Bisphosphonate-Related Osteonecrosis of the Jaw: Clinical Features, Risk Factors, Management, and Treatment Outcomes of 26 Patients

Vivek Thumbigere-Math, Ma'Ann C. Sabino, Rajaram Gopalakrishnan, Sabrina Huckabay, Arkadiusz Z. Dudek, Saonli Basu, Pamela Hughes, Bryan S. Michalowicz, Joseph W. Leach, Karen K. Swenson, James Q. Swift, Cheryl Adkinson, David L. Basi

Research output: Contribution to journalArticle

59 Citations (Scopus)

Abstract

Purpose: To report the clinical features, risk factors, management, and treatment outcomes of nitrogen-containing bisphosphonate (n-BIS)-related osteonecrosis of the jaw (BRONJ). Patients and Methods: Patients with suspected BRONJ were referred to the School of Dentistry for evaluation and treatment. Results: A total of 26 patients (9 men and 17 women, mean age 64 years) were diagnosed with BRONJ. Of the 26 patients, 23 had received n-BIS therapy for cancer and 3 for osteoporosis. BRONJ lesions were noted more frequently in the mandible and in the posterior sextants. Of the 26 patients, 16 had developed BRONJ after dentoalveolar procedures, and 10 had developed it spontaneously. The mean interval to development of BRONJ was shorter in the patients with cancer receiving intravenous n-BIS than in the patients with osteoporosis receiving oral n-BIS (37.1 versus 77.7 months, P = .02). Using the American Association of Oral and Maxillofacial Surgeons staging system, 2 patients were diagnosed with stage I lesions, 19 with stage II, and 5 with stage III lesions. The initial management of BRONJ was nonsurgical, with debridement performed at subsequent visits, if needed. The BRONJ lesions healed completely in 4 patients, healed partially in 8, remained stable in 7, and progressed in 7. The spontaneous lesions responded favorably to BRONJ management compared with lesions that developed after dentoalveolar procedures (P = .01). No significant difference was found in response to BRONJ management between patients who had continued or discontinued n-BIS therapy after the BRONJ diagnosis (P = .54). Conclusions: Long-term n-BIS therapy and recent dental procedures are consistent findings in patients with BRONJ. Spontaneous BRONJ lesions respond favorably to current BRONJ treatment strategies.

Original languageEnglish (US)
Pages (from-to)1904-1913
Number of pages10
JournalJournal of Oral and Maxillofacial Surgery
Volume67
Issue number9
DOIs
StatePublished - Sep 2009
Externally publishedYes

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Bisphosphonate-Associated Osteonecrosis of the Jaw
Osteonecrosis
Risk Management
Jaw
Diphosphonates
Nitrogen
Osteoporosis
School Dentistry
Therapeutics
Debridement
Mandible

ASJC Scopus subject areas

  • Oral Surgery
  • Otorhinolaryngology
  • Surgery

Cite this

Bisphosphonate-Related Osteonecrosis of the Jaw : Clinical Features, Risk Factors, Management, and Treatment Outcomes of 26 Patients. / Thumbigere-Math, Vivek; Sabino, Ma'Ann C.; Gopalakrishnan, Rajaram; Huckabay, Sabrina; Dudek, Arkadiusz Z.; Basu, Saonli; Hughes, Pamela; Michalowicz, Bryan S.; Leach, Joseph W.; Swenson, Karen K.; Swift, James Q.; Adkinson, Cheryl; Basi, David L.

In: Journal of Oral and Maxillofacial Surgery, Vol. 67, No. 9, 09.2009, p. 1904-1913.

Research output: Contribution to journalArticle

Thumbigere-Math, V, Sabino, MAC, Gopalakrishnan, R, Huckabay, S, Dudek, AZ, Basu, S, Hughes, P, Michalowicz, BS, Leach, JW, Swenson, KK, Swift, JQ, Adkinson, C & Basi, DL 2009, 'Bisphosphonate-Related Osteonecrosis of the Jaw: Clinical Features, Risk Factors, Management, and Treatment Outcomes of 26 Patients', Journal of Oral and Maxillofacial Surgery, vol. 67, no. 9, pp. 1904-1913. https://doi.org/10.1016/j.joms.2009.04.051
Thumbigere-Math, Vivek ; Sabino, Ma'Ann C. ; Gopalakrishnan, Rajaram ; Huckabay, Sabrina ; Dudek, Arkadiusz Z. ; Basu, Saonli ; Hughes, Pamela ; Michalowicz, Bryan S. ; Leach, Joseph W. ; Swenson, Karen K. ; Swift, James Q. ; Adkinson, Cheryl ; Basi, David L. / Bisphosphonate-Related Osteonecrosis of the Jaw : Clinical Features, Risk Factors, Management, and Treatment Outcomes of 26 Patients. In: Journal of Oral and Maxillofacial Surgery. 2009 ; Vol. 67, No. 9. pp. 1904-1913.
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abstract = "Purpose: To report the clinical features, risk factors, management, and treatment outcomes of nitrogen-containing bisphosphonate (n-BIS)-related osteonecrosis of the jaw (BRONJ). Patients and Methods: Patients with suspected BRONJ were referred to the School of Dentistry for evaluation and treatment. Results: A total of 26 patients (9 men and 17 women, mean age 64 years) were diagnosed with BRONJ. Of the 26 patients, 23 had received n-BIS therapy for cancer and 3 for osteoporosis. BRONJ lesions were noted more frequently in the mandible and in the posterior sextants. Of the 26 patients, 16 had developed BRONJ after dentoalveolar procedures, and 10 had developed it spontaneously. The mean interval to development of BRONJ was shorter in the patients with cancer receiving intravenous n-BIS than in the patients with osteoporosis receiving oral n-BIS (37.1 versus 77.7 months, P = .02). Using the American Association of Oral and Maxillofacial Surgeons staging system, 2 patients were diagnosed with stage I lesions, 19 with stage II, and 5 with stage III lesions. The initial management of BRONJ was nonsurgical, with debridement performed at subsequent visits, if needed. The BRONJ lesions healed completely in 4 patients, healed partially in 8, remained stable in 7, and progressed in 7. The spontaneous lesions responded favorably to BRONJ management compared with lesions that developed after dentoalveolar procedures (P = .01). No significant difference was found in response to BRONJ management between patients who had continued or discontinued n-BIS therapy after the BRONJ diagnosis (P = .54). Conclusions: Long-term n-BIS therapy and recent dental procedures are consistent findings in patients with BRONJ. Spontaneous BRONJ lesions respond favorably to current BRONJ treatment strategies.",
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AU - Thumbigere-Math, Vivek

AU - Sabino, Ma'Ann C.

AU - Gopalakrishnan, Rajaram

AU - Huckabay, Sabrina

AU - Dudek, Arkadiusz Z.

AU - Basu, Saonli

AU - Hughes, Pamela

AU - Michalowicz, Bryan S.

AU - Leach, Joseph W.

AU - Swenson, Karen K.

AU - Swift, James Q.

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N2 - Purpose: To report the clinical features, risk factors, management, and treatment outcomes of nitrogen-containing bisphosphonate (n-BIS)-related osteonecrosis of the jaw (BRONJ). Patients and Methods: Patients with suspected BRONJ were referred to the School of Dentistry for evaluation and treatment. Results: A total of 26 patients (9 men and 17 women, mean age 64 years) were diagnosed with BRONJ. Of the 26 patients, 23 had received n-BIS therapy for cancer and 3 for osteoporosis. BRONJ lesions were noted more frequently in the mandible and in the posterior sextants. Of the 26 patients, 16 had developed BRONJ after dentoalveolar procedures, and 10 had developed it spontaneously. The mean interval to development of BRONJ was shorter in the patients with cancer receiving intravenous n-BIS than in the patients with osteoporosis receiving oral n-BIS (37.1 versus 77.7 months, P = .02). Using the American Association of Oral and Maxillofacial Surgeons staging system, 2 patients were diagnosed with stage I lesions, 19 with stage II, and 5 with stage III lesions. The initial management of BRONJ was nonsurgical, with debridement performed at subsequent visits, if needed. The BRONJ lesions healed completely in 4 patients, healed partially in 8, remained stable in 7, and progressed in 7. The spontaneous lesions responded favorably to BRONJ management compared with lesions that developed after dentoalveolar procedures (P = .01). No significant difference was found in response to BRONJ management between patients who had continued or discontinued n-BIS therapy after the BRONJ diagnosis (P = .54). Conclusions: Long-term n-BIS therapy and recent dental procedures are consistent findings in patients with BRONJ. Spontaneous BRONJ lesions respond favorably to current BRONJ treatment strategies.

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