Clinical aspects of bisphosphonate-associated oral osteonecrosis: Patients and methods
Posted by JamesWe analysed the clinical data of 9 patients demanding treatment for maxillary bone necrosis of unknown origin, sent to us by the Haematology department of the “San Giacomo” Hospital of Rome. The 9 patients belong to a group of 54 patients (41F, 13M) who were under bisphosphonate treatment for multiple myeloma, osteoporosis, hyperparathyroidism and Paget’s disease (Table I).
Table I – Group of analysed patients.
|
Diagnosis |
Patient’s number |
|
|
Asymptomatic myeloma |
4 |
(3F, 1M) |
|
Symptomatic myeloma |
36 |
(28F, 8M) |
|
Osteoporosis |
8 |
(6F, 2M) |
|
Hyperparathyroidism |
4 |
(4F) |
|
Paget’s disease |
2 |
(2M) |
|
Total |
54 |
(41F, 13M) |
Table II shows the clinical data of the 9 patients with maxillary osteonecrosis associated with bisphosphonate treatment. The group included 8 females and 1 male, with average age 71 years (range 89-59) and affected for multiple myeloma (6 cases), chronic leukemia (1 case), osteoporosis (1 case) and Waldenstrom’s disease with osteoporosis (1 case). Average bisphosphonates treatment duration was 42 months (range 18-75). Oral manifestations were of upper maxillary osteonecrosis areas in 4 cases and mandibular lesions in 5 cases. All patients were under observation because of the presence of an infection in the exposed areas, with stinging and diffused pain that demanded systemic antibiotic treatment.
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Table II – Demographics of 9 patients with bisphosphonates-associated oral cavity osteonecrosis.
|
Patient n. |
Sex |
Age |
Systemic disease |
Bisphosphonates therapy (months) |
Oral manifestations (type/location) |
Therapy |
|
1 |
F |
81 |
Multiple myeloma-k |
Pamidronate (2) Zolendronate (27) |
Osteonecrosis, infection/ mandible postextraction |
Antibiotics, Rinses, Analgesics |
|
2 |
F |
58 |
Waldenstrom’s disease and severe osteoporosis |
Pamidronate (59) Zolendronate (27) |
Osteonecrosis, infection/ maxilla |
Sequestrectomy, Hyperbaric oxigen therapy, Antibiotics |
|
3 |
M |
84 |
Multiple myeloma IgG-lamba |
Zolendronate (18) |
Osteonecrosis, infection/ maxilla postextraction |
Sequestrectomy, Antibiotics |
|
4 |
F |
59 |
Multiple myeloma IgA-k |
Pamidronate (75) |
Osteonecrosis, infection/ mandible postextraction |
Sequestrectomy, Hyperbaric oxigen therapy, Antibiotics |
|
5 |
F |
67 |
Multiple myeloma IgG-k |
Pamidronate (13) Zolendronate (34) |
Osteonecrosis, infection/ mandible postextraction |
Sequestrectomy, Hyperbaric oxigen therapy, Antibiotics |
|
6 |
F |
70 |
Multiple myeloma IgG-k |
Pamidronate (53) Zolendronate (27) |
Osteonecrosis, infection/ maxilla |
Antibiotics, Rinses |
|
7 |
F |
72 |
Severe osteoporosis with chronic lymphatic leukemia |
Pamidronate (26) Zolendronate (20) |
Osteonecrosis, infection/ mandible postextraction |
Sequestrectomy, Hyperbaric oxigen therapy, Antibiotics |
|
8 |
F |
71 |
Severe osteoporosis |
Pamidronate (3) Zolendronate (47) |
Osteonecrosis/mandible |
Antibiotics, Rinses |
|
9 |
F |
78 |
Multiple myeloma IgG-k |
Pamidronate (20) Zolendronate (29) |
Osteonecrosis, infection/ maxilla |
Hyperbaric oxigen therapy, Antibiotics |
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