Clinical aspects of bisphosphonate-associated oral osteonecrosis in patients with multiple myeloma

Gaglioti, Domenico and Andriani, Alessandro and Colasanti, Ubalbo and Papa, Raffaele and Villivà, Nicoletta and Riva, Chiara (2006) Clinical aspects of bisphosphonate-associated oral osteonecrosis in patients with multiple myeloma. Clinical cases in mineral and bone metabolism, 3 (2). pp. 192-197. ISSN 1971-3266

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Abstract

Background. Bisphosphonates are drugs which act on bone metabolism. They act on osteoclastic activity and inhibit neoangiogenesis. In the bisphosphonate class the most clinically used molecules are pamidronate and zolendronate. They represent “the gold standard” and are used in multiple myeloma treatment, solid tumors with bone metastases, and prevention of pathological fractures. In recent years it has been supposed that bisphosphonates may lead to jaws osteonecrosis, expecially after dentistry procedures such as dental extractions, implant surgery and periodontics interventions. Our work aim is to delineate clinical aspects of patients’ lesions come to our observation for jaws osteonecrosis. These belonged to a patients’ group treated by bisphosphonates for multiple myeloma, osteoporosis, hyperparathyroidism, Paget’s disease. Patients and methods. We examinated clinical data of 9 patients(8 females, 1 male), with jaws osteonecrotic lesions and treated by bisphosphonates, for a mean time of 42 months. Six of the 9 patients were treated for multiple myeloma. In 4 cases osteonecrotic were located on superior maxillary, in 5 ones on jaw. Clinically exposed bone area was infected, with radiated and burning pain, and antibiotic therapy was necessary. Results. Most clinically represented lesion was an area of ulcerated mucosa with not vital exposed bone. Flogosis was typical in area surrounding the necrosis. Neither bleeding nor pain could be appreciated in the exposed bone area. Painful lesions make more difficult oral hygiene, with frequent onset of local parodontosis. At radiographic exams typical illness marks are not corresponded instead. A standardized protocol for jaws osteonecrosis doesn’t exist. In our clinical trial we performed several clinical plans, with different results. The suspension of bisphosphonate therapy does not appear to hasten recovery of the osteonecrosis. Despite antibiotic therapy, resective surgery, osteoplastics and hyperbaric oxygen therapy most of the lesions did not respond well to therapy. Discussion. Although bisphosponates use started about 30 years ago, first osteonecrotic lesions were described in 2003 (Max and Stern). The pathogenesis is correlated to the modifications of vascularization induced from such drugs, but would compete even factors as masticatory stress, iatrogenic procedures, local bacterial position, association with other rugs and some systemic pathologies. Surgical treatment may lead to not predictable results and recurrences. Antibiotic therapy reduces the inflammation and the pain, but did not assure healing; therapies with disinfectant and irrigantes have not produced results; in our clinic the hyperbaric oxygen therapy has gotten good results toward in the comparisons of the inflammation and in the improvement of the course-operating after sequestrotomy. Conclusions. Bisphosphonates are essential drugs in the treatment of several diseases other than osteoporosis. But considering the impact on the quality of life of the patients on which rise up osteonecrosis of the maxillary, it is necessary to perform odontostomatologic visit before the therapy, and to evaluated the relationship between benefit of the treatment and the risk of such lesions

Item Type:	Article
Uncontrolled Keywords:	Osteonecrosis, bisphosphonates, osteoporosis, multiple myeloma
Subjects:	600 Tecnologia - Scienze applicate > 610 Medicina e salute (Classificare qui la tecnologia dei servizi medici) > 612 Fisiologia umana > 612.7 Sistema muscoloscheletrico, tegumento
Depositing User:	Danilo Dezzi
Date Deposited:	20 Jan 2014 11:37
Last Modified:	20 Jan 2014 11:37
URI:	http://eprints.bice.rm.cnr.it/id/eprint/4786

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