Osteoporosis and bisphosphonates-related osteonecrosis of the jaw: Not just a sporadic coincidence – a multi-centre study☆

Received 7 February 2010; accepted 20 May 2010. published online 28 June 2010.
Corrected Proof

Summary

Introduction

Bisphosphonates (BPs) are powerful drugs that inhibit bone metabolism. Adverse side effects are rare but potentially severe such as bisphosphonate-related osteonecrosis of the jaw (BRONJ). To date, research has primarily focused on the development and progression of BRONJ in cancer patients with bone metastasis, who have received high dosages of BPs intravenously. However, a potential dilemma may arise from a far larger cohort, namely the millions of osteoporosis patients on long-term oral BP therapy.

Patients and methods

This current study assessed 470 cases of BRONJ diagnosed between 2004 and 2008 at eleven different European clinical centres and has resulted in the identification of a considerable cohort of osteoporosis patients suffering from BRONJ. Each patient was clinically examined and a detailed medical history was raised.

Results

In total, 37/470 cases (7.8%) were associated with oral BP therapy due to osteoporosis. The majority (57%) of affected individuals did not have any risk factors for BRONJ as defined by the American Association of Oral and Maxillofacial Surgery. The average duration of BP intake of patients without risk factors was longer and the respective patients were older compared to patients with risk factors, but no statistical significant difference was found. In 78% of patients the duration of oral BP therapy exceeded 3 years prior to BRONJ diagnosis.

Discussion

The results from this study suggest that the relative frequency of osteoporosis patients on oral BPs suffering from BRONJ is higher than previously reported. There is an urgent need to substantiate epidemiological characteristics of BRONJ in large cohorts of individuals.

Keywords: bisphosphonate, bisphosphonate-related osteonecrosis of the jaw, BRONJ, osteoporosis, osteonecrosis, necrosis, ONJ, oral

1 Department of Oral and Maxillofacial Surgery (Head of Department: Prof. Dr. Dr. Michael Ehrenfeld), University of Munich, Lindwurmstr. 2a, D-80336 Munich, Germany

2 Department of Oral and Maxillofacial Surgery (Head of Department: Prof. Dr. Dr. Thomas Kreusch), Asklepios Klinik Nord – Heidberg, Tangstedter Landstr. 400, D-22417 Hamburg, Germany

3 Department of Oral Medicine (Head of Department: Prof. Stephen Porter), UCL Eastman Dental Institute, 256 Gray’s Inn Road, WC1X 8LD London, UK

4 Faculty of Health Sciences and Medicine (Chair of Surgery: Prof. Dr. Dr. Patrick H. Warnke), Bond University, Gold Coast, Queensland 4229, Australia

5 Department of Oral and Maxillofacial and Facial Plastic Surgery (Head of Department: Prof. Dr. Dr. Jörg Wiltfang), University of Kiel, Arnold-Heller-Strasse 16, D-24105 Kiel, Germany

6 Department of Oral and Maxillofacial Surgery (Head of Department: Prof. Dr. Dr. Klaus-Dietrich Wolff), Technische Universität München, Ismaninger Str. 22, D-81675 Munich, Germany

7 Department of Oral and Maxillofacial Plastic Surgery (Prof. Dr. Dr. Martin Kunkel succeeded Prof. Dr. Dr. Klaus-Dietrich Wolff as Head of Department in Feb 2008), Ruhr-University Bochum, Knappschaftskrankenhaus Bochum-Langendreer, D- 44892 Bochum, Germany

8 Department of Oral and Maxillofacial Surgery (Head of Department: Prim. Univ.-Doz. DDr. Oliver Ploder), Landeskrankenhaus Feldkirch, A-6807 Feldkirch, Austria

9 Experimental Surgery and Regenerative Medicine, Department of Surgery (Head of Department: Prof. Dr. Matthias Schieker), University of Munich, Nussbaumstraße 20, D-80336 Munich, Germany

10 Department of Cranio-Maxillofacial Surgery (Head of Department: Prof. Dr. Dr. Tateyuki Iizuka), University of Bern, Inselspital, CH-3010 Bern, Switzerland

11 Department of Oral and Maxillofacial Surgery (Head of Department: Prof. Dr. Dr. Andreas Neff), University of Marburg, Georg-Voigt-Straße 3, D-35039 Marburg, Germany

12 Department of Oral Sciences (Head of Department: Prof. Messina Pietro), University of Palermo, Via del Vespro 129, 90127 Palermo, Italy

13 Department of Head and Neck Surgery (Head of Department: Prof. Sergio Tartaro), Second University of Naples, Piazza Miraglia, 80100 Naples, Italy

14 Pharmaceutical Science Division (Head of Department: Prof. Frank Kelly), King’s College London, London SE1 9NH, UK

PD Dr. Dr. Christoph Pautke, MD, DMD, Senior Consultant, Department of Oral and Maxillofacial Surgery, University of Munich, Lindwurmstr. 2a, D-80337 Munich, Germany. Tel.: +49 (0) 89 5160 2919; Fax: +49 (0) 89 5160 4743.

☆ The study was not supported by research grants or any other sources.

PII: S1010-5182(10)00130-7

doi:10.1016/j.jcms.2010.05.009