Bone Abstracts

Bisphosphonates (BP) are powerful bone resorption inhibitors. They are used for the symptomatic treatment of malignant osteolytic bone disease (e.g. multiple myeloma and bone metastasis), as well as bone diseases associated with high bone resorption (e.g. postmenopausal osteoporosis, cortisone-induced osteoporosis). However, recent data showed that a rare, but serious, adverse effect of BP therapy is osteonecrosis of the jaw (BRONJ). Given the increasing number of persons receiving chronic oral-BP therapy, it is important to accurately identify pathogenesis, risk factors and management strategies for BRONJ in patients with non-malignant disease. The objective of this study was to review cases of BRONJ occurring in association with benign disease and to describe and compare the clinical course and outcome for patients with BRONJ and rheumatoid arthritis or osteoporosis. We retrospectively reviewed observations of all patients referred for treatment and follow-up for BRONJ from January 2007 to December 2011. Demographic data, medical history, maxillofacial findings, BRONJ treatment and follow-up were reviewed for each case. Over a 5-year period, we diagnosed 112 patients with BRONJ. Among these patients, 15 received bisphosphonate treatment for non-malignant disease. Patients received bisphosphonates for a variety of reasons: eight (53%) to prevent osteoporosis in association with underlying rheumatoid arthritis; six (40%) to prevent idiopathic osteoporosis, and one (7%) to treat ankle algodystrophy. The mean oral bisphosphonate exposure period was 48.4 months. In 13 cases (86.6%), BRONJ was diagnosed following dental extraction. Major surgery, sequestrectomy or alveolectomy was performed in nine patients (60%), all of whom healed within 3–36 months. Comparative analysis of all the variables showed no statistically significant differences between patients with rheumatoid arthritis and others.in conclusion, within the limits of our study, we were unable to demonstrate a difference in BRONJ disease spectrum, clinical course or outcome between patients with or without rheumatoid arthritis.