 |
 |
|
Home |
Current Issue |
Past Issues |
In the Clinic |
ACP Journal Club |
CME |
Collections |
Audio/Video |
Mobile |
Subscribe |
Tools |
Help |
ACP Online
|
| |||||||||||||||||||||||||||||||||||||||||||||||||
16 May 2006 | Volume 144 Issue 10 | Pages 753-761
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 débridement 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.
Author and Article Information
From Brigham and Women's Hospital and Harvard School of Dental Medicine, Boston, Massachusetts; University of Iowa College of Dentistry, Iowa City, Iowa; and The Ohio State University College of Dentistry, Columbus, Ohio.
Note: This is a position paper of the American Academy of Oral and Maxillofacial Pathology.
Grant Support: None.
Potential Financial Conflicts of Interest: Grants received: S.-B. Woo (Novartis).
Requests for Single Reprints: Sook-Bin Woo, DMD, Brigham and Women's Hospital, 45 Francis Street, Boston, MA 02115.
Current Author Addresses: Dr. Woo: Brigham and Women's Hospital, 45 Francis Street, Boston, MA 02115.
Dr. Hellstein: University of Iowa, 356 Dental Science South, Iowa City, IA 52246.
Dr. Kalmar: The Ohio State University, 305 West 12th Avenue, Columbus, OH 43210. REVIEW
Systematic Review: Bisphosphonates and Osteonecrosis of the Jaws
Related articles in Annals:
This article has been cited by other articles:
|
|
 |
|
  J. L. Kelsey and I. B. Lamster Influence of Musculoskeletal Conditions on Oral Health Among Older Adults Am J Public Health, July 1, 2008; 98(7): 1177 - 1183. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. Gehrig, J. Lane, and M. I. O'Connor Osteoporosis: Management and Treatment Strategies for Orthopaedic Surgeons J. Bone Joint Surg. Am., June 1, 2008; 90(6): 1362 - 1374. [Full Text] [PDF]
|
|
|
|
 |
|
 B. J. Edwards and C. A. Migliorati Osteoporosis and Its Implications for Dental Patients J Am Dent Assoc, May 1, 2008; 139(5): 545 - 552. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 N. Raje, S.-B. Woo, K. Hande, J. T. Yap, P. G. Richardson, S. Vallet, N. Treister, T. Hideshima, N. Sheehy, S. Chhetri, et al. Clinical, Radiographic, and Biochemical Characterization of Multiple Myeloma Patients with Osteonecrosis of the Jaw Clin. Cancer Res., April 15, 2008; 14(8): 2387 - 2395. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. B. Dodson, N. S. Raje, P. A. Caruso, and A. E. Rosenberg Case 9-2008 -- A 65-Year-Old Woman with a Nonhealing Ulcer of the Jaw N. Engl. J. Med., March 20, 2008; 358(12): 1283 - 1291. [Full Text] [PDF]
|
|
|
|
 |
|
 M. Aapro, P. A. Abrahamsson, J. J. Body, R. E. Coleman, R. Colomer, L. Costa, L. Crino, L. Dirix, M. Gnant, J. Gralow, et al. Guidance on the use of bisphosphonates in solid tumours: recommendations of an international expert panel Ann. Onc., March 1, 2008; 19(3): 420 - 432. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. Ibrahim, F. Barbanti, G. Giorgio-Marrano, L. Mercatali, S. Ronconi, C. Vicini, and D. Amadori Osteonecrosis of the Jaw in Patients with Bone Metastases Treated with Bisphosphonates: A Retrospective Study Oncologist, March 1, 2008; 13(3): 330 - 336. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. J. MacLaughlin and C. L. Raehl ASHP Therapeutic Position Statement on the Prevention and Treatment of Osteoporosis in Adults Am. J. Health Syst. Pharm., February 15, 2008; 65(4): 343 - 357. [Full Text] [PDF]
|
|
|
|
 |
|
 C. MacLean, S. Newberry, M. Maglione, M. McMahon, V. Ranganath, M. Suttorp, W. Mojica, M. Timmer, A. Alexander, M. McNamara, et al. Systematic Review: Comparative Effectiveness of Treatments to Prevent Fractures in Men and Women with Low Bone Density or Osteoporosis Ann Intern Med, February 5, 2008; 148(3): 197 - 213. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
V. M. Cartsos, S. Zhu, and A. I. Zavras Bisphosphonate Use and the Risk of Adverse Jaw Outcomes: A medical claims study of 714,217 people J Am Dent Assoc, January 1, 2008; 139(1): 23 - 30. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. T. Grbic, R. Landesberg, S.-Q. Lin, P. Mesenbrink, I. R. Reid, P.-C. Leung, N. Casas, C. P. Recknor, Y. Hua, P. D. Delmas, et al. Incidence of Osteonecrosis of the Jaw in Women With Postmenopausal Osteoporosis in the Health Outcomes and Reduced Incidence With Zoledronic Acid Once Yearly Pivotal Fracture Trial J Am Dent Assoc, January 1, 2008; 139(1): 32 - 40. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. Jadu, L. Lee, M. Pharoah, D. Reece, and L. Wang A retrospective study assessing the incidence, risk factors and comorbidities of pamidronate-related necrosis of the jaws in multiple myeloma patients Ann. Onc., December 1, 2007; 18(12): 2015 - 2019. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S.L. Ruggiero and S.J. Drew Osteonecrosis of the Jaws and Bisphosphonate Therapy J. Dent. Res., November 1, 2007; 86(11): 1013 - 1021. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. B. Herndon, L. M. Schwartz, S. Woloshin, and H. G. Welch Implications Of Expanding Disease Definitions: The Case Of Osteoporosis Health Aff., November 1, 2007; 26(6): 1702 - 1711. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. A. Siegel, C. A. Migliorati, I. Velez, and M. Forrest Exposed bone in the palate J Am Dent Assoc, October 1, 2007; 138(10): 1341 - 1343. [Full Text] [PDF]
|
|
|
|
|
|
J. E. Brown, S. P. Ellis, J. E. Lester, S. Gutcher, T. Khanna, O.-P. Purohit, E. McCloskey, and R. E. Coleman Prolonged Efficacy of a Single Dose of the Bisphosphonate Zoledronic Acid Clin. Cancer Res., September 15, 2007; 13(18): 5406 - 5410. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. Levin, A. Laviv, and D. Schwartz-Arad Denture-Related Osteonecrosis of the Maxilla Associated With Oral Bisphosphonate Treatment J Am Dent Assoc, September 1, 2007; 138(9): 1218 - 1220. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. A. CHAFFINS Paget Disease of Bone Radiol. Technol., September 1, 2007; 79(1): 27 - 40. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. S. Wilkinson, Y.-F. Kuo, J. L. Freeman, and J. S. Goodwin Intravenous Bisphosphonate Therapy and Inflammatory Conditions or Surgery of the Jaw: A Population-Based Analysis J Natl Cancer Inst, July 4, 2007; 99(13): 1016 - 1024. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 N. G. Shenker and A. S. M. Jawad Bisphosphonates and osteonecrosis of the jaw Rheumatology, July 1, 2007; 46(7): 1049 - 1051. [Full Text] [PDF]
|
|
|
|
 |
|
 R. A. Kyle, G. C. Yee, M. R. Somerfield, P. J. Flynn, S. Halabi, S. Jagannath, R. Z. Orlowski, D. G. Roodman, P. Twilde, and K. Anderson American Society of Clinical Oncology 2007 Clinical Practice Guideline Update on the Role of Bisphosphonates in Multiple Myeloma J. Clin. Oncol., June 10, 2007; 25(17): 2464 - 2472. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. F. Lata and M. E. Elliott Patient Assessment in the Diagnosis, Prevention, and Treatment of Osteoporosis Nutr Clin Pract, June 1, 2007; 22(3): 261 - 275. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. L. Mayes Review of Postmenopausal Osteoporosis Pharmacotherapy Nutr Clin Pract, June 1, 2007; 22(3): 276 - 285. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. Crivellari, M. Aapro, R. Leonard, G. von Minckwitz, E. Brain, A. Goldhirsch, A. Veronesi, and H. Muss Breast Cancer in the Elderly J. Clin. Oncol., May 10, 2007; 25(14): 1882 - 1890. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. M. Black, P. D. Delmas, R. Eastell, I. R. Reid, S. Boonen, J. A. Cauley, F. Cosman, P. Lakatos, P. C. Leung, Z. Man, et al. Once-Yearly Zoledronic Acid for Treatment of Postmenopausal Osteoporosis N. Engl. J. Med., May 3, 2007; 356(18): 1809 - 1822. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Compston Treatments for Osteoporosis -- Looking beyond the HORIZON N. Engl. J. Med., May 3, 2007; 356(18): 1878 - 1880. [Full Text] [PDF]
|
|
|
|
|
|
M. D. Michaelson, D. S. Kaufman, H. Lee, F. J. McGovern, P. W. Kantoff, M. A. Fallon, J. S. Finkelstein, and M. R. Smith Randomized Controlled Trial of Annual Zoledronic Acid to Prevent Gonadotropin-Releasing Hormone Agonist-Induced Bone Loss in Men With Prostate Cancer J. Clin. Oncol., March 20, 2007; 25(9): 1038 - 1042. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. Shoback Update in Osteoporosis and Metabolic Bone Disorders J. Clin. Endocrinol. Metab., March 1, 2007; 92(3): 747 - 753. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. J. Favus Diabetes and the Risk of Osteonecrosis of the Jaw J. Clin. Endocrinol. Metab., March 1, 2007; 92(3): 817 - 818. [Full Text] [PDF]
|
|
|
|
 |
|
 M. R. McClung Bisphosphonate Therapy: To Stop or Not to Stop? IBMS BoneKEy, February 1, 2007; 4(2): 78 - 82. [Full Text] [PDF]
|
|
|
|
 |
|
 C. D Krueger, P. M West, M. Sargent, A. E Lodolce, and A S. Pickard Bisphosphonate-Induced Osteonecrosis of the Jaw Ann. Pharmacother., February 1, 2007; 41(2): 276 - 284. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. M. Black, A. V. Schwartz, K. E. Ensrud, J. A. Cauley, S. Levis, S. A. Quandt, S. Satterfield, R. B. Wallace, D. C. Bauer, L. Palermo, et al. Effects of Continuing or Stopping Alendronate After 5 Years of Treatment: The Fracture Intervention Trial Long-term Extension (FLEX): A Randomized Trial JAMA, December 27, 2006; 296(24): 2927 - 2938. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. Tosi, E. Zamagni, D. Cangini, P. Tacchetti, F. Di Raimondo, L. Catalano, A. D'Arco, S. Ronconi, C. Cellini, M. Offidani, et al. Osteonecrosis of the jaws in newly diagnosed multiple myeloma patients treated with zoledronic acid and thalidomide-dexamethasone. Blood, December 15, 2006; 108(12): 3951 - 3952. [Full Text] [PDF]
|
|
|
|
|
|
S. R. Cummings A 55-Year-Old Woman With Osteopenia JAMA, December 6, 2006; 296(21): 2601 - 2610. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. Lentle and D. Worsley Osteoporosis Redux J. Nucl. Med., December 1, 2006; 47(12): 1945 - 1959. [Full Text] [PDF]
|
|
|
|
|
|
J. P. Bilezikian Osteonecrosis of the Jaw -- Do Bisphosphonates Pose a Risk? N. Engl. J. Med., November 30, 2006; 355(22): 2278 - 2281. [Full Text] [PDF]
|
|
|
|
|
|
A. Grey and T. Cundy Bisphosphonates and osteonecrosis of the jaw. Ann Intern Med, November 21, 2006; 145(10): 791 - 791. [Full Text] [PDF]
|
|
|
|
|
|
N. B. Watts, S. T. Harris, M. R. McClung, J. P. Bilezikian, S. L. Greenspan, and M. M. Luckey Bisphosphonates and osteonecrosis of the jaw. Ann Intern Med, November 21, 2006; 145(10): 791 - 792. [Full Text] [PDF]
|
|
|
|
 |
|
 B. N. Landis, M. Richter, I. Dojcinovic, and M. Hugentobler Osteonecrosis of the jaw after treatment with bisphosphonates: Is irreversible, so the focus must be on prevention BMJ, November 11, 2006; 333(7576): 982 - 983. [Full Text] [PDF]
|
|
|
|
|
|
T. A. Guise Bone Loss and Fracture Risk Associated with Cancer Therapy Oncologist, November 1, 2006; 11(10): 1121 - 1131. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Hirbe, E. A. Morgan, O. Uluckan, and K. Weilbaecher Skeletal complications of breast cancer therapies. Clin. Cancer Res., October 15, 2006; 12(20): 6309s - 6314s. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Bisphosphonates and Osteonecrosis of the Jaw Journal Watch Women's Health, September 14, 2006; 2006(914): 2 - 2. [Full Text]
|
|
|
|
|
|
M. J. Somerman and L. K. McCauley Bisphosphonates: Sacrificing the Jaw to Save the Skeleton? IBMS BoneKEy, September 1, 2006; 3(9): 12 - 18. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. R. Smith Bisphosphonates for Metastatic Bone Disease -- Too Much of a Good Thing? IBMS BoneKEy, September 1, 2006; 3(9): 24 - 27. [Full Text] [PDF]
|
|
|
|
|
|
M. P. Whyte Paget's Disease of Bone N. Engl. J. Med., August 10, 2006; 355(6): 593 - 600. [Full Text] [PDF]
|
|
|
|
|
|
American Dental Association Council on Scientific Dental management of patients receiving oral bisphosphonate therapy: Expert panel recommendations. J Am Dent Assoc, August 1, 2006; 137(8): 1144 - 1150. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Correction: Bisphosphonates and Osteonecrosis of the Jaws Ann Intern Med, August 1, 2006; 145(3): 235 - 235. [Full Text] [PDF]
|
|
|
|
 |
|
 B. Mehrotra and S. Ruggiero Bisphosphonate Complications Including Osteonecrosis of the Jaw Hematology, January 1, 2006; 2006(1): 356 - 360. [Abstract] [Full Text] [PDF]
|
|
Read all Rapid Responses
Article
