Abstract
Purpose
Osteonecroses of the jaws are caused by several reasons. Bisphosphonate-associated osteonecrosis of the jaws (BP-ONJ) is known since 2003 with an increasing incidence in the first years. Along with more knowledge about the pathophysiology, preventive strategies were implemented trying to reduce the incidence. The aim of this retrospective study was to analyze the frequency and overall proportion of BP-ONJ within the field of osteonecrosis. The data was compared to a similar study performed in 2005.
Methods
All patients with osteonecrosis or osteomyelitis treated in the period from April 2005 to July 2012 in the Oral and Maxillofacial Surgery at the University of Mainz, Germany, were analyzed.
Results
The reasons for osteonecrosis were bisphosphonates in 45 %, odontogenic or surgically induced osteonecrosis in 32 %, osteoradionecrosis in 17 %, traumas in 1 %, and in 4 % the reason remained unclear. The BP-ONJ became the most important factor for osteonecrosis. Its fraction in the years 2000–2005 was 10 % only.
Conclusions
Although preventive strategies are implemented, the number of new cases got bigger. The implemented prevention strategies did not manage to reduce the overall number of new cases. Furthermore, the launch of other medications with a similar side effect on the jawbone as the BP-ONJ for bisphosphonates might influence the overall distribution of osteonecroses.
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References
Marx RE (2003) Pamidronate (Aredia) and zoledronate (Zometa) induced avascular necrosis of jaws: a growing epidemic. J Oral Maxillofac Surg 61(9):1115–1117
Tarassoff P, Csermak K (2003) Avascular necrosis of the jaws: risk factors in metastatic cancer patients. J Oral Maxillofac Surg 61(10):1238–1239
Walter C, Grotz KA, Kunkel M, Al-Nawas B (2007) Prevalence of bisphosphonate associated osteonecrosis of the jaw within the field of osteonecrosis. Support Care Cancer 15(2):197–202
Walter C, Al-Nawas B, Frickhofen N, Gamm H, Beck J, Reinsch L, Blum C, Grotz KA, Wagner W (2011) Prevalence of bisphosphonate associated osteonecrosis of the jaws in multiple myeloma patients. Head Face Med 6:11
Walter C, Al-Nawas B, Grotz KA, Thomas C, Thuroff JW, Zinser V, Gamm H, Beck J, Wagner W (2008) Prevalence and risk factors of bisphosphonate-associated osteonecrosis of the jaw in prostate cancer patients with advanced disease treated with zoledronate. Eur Urol 54(5):1066–1072
Walter C, Al-Nawas B, du Bois A, Buch L, Harter P, Grotz KA (2009) Incidence of bisphosphonate-associated osteonecrosis of the jaws in breast cancer patients. Cancer 115(8):1631–1637
Walter C, Klein MO, Pabst A, Al-Nawas B, Duschner H, Ziebart T (2010) Influence of bisphosphonates on endothelial cells, fibroblasts, and osteogenic cells. Clin Oral Investig 14(1):35–41
Ziebart T, Pabst A, Klein MO, Kammerer P, Gauss L, Brullmann D, Al-Nawas B, Walter C (2011) Bisphosphonates: restrictions for vasculogenesis and angiogenesis: inhibition of cell function of endothelial progenitor cells and mature endothelial cells in vitro. Clin Oral Investig 15(1):105–111. doi:10.1007/s00784-009-0365-2
Pabst AM, Ziebart T, Koch FP, Taylor KY, Al-Nawas B, Walter C (2012) The influence of bisphosphonates on viability, migration, and apoptosis of human oral keratinocytes—in vitro study. Clin Oral Investig 16(1):87–93. doi:10.1007/s00784-010-0507-6
Allen MR, Burr DB (2009) The pathogenesis of bisphosphonate-related osteonecrosis of the jaw: so many hypotheses, so few data. J Oral Maxillofac Surg 67(5 Suppl):61–70
Walter C, Laux C, Sagheb K (2013) Radiologic bone loss in patients with bisphosphonate-associated osteonecrosis of the jaws: a case-control study. Clin Oral Investig. doi:10.1007/s00784-013-0974-7
Soydan SS, Uckan S (2013) Management of bisphosphonate-related osteonecrosis of the jaw with a platelet-rich fibrin membrane: technical report. J Oral Maxillofac Surg. doi:10.1016/j.joms.2013.07.027
Blus C, Szmukler-Moncler S, Giannelli G, Denotti G, Orru G (2013) Use of ultrasonic bone surgery (Piezosurgery) to surgically treat bisphosphonate-related osteonecrosis of the jaws (BRONJ). A case series report with at least 1 year of follow-up. Open Dent J 7:94–101. doi:10.2174/1874210601307010094
Assaf AT, Zrnc TA, Riecke B, Wikner J, Zustin J, Friedrich RE, Heiland M, Smeets R, Grobe A (2013) Intraoperative efficiency of fluorescence imaging by Visually Enhanced Lesion Scope (VELscope) in patients with bisphosphonate related osteonecrosis of the jaw (BRONJ). J Craniomaxillofac Surg. doi:10.1016/j.jcms.2013.07.014
Grötz KA, Kreusch T (2006) Zahnärztliche Betreuung von Patienten unter/nach Bisphosphonat-Medikation. DZZ 60:10
Ruggiero SL, Dodson TB, Assael LA, Landesberg R, Marx RE, Mehrotra B (2009) American Association of Oral and Maxillofacial Surgeons position paper on bisphosphonate-related osteonecrosis of the jaws—2009 update. J Oral Maxillofac Surg 67(5 Suppl):2–12
Grötz KA, Piesold JU, Al-Nawas B (2012) AWMF Leitlinie Bisphosphonat-assoziierte Kiefernekrose (BP-ONJ) und andere Medikamenten-assoziierte Kiefernekrosen. AWMF
Montefusco V, Gay F, Spina F, Miceli R, Maniezzo M, Teresa Ambrosini M, Farina L, Piva S, Palumbo A, Boccadoro M, Corradini P (2008) Antibiotic prophylaxis before dental procedures may reduce the incidence of osteonecrosis of the jaw in patients with multiple myeloma treated with bisphosphonates. Leuk Lymphoma 49(11):2156–2162
Bonacina R, Mariani U, Villa F, Villa A (2011) Preventive strategies and clinical implications for bisphosphonate-related osteonecrosis of the jaw: a review of 282 patients. J Can Dent Assoc 77:b147
Gnant M, Dubsky P, Hadji P (2012) Bisphosphonates: prevention of bone metastases in breast cancer. Recent Results Cancer Res 192:65–91. doi:10.1007/978-3-642-21892-7_3
Coleman RE (2012) Adjuvant bone-targeted therapy to prevent metastasis: lessons from the AZURE study. Curr Opin Support Palliat Care 6(3):322–329. doi:10.1097/SPC.0b013e32835689cd
Advisory Task Force on Bisphosphonate-Related Osteonecrosis of the Jaws AAoOaMS (2007) American Association of Oral and Maxillofacial Surgeons position paper on bisphosphonate-related osteonecrosis of the jaws. J Oral Maxillofac Surg 65(3):369–376
Schwabe U, Paffrath D (2007) Arzneimittelverordnungs-Report 2006: Aktuelle Daten, Kosten, Trends und Kommentare. Springer, Heidelberg
Schwabe U, Paffrath D (2012) Arzneiverordnungs-Report 2012: Aktuelle Daten, Kosten, Trends und Kommentare. Springer, Heidelberg
Henry DH, Costa L, Goldwasser F, Hirsh V, Hungria V, Prausova J, Scagliotti GV, Sleeboom H, Spencer A, Vadhan-Raj S, von Moos R, Willenbacher W, Woll PJ, Wang J, Jiang Q, Jun S, Dansey R, Yeh H (2011) Randomized, double-blind study of denosumab versus zoledronic acid in the treatment of bone metastases in patients with advanced cancer (excluding breast and prostate cancer) or multiple myeloma. J Clin Oncol 29(9):1125–1132. doi:10.1200/JCO.2010.31.3304
Guarneri V, Miles D, Robert N, Dieras V, Glaspy J, Smith I, Thomssen C, Biganzoli L, Taran T, Conte P (2010) Bevacizumab and osteonecrosis of the jaw: incidence and association with bisphosphonate therapy in three large prospective trials in advanced breast cancer. Breast Cancer Res Treat 122(1):181–188
Koch FP, Walter C, Hansen T, Jager E, Wagner W (2011) Osteonecrosis of the jaw related to sunitinib. Oral Maxillofac Surg 15(1):63–66. doi:10.1007/s10006-010-0224-y
Ziebart T, Koch F, Klein MO, Guth J, Adler J, Pabst A, Al-Nawas B, Walter C (2011) Geranylgeraniol—a new potential therapeutic approach to bisphosphonate associated osteonecrosis of the jaw. Oral Oncol 47(3):195–201. doi:10.1016/j.oraloncology.2010.12.003
Conflict of interest
The authors declare no conflict of interest. The study was not funded by anyone. We have full control of all primary data, and we allow the journal to review our data if requested.
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Christian Walter and Keyvan Sagheb contributed equally to this work.
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Walter, C., Sagheb, K., Bitzer, J. et al. Analysis of reasons for osteonecrosis of the jaws. Clin Oral Invest 18, 2221–2226 (2014). https://doi.org/10.1007/s00784-014-1205-6
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DOI: https://doi.org/10.1007/s00784-014-1205-6