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Bisphosphonate-related osteonecrosis of the jaw in patients with oral bisphosphonate exposure: clinical course and outcomes.
- Source :
-
Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons [J Oral Maxillofac Surg] 2012 Aug; Vol. 70 (8), pp. 1844-53. Date of Electronic Publication: 2012 May 16. - Publication Year :
- 2012
-
Abstract
- Purpose: To characterize the spectrum and outcomes of bisphosphonate-related osteonecrosis of the jaw (BRONJ) occurring with oral bisphosphonate therapy.<br />Materials and Methods: We assembled a retrospective cohort of patients who had developed oral BRONJ according to the 2009 American Association of Oral and Maxillofacial Surgeons criteria and received care within Kaiser Permanente, Northern California, during 2004 to 2011. Patients with intravenous bisphosphonate exposure were excluded. The demographic factors, comorbidities, pharmacologic exposure, maxillofacial findings, and outcomes were ascertained from the clinical and radiologic records.<br />Results: We identified 30 cases of oral BRONJ (median age 77 years, 87% women). All had received oral bisphosphonate for osteoporosis/osteopenia (median duration 4.4 years, interquartile range 1.9 to 6.6). More than one half (57%) had comorbidities or relevant drug exposure, including rheumatoid arthritis, diabetes, glucocorticoid therapy, and disease-modifying antirheumatic medications. Extractions preceded BRONJ in 17 patients and trauma in 3; 10 developed BRONJ spontaneously. Overall, 83% had healed within 3 to 52 months, although the relative rate of healing varied by antecedent factor and/or the presence of comorbid conditions/exposures. Nearly all patients with trauma-related and spontaneous BRONJ healed within 1 year (median 7.0 and 7.5 months, respectively) compared with those developing BRONJ after extraction, in whom the median time to healing was 18 months (P < .0001). Patients with relevant comorbidities had a lower probability of healing (P = .0002) and a longer median time to healing (20 months) than patients without comorbidities (7.5 months).<br />Conclusions: We found that postextraction patients and those with comorbid conditions/exposures showed refractory BRONJ with prolonged healing times. Practitioners should be aware that the BRONJ clinical course and outcome varies depending on the antecedent factor and comorbidity status.<br /> (Copyright © 2012. Published by Elsevier Inc.)
- Subjects :
- Administration, Oral
Aged
Aged, 80 and over
Alendronate administration & dosage
Alendronate adverse effects
Anti-Bacterial Agents therapeutic use
Antirheumatic Agents therapeutic use
Bisphosphonate-Associated Osteonecrosis of the Jaw surgery
Bone Density Conservation Agents adverse effects
Bone Diseases, Metabolic drug therapy
Chronic Disease
Cohort Studies
Debridement
Diphosphonates adverse effects
Female
Follow-Up Studies
Glucocorticoids therapeutic use
Humans
Ibandronic Acid
Male
Middle Aged
Osteolysis etiology
Osteoporosis drug therapy
Osteosclerosis etiology
Retrospective Studies
Tooth Extraction
Treatment Outcome
Wound Healing physiology
Bisphosphonate-Associated Osteonecrosis of the Jaw etiology
Bone Density Conservation Agents administration & dosage
Diphosphonates administration & dosage
Subjects
Details
- Language :
- English
- ISSN :
- 1531-5053
- Volume :
- 70
- Issue :
- 8
- Database :
- MEDLINE
- Journal :
- Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons
- Publication Type :
- Academic Journal
- Accession number :
- 22595135
- Full Text :
- https://doi.org/10.1016/j.joms.2011.08.033