This Article Full Text (PDF) All Versions of this Article: theoncologist.2008-0091v1 13/8/911    most recent eLetters: Submit a response to this article Purchase Article View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services E-mail this article link to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Reprints/Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Estilo, C. L. Articles by Huryn, J. M. Search for Related Content PubMed PubMed Citation Articles by Estilo, C. L. Articles by Huryn, J. M.

Osteonecrosis of the Maxilla and Mandible in Patients with Advanced Cancer Treated with Bisphosphonate Therapy

^aDental Service, Department of Surgery, ^cDepartment of Epidemiology and Biostatistics, ^dSurgical Pathology Service, Department of Pathology, ^eNuclear Medicine Service, Department of Radiology, ^fEndocrinology Service, Department of Medicine, and ^gBreast Cancer Medicine Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York, USA; ^bDepartment of Internal Medicine, University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan, USA

Key Words. Key Words. • Bisphosphonate therapy • Pamidronate • Zoledronic acid • Osteonecrosis of the jaw

Correspondence: Cherry L. Estilo, D.M.D., Dental Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, New York 10021, USA. Telephone: 212-639-7644; Fax: 212-717-3601; e-mail: estiloc{at}mskcc.org

Received April 14, 2008; accepted for publication July 10, 2008; first published online in THE ONCOLOGIST Express on August 11, 2008.

ABSTRACT

Cases of osteonecrosis of the jaw (ONJ) have been reported with an increasing frequency over the past 5 years. ONJ is most often identified in patients with cancer who are receiving intravenous bisphosphonate (IVBP) therapy, but it has also been diagnosed in patients receiving oral bisphosphonates for nonmalignant conditions. To further categorize risk factors associated with ONJ and potential clinical outcomes of this condition, we performed a retrospective study of patients with metastatic bone disease treated with intravenous bisphosphonates who have been evaluated by the Memorial Sloan-Kettering Cancer Center Dental Service between January 1, 1996 and January 31, 2006. We identified 310 patients who met these criteria. Twenty-eight patients were identified as having ONJ at presentation to the Dental Service and an additional 7 patients were subsequently diagnosed with ONJ. Statistically significant factors associated with increased likelihood of ONJ included type of cancer, duration of bisphosphonate therapy, sequential IVBP treatment with pamidronate followed by zoledronic acid, comorbid osteoarthritis or rheumatoid arthritis, and benign hematologic conditions. Our data do not support corticosteroid use or oral health as a predictor of risk for ONJ. Clinical outcomes of patients with ONJ were variable with 11 patients demonstrating improvement or healing with conservative management. Our ONJ experience is presented here.

This article has been cited by other articles:

				K. Vahtsevanos, A. Kyrgidis, E. Verrou, E. Katodritou, S. Triaridis, C. G. Andreadis, I. Boukovinas, G. E. Koloutsos, Z. Teleioudis, K. Kitikidou, et al. Longitudinal Cohort Study of Risk Factors in Cancer Patients of Bisphosphonate-Related Osteonecrosis of the Jaw J. Clin. Oncol., November 10, 2009; 27(32): 5356 - 5362. [Abstract] [Full Text] [PDF]

				Y. Morag, M. Morag-Hezroni, D. A. Jamadar, B. B. Ward, J. A. Jacobson, S. R. Zwetchkenbaum, and J. Helman Bisphosphonate-related Osteonecrosis of the Jaw: A Pictorial Review RadioGraphics, November 1, 2009; 29(7): 1971 - 1984. [Abstract] [Full Text] [PDF]

				S. A. Almazrooa and S.-B. Woo Bisphosphonate and Nonbisphosphonate-Associated Osteonecrosis of the Jaw: A Review J Am Dent Assoc, July 1, 2009; 140(7): 864 - 875. [Abstract] [Full Text] [PDF]

				T. Van den Wyngaert, M. T. Huizing, E. Fossion, and J. B. Vermorken Bisphosphonates in Oncology: Rising Stars or Fallen Heroes Oncologist, February 1, 2009; 14(2): 181 - 191. [Abstract] [Full Text] [PDF]

				J. B. Aragon-Ching and W. L. Dahut Osteonecrosis of the Jaw and the Use of Antiangiogenic Agents: Just an Association? Oncologist, December 1, 2008; 13(12): 1314 - 1314. [Full Text] [PDF]

				C. L. Estilo, C. Van Poznak, and J. M. Huryn In Reply Oncologist, December 1, 2008; 13(12): 1315 - 1315. [Full Text] [PDF]