Current prospective management of patients with osteonecrosis drug-induced (bisphosphonates) of the jaws: our experience
© Giudice and Cristofaro; licensee BioMed Central Ltd. 2010
Published: 19 May 2010
Bisphosphonates (BP) are frequently used for the treatment of multiple myeloma, bone metastasis and for osteoporosis, the most used are Alendronic and Zolendronic acids (1). This type of drugs, especially Zolendronic acid, pointed out a serious side effect: ostenecrosis of the jaws (ONJ). It is demonstrated they reduce bone turn-over and induce apoptosis of the osteoclasts. BP have remarkable ability of anti-angiogenesis, that together to micro-traumas and inflammations, it can be a contributory cause of the ONJ onset.
Patients can remain asymptomatic even for a long time, but secondary infection of the bone exposed due to teeth extraction or other surgical procedures cause pain (2), soft tissue swelling, purulent collections that can drain in the mouth or outside.
Materials and methods
Stage 0 (sub-clinic stage)
Stage I (bone-exposure without pain and infection)
a lesion < 1cm
b lesion > 1cm
Stage II (bone-exposure with pain and infection)
a lesion < 2cm
b lesion > 3cm
a bone-exposure > 3cm with clear osteolyses
b pathological fractures; ect..
To date management of ONJ patients is difficult for the prognosis and therapy, expecially for several cases.
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