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Risk of osteonecrosis of the jaw for patients with underlying malignant condition treated with iv bisphosphonates

Researches at Elkhart General Hospital, in United States, have assessed the prevalence of osteonecrosis of the jaw in patients receiving bisphosphonate therapy and in those who were bisphosphonate naïve.

They undertook a retrospective review of medical records of patients at the New York Harbor Health Care System from 1999 through 2004.

Among 1,951 medical records reviewed, 2 patients with osteonecrosis of the jaw have been identified who had received bisphosphonates and 2 patients with osteonecrosis of the jaw who were bisphosphonate naïve.

Both patients treated with bisphosphonates had multiple myeloma and were receiving monthly infusions. They had initially received Pamidronate ( Aredia ) before treatment was changed to Zoledronic Acid ( Aclasta / Zometa ). In each case, osteonecrosis of the jaw was precipitated by a routine dental extraction.

The prevalence of osteonecrosis of the jaw in our patient population receiving intravenously administered bisphosphonates was 1 in 71.5.

Of the 2 cases of osteonecrosis of the jaw in bisphosphonate-naïve patients, osteoradionecrosis was clearly incriminated in 1 patient and potentially the causative factor in the other patient as well.

No patients receiving orally administered bisphosphonates had osteonecrosis of the jaw, nor did this complication occur in any patients receiving parenteral bisphosphonate therapy for disorders such as osteoporosis or Paget's disease of bone.

According to Authors, bisphosphonates remain an important option for management of metabolic bone disease and complications of malignant disease. The overall prevalence of osteonecrosis of the jaw in patients receiving bisphosphonates seems to be very low; however, patients receiving intense parenteral therapy for an underlying malignant condition appear to have a uniquely elevated risk for the development of this complication.

Source: Endocrine Practice, 2007