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Bisphosphonate-Related Osteonecrosis of the Jaw

Daniel Rachev, Desislav Dobrev, Borislava Toncheva, Rossen Kolarov


Introduction: Bisphosphonates are efficiently used to treat osteoporosis, bone metastases of malignant tumors, Paget`s disease and multiple myeloma. Bisphosphonate-related osteonecrosis of the jaw (BRONJ) represents a severe side effect, consisting of progressive bone destruction in the maxillofacial region. The aim of the study is to present clinical information from patients diagnosed with medication-related osteonecrosis of the jaw.

Materials and Methods: A retrospective study was performed involving 32 patients hospitalized at the Specialized Hospital for Maxillofacial Surgery in Sofia, Bulgaria with diagnosis of osteonecrosis of the jaws. The selection criteria of the patients were based on the existence of history of bisphosphonate treatment.

Results: Thirty-one patients were on a bisphosphonate therapy for bone metastasis. Among cancer patients, the use of denosumab and zoledronic acid was reported. One patient had received oral treatment with ibandronic acid for osteoporosis. In 23 patients, the bone lesions involved the lower jaw, while in 9 patients the lesions persisted in the maxillary bone. Twenty-eight patients were diagnosed with a second stage of BRONJ. Exposed bone, purulent secretion, fistulas and swelling were clinically observed among patients. All of the patients received antibiotic treatment for BRONJ, while 2 of them were treated surgically. All patients were discharged with improvement after the treatment. Six patients were hospitalized again after time due to remission.

Conclusion: In conclusion, the study shows that BRONJ is mainly associated with the use of denosumab and zoledronic acid. Most of the patients seek medical attention in second stage of osteonecrosis. The recommended conservative treatment with antibiotics can lead to remission only in some cases.  


bisphosphonate, osteonecrosis, jaws



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