Bisphosphonates and osteonecrosis of the jaw: a case report

Uncommon presentation of medication-related osteonecrosis of the mandible in a patient with metastatic prostate cancer

An 82-year-old man with a background of prostate carcinoma and bony metastases presented with bilateral discharging neck fistulae. Two years prior to presentation, the patient had been treated with intravenous zoledronic acid for 1 year as part of chemotherapy. Intraoral examination revealed extensive bilateral medication-related osteonecrosis, with orocutaneous fistulae within the neck. Treatment comprised removal of loose necrotic bone sequestrae, debridement of the fistulae and long-term administration of antibiotics, vitamin E and pentoxifylline. Four weeks later, the orocutaneous fistulae had healed.

Bisphosphonate-related osteonecrosis of jaws in advanced stage breast cancer was detected from bone scan: a case report

Bisphosphonates (BPs) are indicated to treat skeletal-related events (SREs) for cancer patients with bone metastasis. We report a 79-year-old woman with advanced stage breast cancer with bone metastasis who was prescribed BPs (zoledronate), then developed osteonecrosis of jaw. We provide a brief review of the pathogenesis, diagnosis and treatment of this complication.

Radiography finding in the jaws in children taking bisphosphonate

BACKGROUND

Bisphosphonates‎ inhibit osteoclasts, prevent bone resorption and decrease bone turnover. This study examined radiography finding in bisphosphonate-associated osteonecrosis of jaws.

MATERIALS AND METHODS

This is a retrospective series of 12 clinically diagnosed patients between 7 to 21 year old (average 13 years). They required emergency dental conditions requiring management by dentist: non healing ‎extraction sockets and pain of bone exposure. The panoramic radiography and cone beam computed tomography was performed ‎to assess the problem. Thickening of the lamina dura was observed in 7 patients (58.3 %). But full-thickness sclerosis was seen in 6 patients (50 %). Sclerotic changes in the mandibular canal were noted in 3 patients (25 %). 5 patients (41.6 %) had poorly healing or non-healing of socket in extracted tooth and periapical lucencies. 4 people (33.3 %) had widening of periodontal ligament (PDL) space and osteolysis. Sequestra were seen in 3 persons (25 %). Finally in 2 children (16.6 %) were found oroantral fistula. Only one child (8.3 %) had thickening of soft tissue mid periosteal reaction.

RESULTS

Most patients had some degree of osteosclerosis, especially in the area of alveolar bone. Thickening of the lamina dura was also seen in children. Other findings include: osteolysis, sequestra, periosteal new bone formation, widening of PDL,soft tissue thickening, non healing extraction sockets, oroantral fistula and periapical lucencies (P-value < 0.05).

CONCLUSION

Common radiographic features in patients taking bisphosphonate, was osteosclerosis. This sclerosis had different views that thickening of the lamina dura and alveolar crest were most common.

A systematic review of microsurgical reconstruction of the jaws using vascularized fibula flap technique in patients with bisphosphonate-related osteonecrosis

Objective

The aim of this systematic review was to assess the role of microsurgical reconstruction of the jaws in patients with bisphosphonate-related osteonecrosis, and biological complications after an observation period of at least 12 months.

Material and methods

An electronic MEDLINE search supplemented by manual searching was conducted to identify studies reporting data of at least 12 months observation on the microsurgical reconstruction of the jaws in patients with bisphosphonate-related osteonecrosis.

Results

Four studies resulted eligible for the analysis yielded. Three out of five studies were free of complications, with a success rate of 100% as no recurrence of osteonecrosis was registered.

Conclusions

Microsurgical reconstruction of the jaws represents a valid treatment modality in patients with bisphosphonate-related osteonecrosis at 3^rd stage of the disease.

Estudo de publicações em periódicos gerais de artigos sobre ortopedia e aparelho locomotor

Os autores estudam o perfil de publicação de artigos sobre ortopedia e área de interesse em aparelho locomotor em revistas gerais, não específicas de ortopedia, com registro no PUBMED, em um período de dois anos. Selecionados 67 artigos com distribuição heterogênea entre as revistas estudadas foi constatada presença de 26,47% de artigos com desenho de intervenção e 38% com desenho observacional. Os dados são comentados.

Bisphosphonate osteonecrosis of the jaw: a literature review of UK policies versus international policies on the management of bisphosphonate osteonecrosis of the jaw

Despite the increasing number of cases of osteonecrosis of the jaws related to bisphosphonate therapy described in the literature there is a paucity of evidence-based treatment for the condition. In this second article on bisphosphonate-related jaw complications we discuss the different treatment strategies for the condition, review current literature, particularly in relation to the recommendations that have been published, and discuss the evidence behind them.