Biophosphonate-related osteonecrosis of the jaws, eight cases report

Background: Biophosphonates are kinds of world wide application drugs for the management of resorptable bony lesions such as osteoporosis, hypercalcemia of malignancy and Paget's disease. This has close linkage to its action of anti-osteoclastic activity. However in 2003 the first report of osteonecrosis of the jaws caused by biophosphonate published, from then on, this serious biophosphonates related complication is raising more and more attentions. Objective: To discuss the biophosphonate related osteonecrosis of the jaws in the aspects of clinical manifestation, management, risk and prevention. Methods: Retrospectively analysis of 8 cases with osteonecrosis of jaws induced by biophosphonates was done. Of them 4 were males, 4 females (median age 64 years). All of them received IV amino-biophosphonates (Pamidronate, zolendronate, clodronate) for the treatment of bony metastasis (Multiple myeloma, breast cancer, lung cancer) for average 43 months. 4 cases involved in mandible, two in maxilla, two in both jaws. All cases had episodes of trauma in the alveolar bone (extraction and denture trauma) before occurrence of osteonecrosis. Subsequently conservative procedures (local debridement with /without B.I.P.P pack) and anti-infection coverage were given to all patients. Results: No characteristic radiographic appearance (OPG or CT scan) in the biophosphonate related osteonecrosis of the jaws. Following the palliative management, the symptoms (bone exposure, pain, swelling and oral odor) were relieved in different degree from asymptomatic stabilization to wound completely healing. No disfigure disaster occurred in all the cases. Conclusion: Guideline of the risk, prevention, and management of biophosphonate related osteonecrosis of the jaws were established initially.