Evolution of bisphosphonate-related osteonecrosis of the jaw in patients with multiple myeloma and Waldenstrom's macroglobulinemia: a retrospective multicentric study

• Published in: Blood cancer journal (New York) Vol. 2; no. 3; p. e62
• Main Authors: Andriani, A, Petrucci, M T, Caravita, T, Montanaro, M, Villivà, N, Levi, A, Siniscalchi, A, Bongarzoni, V, Pisani, F, De Muro, M, Coppetelli, U, Avvisati, G, Zullo, A, Agrillo, A, Gaglioti, D
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01.03.2012; Springer Nature B.V; Nature Publishing Group
• Subjects: 692/699/67/1990/804; 692/700/139/422; 692/700/565/809; Biomedical and Life Sciences; Biomedicine; Cancer Research; Hematology; Oncology; Original; original-article; pamidronate; bisphosphonate; multiple myeloma; osteonecrosis; zolendronate
• ISSN: 2044-5385; 2044-5385
• DOI: 10.1038/bcj.2012.9

Bisphosphonates (BPs) are used intravenously to treat cancer-related conditions for the prevention of pathological fractures. Osteonecrosis of the jaw (BRONJ) is a rare complication reported in 4–15% of patients. We studied, retrospectively, 55 patients with multiple myeloma or Waldenstrom's macroglobulinemia followed up from different haematological departments who developed BRONJ. All patients were treated with BPs for bone lesions and/or fractures. The most common trigger for BRONJ was dental alveolar surgery. After a median observation of 26 months, no death caused by BRONJ complication was reported. In all, 51 patients were treated with antibiotic therapy, and in 6 patients, this was performed in association with surgical debridement of necrotic bone, in 16 with hyperbaric O 2 therapy/ozonotherapy and curettage and in 12 with sequestrectomy and O 2 /hyperbaric therapy. Complete response was observed in 20 cases, partial response in 21, unchanged in 9 and worsening in 3. The association of surgical treatment with antibiotic therapy seems to be more effective in eradicating the necrotic bone than antibiotic treatment alone. O 2 hyperbaric/ozonotherapy is a very effective treatment. The cumulative dosage of BPs is important for the evolution of BRONJ. Because the most common trigger for BRONJ was dental extractions, all patients, before BP treatment, must achieve an optimal periodontal health.