| Osteonecrosis of the jaw in patients on bisphosphonate treatment. review of literature with contribution of a case of multiple myeloma. | |
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MedLine Citation:
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PMID: 20232660 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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In recent years, the incidence of osteonecrosis of the jaw (ONJ) as an unknown complication in patients receiving bisphosphonates (BP) has been on the increase. According to literature data it is in the range of 0.83% to 11.9%. ONJ has been mostly reported in patients with malignancies--mainly in multiple myeloma (MM) patients, followed by patients with bone metastases from breast and prostatic cancer. The view that is supported by a growing body of researchers in the discussion on the etiopathogenetic relationship between ONJ and BPs is that ONJ seems to be a class-specific side effect rather than a result of the use of a specific drug. The major risk factor for development of ONJ is not the BP type, but the time of their administration and accumulation in the bone structures. More than 70% of the ONJ patients report preceding dental problems. The immunosuppressive effects of chemo- and radiotherapy, the impaired bone remodeling resulting from corticoid therapy, the antiangiogenetic properties of thalidomide slow down the reparative processes in the oral cavity and appear as a predisposing factor for the development of ONJ. Possibilities for successful treatment are limited; conservative approaches and least surgery, if larger areas are involved, are recommended. Dental prophylaxis is of particular importance. We present a 66-year-old man with multiple myeloma, IgG, BJ(k), II A KC (after Durie and Salmon staging system). ONJ was diagnosed one year after the disease onset, during which the patient received chemotherapy and was administered concurrently 14 cycles of BPs (pamidronate/zolendronate). The diagnosis was based on clinical, radiologic and histological evidence. Surgical removal of the necrotic sequesters and antibiotic treatment produced a clinical improvement. This rare, refractory complication requires the joint efforts of hematologists, oncologists, and maxillofacial surgeons to diagnose, manage prophylactically and treat. |
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Authors:
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Vesselina S Goranova-Marinova; Petya F Pechalova-Petrova; Stefan G Goranov |
Publication Detail:
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Type: Case Reports; Journal Article |
Journal Detail:
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Title: Folia medica Volume: 51 ISSN: 0204-8043 ISO Abbreviation: Folia Med (Plovdiv) Publication Date: 2009 Oct-Dec |
Date Detail:
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Created Date: 2010-03-17 Completed Date: 2010-04-20 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 2984761R Medline TA: Folia Med (Plovdiv) Country: Bulgaria |
Other Details:
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Languages: eng Pagination: 53-7 Citation Subset: IM |
Affiliation:
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Department of Maxillofacial Surgery, St George University Hospital, Medical University, Plovdiv, Bulgaria. vesselina_goranova@yahoo.com |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Aged Anti-Bacterial Agents / therapeutic use Bone Density Conservation Agents / adverse effects, therapeutic use Debridement / methods Diagnosis, Differential Diphosphonates / adverse effects*, therapeutic use Follow-Up Studies Humans Jaw Diseases / chemically induced*, diagnosis, therapy Male Multiple Myeloma / complications*, diagnosis Osteolysis / drug therapy Osteonecrosis / chemically induced*, diagnosis, therapy |
| Chemical | |
Reg. No./Substance:
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0/Anti-Bacterial Agents; 0/Bone Density Conservation Agents; 0/Diphosphonates |
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