Clinical aspects of bisphosphonate-associated oralosteonecrosis in patients with multiple myeloma
Year: 2006
Type: article
Abstract: Background. Bisphosphonates are drugs which act on bone \nmetabolism. They act on osteoclastic activity and inhibit \nneoangiogenesis. 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. \nIn recent years it has been supposed that bisphosphonates \nmay lead to jaws osteonecrosis, expecially after dentistry procedures such as dental extractions, implant surgery and periodontics interventions. \nOur 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. \nPatients 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. \nSix 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. \nResults. 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 \nof bisphosphonate therapy does not appear to hasten \nrecovery of the osteonecrosis. Despite antibiotic therapy, resective surgery, osteoplastics and hyperbaric oxygen therapy most of the lesions did not respond well to therapy. \nDiscussion. Although bisphosponates use started about 30 \nyears 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 \nhas gotten good results toward in the comparisons of the \ninflammation and in the improvement of the course-operating \nafter sequestrotomy. \nConclusions. Bisphosphonates are essential drugs in the \ntreatment of several diseases other than osteoporosis. But \nconsidering 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 \n
Authors: Domenico Gaglioti, Alessandro Andriani, Ubalbo Colasanti, Raffaele Papa, Nicoletta Villivà, Chiara Riva
Language: English
Topic: Bone health and treatments
Subfield: Oncology
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W2121031772