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. 2009 Feb;5(1):217-27.
doi: 10.2147/tcrm.s1697. Epub 2009 Mar 26.

Biphosphonates-related osteonecrosis of the jaw: Clinical and physiopathological considerations

Alberto Borgioli  1 , Christian Viviani, Marco Duvina, Leila Brancato, Giuseppe Spinelli, Maria Luisa Brandi, Paolo Tonelli
Affiliations

Biphosphonates-related osteonecrosis of the jaw: Clinical and physiopathological considerations

Alberto Borgioli et al. Ther Clin Risk Manag. 2009 Feb.

Abstract

Since osteonecrosis of the jaw was related to biphosphonate administration by Marx, studies showing clinical symptoms, drug and surgical therapies overwhelmed the literature. Furthermore, the literature demonstrated the correlation between chronic biphosphonate adsumption and osteonecrosis of the jaw onset. Nitrogen-containing biphosphonates are widely used for the management of metastatic cancer, for prevention and treatment of osteoporosis, for the treatment of Paget's disease, and for the management of acute hypercalcemia. According to our experience, the treatment of BRON-J's lesions is difficult and prolonged. For this reason, in order to avoid these complications it is mandatory to perform a risk staging in patients who must undergo biphosphonate administration. When pharmacologic treatments with antibiotics and local antiseptics are not able to control the development of BRON-J's complications, the clinicians should perform radical surgical treatments such as the resection of the bone involved.

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Figures

Figure 1
Figure 1. Osteolytic lesion in the lower jaw of patient treated with Zometa® for 12 months (59 years old, female, breast cancer).
Figure 2
Figure 2. Worsening of the lesion after sequestrectomy in patient treated with Zometa® for 12 months (59 years old, female, breast cancer).
Figure 3
Figure 3. Cutaneous fistula in patient treated with Aredia® and Zometa® for 24 months (48 years old, female, breast cancer).
Figure 4
Figure 4. Computed tomographic scan of the bone sequestrum in patient treated with Zometa® for 5 months (75 years old, female, breast cancer).
Figure 5
Figure 5. Spontaneous fracture of the lower jaw in patient treated with Aredia® and Zometa® for 24 months (43 years old, female, breast cancer).
Figure 6
Figure 6. Early clinical picture of the lower jaw in patient treated with Aredia® and Zometa® for 24 months (48 years old, female, breast cancer).
Figure 7
Figure 7. Advanced lesion of the upper jaw in patient treated with Zometa® for 12 months (69 years old, male, multiple myeloma).
Figure 8
Figure 8. Abscessual complication of necrotic bone lesion in patient treated with Zometa® for 11 months (61 years old, male, prostatic cancer).
Figure 9
Figure 9. Use of platelet-rich plasma in the surgical treatment of the lesion in patient treated with Zometa® for 12 months (59 years old, female, breast cancer).
See this image and copyright information in PMC

References

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