Occurrence of bisphosphonate-related osteonecrosis of the jaw after surgical tooth extraction

J Oral Maxillofac Surg. 2010 Apr;68(4):797-804. doi: 10.1016/j.joms.2009.10.026.

Abstract

Purpose: To evaluate the occurrence of bisphosphonate-related osteonecrosis of the jaw (BRONJ) in patients exposed to nitrogen-containing bisphosphonates (NBPs) requiring surgical tooth extraction.

Patients and methods: Sixty high-risk patients exposed to NBPs underwent surgical tooth extraction with bone biopsy and were treated with a 7-day cycle of oral antibiotics and discontinuation of NBPs for 1 month. BRONJ was defined as the occurrence of any BRONJ stage (0-3) at 3, 6, or 12 months of follow-up. Inferential analysis was performed on a per-bone (maxilla and/or mandible) basis (n = 72). The time to BRONJ was calculated, and age, gender, cancer diagnosis, and baseline osteomyelitis were evaluated as potential predictors. Exact logistic regression was used to model the time-to-outcome relationship, and hazard rates were calculated from logistic probabilities.

Results: BRONJ was detected at 3 months' follow-up in 4 bones and at 6 months in 1 further bone. In the whole cohort of bones, the hazard rate of BRONJ was 5.6% at 3 months and 1.5% at 6 months. Baseline osteomyelitis was a strong risk factor for BRONJ development (odds ratio, 156.96; exact 95% confidence interval, 18.99 to infinity; exact P < .0001).

Conclusion: In this 12-month follow-up study, BRONJ was a rare outcome in high-risk NBP users who underwent surgical tooth extraction. Moreover, baseline osteomyelitis was a very strong risk factor for BRONJ development.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Alveolar Process / diagnostic imaging
  • Alveolar Process / surgery
  • Bone Density Conservation Agents / adverse effects*
  • Bone Density Conservation Agents / chemistry
  • Bone Neoplasms / drug therapy
  • Bone Neoplasms / secondary
  • Cohort Studies
  • Diphosphonates / adverse effects*
  • Diphosphonates / chemistry
  • Female
  • Follow-Up Studies
  • Humans
  • Jaw Diseases / etiology*
  • Logistic Models
  • Male
  • Middle Aged
  • Multiple Myeloma / drug therapy
  • Nitrogen
  • Odds Ratio
  • Osteomyelitis / complications
  • Osteonecrosis / etiology*
  • Radiography
  • Risk Factors
  • Statistics, Nonparametric
  • Tooth Extraction / adverse effects*
  • Tooth Socket / diagnostic imaging
  • Tooth Socket / surgery
  • Young Adult

Substances

  • Bone Density Conservation Agents
  • Diphosphonates
  • Nitrogen