs was 31.5%. Clinical studies in Group 1 patients revealed mainly stage 1 and 2 disease. There were no significant differences in CTX levels for either of the two groups evaluated. Conclusion: The results of the present study suggest a significant incidence of ONJBPs, especially when only individuals treated with BPs are included for the calculations. It is also clear that interaction among healthcare professionals is essential, since ONJBPs prevention is better than its treatment.

Silvana Noemi Picardo* and Eduardo Alberto Rey

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