Journal of Clinical Oncology, Vol 24, No 6 (February 20), 2006: pp. 945-952
© 2006 American Society of Clinical Oncology.
DOI: 10.1200/JCO.2005.04.2465
Osteonecrosis of the Jaw in Multiple Myeloma Patients: Clinical Features and Risk Factors
Ashraf Badros,
Dianna Weikel,
Andrew Salama,
Olga Goloubeva,
Abraham Schneider,
Aaron Rapoport,
Robert Fenton,
Natalie Gahres,
Edward Sausville,
Robert Ord,
Timothy Meiller
From the University of Maryland Marlene and Stewart Greenebaum Cancer Center; University of Maryland Dental School, Baltimore, MD
Address reprint requests to Ashraf Badros, University of Maryland, Greenebaum Cancer Center, 22 S Greene St, Baltimore, MD 21201; e-mail: abadros{at}umm.edu
PURPOSE: To describe the clinical, radiologic, and pathologic features and risk factors for osteonecrosis of the jaw (ONJ) in multiple myeloma (MM) patients.
PATIENTS AND METHODS: A retrospective review of 90 MM patients who had dental assessments, including 22 patients with ONJ. There were 62 men; the median age was 61 years in ONJ patients and 58 years among the rest. Prior MM therapy included thalidomide (n = 67) and stem-cell transplantation (n = 72). Bisphosphonate therapy included zoledronate (n = 34) or pamidronate (n = 17) and pamidronate followed by zoledronate (n = 33). Twenty-seven patients had recent dental extraction, including 12 patients in the ONJ group. Median time from MM diagnosis to ONJ was 8.4 years for the whole group.
RESULTS: Patients usually presented with pain. ONJ occurred posterior to the cuspids (n = 20) mostly in the mandible. Debridement and sequestrectomy with primary closure were performed in 14 patients; of these, four patients had major infections and four patients had recurrent ONJ. Bone histology revealed necrosis and osteomyelitis. Microbiology showed actinomycetes (n = 7) and mixed bacteria (n = 9). More than a third of ONJ patients also suffered from long bone fractures (n = 4) and/or avascular necrosis of the hip (n = 4). The variables predictive of developing ONJ were dental extraction (P = .009), treatment with pamidronate/zoledronate (P = .009), longer follow-up time (P = .03), and older age at diagnosis of MM (P = .006).
CONCLUSION: ONJ appears to be time-dependent with higher risk after long-term use of bisphosphonates in older MM patients often after dental extractions. No satisfactory therapy is currently available. Trials addressing the benefits/risks of continuing bisphosphonate therapy are needed.
Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.
This article has been cited by other articles:

|
 |

|
 |
 
J. L. Kelsey and I. B. Lamster
Influence of Musculoskeletal Conditions on Oral Health Among Older Adults
Am J Public Health,
July 1, 2008;
98(7):
1177 - 1183.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
T. B. Dodson, N. S. Raje, P. A. Caruso, and A. E. Rosenberg
Case 9-2008 -- A 65-Year-Old Woman with a Nonhealing Ulcer of the Jaw
N. Engl. J. Med.,
March 20, 2008;
358(12):
1283 - 1291.
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
T. Ibrahim, F. Barbanti, G. Giorgio-Marrano, L. Mercatali, S. Ronconi, C. Vicini, and D. Amadori
Osteonecrosis of the Jaw in Patients with Bone Metastases Treated with Bisphosphonates: A Retrospective Study
Oncologist,
March 1, 2008;
13(3):
330 - 336.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
J. T. Grbic, R. Landesberg, S.-Q. Lin, P. Mesenbrink, I. R. Reid, P.-C. Leung, N. Casas, C. P. Recknor, Y. Hua, P. D. Delmas, et al.
Incidence of Osteonecrosis of the Jaw in Women With Postmenopausal Osteoporosis in the Health Outcomes and Reduced Incidence With Zoledronic Acid Once Yearly Pivotal Fracture Trial
J Am Dent Assoc,
January 1, 2008;
139(1):
32 - 40.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
F. Jadu, L. Lee, M. Pharoah, D. Reece, and L. Wang
A retrospective study assessing the incidence, risk factors and comorbidities of pamidronate-related necrosis of the jaws in multiple myeloma patients
Ann. Onc.,
December 1, 2007;
18(12):
2015 - 2019.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
S.L. Ruggiero and S.J. Drew
Osteonecrosis of the Jaws and Bisphosphonate Therapy
J. Dent. Res.,
November 1, 2007;
86(11):
1013 - 1021.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
J. A. Katzel, P. Hari, and D. H. Vesole
Multiple Myeloma: Charging Toward a Bright Future
CA Cancer J Clin,
September 1, 2007;
57(5):
301 - 318.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
S.-B. Woo and D. H. Solomon
Bisphosphonate Therapy for Cancer and Prevalence of Inflammatory Jaw Conditions
J Natl Cancer Inst,
July 4, 2007;
99(13):
986 - 987.
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
N. G. Shenker and A. S. M. Jawad
Bisphosphonates and osteonecrosis of the jaw
Rheumatology,
July 1, 2007;
46(7):
1049 - 1051.
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
R. A. Kyle, G. C. Yee, M. R. Somerfield, P. J. Flynn, S. Halabi, S. Jagannath, R. Z. Orlowski, D. G. Roodman, P. Twilde, and K. Anderson
American Society of Clinical Oncology 2007 Clinical Practice Guideline Update on the Role of Bisphosphonates in Multiple Myeloma
J. Clin. Oncol.,
June 10, 2007;
25(17):
2464 - 2472.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
D Aguiar Bujanda, U Bohn Sarmiento, M. Cabrera Suarez, and J Aguiar Morales
Assessment of renal toxicity and osteonecrosis of the jaws in patients receiving zoledronic acid for bone metastasis
Ann. Onc.,
March 1, 2007;
18(3):
556 - 560.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
C. D Krueger, P. M West, M. Sargent, A. E Lodolce, and A S. Pickard
Bisphosphonate-Induced Osteonecrosis of the Jaw
Ann. Pharmacother.,
February 1, 2007;
41(2):
276 - 284.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
C. Gridelli
The Use of Bisphosphonates in Elderly Cancer Patients
Oncologist,
January 1, 2007;
12(1):
62 - 71.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
P. Tosi, E. Zamagni, D. Cangini, P. Tacchetti, F. Di Raimondo, L. Catalano, A. D'Arco, S. Ronconi, C. Cellini, M. Offidani, et al.
Osteonecrosis of the jaws in newly diagnosed multiple myeloma patients treated with zoledronic acid and thalidomide-dexamethasone.
Blood,
December 15, 2006;
108(12):
3951 - 3952.
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
T. A. Guise
Bone Loss and Fracture Risk Associated with Cancer Therapy
Oncologist,
November 1, 2006;
11(10):
1121 - 1131.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
G Sanna, L Preda, R Bruschini, M Cossu Rocca, S Ferretti, L Adamoli, E Verri, L Franceschelli, A Goldhirsch, and F Nole
Bisphosphonates and jaw osteonecrosis in patients with advanced breast cancer
Ann. Onc.,
October 1, 2006;
17(10):
1512 - 1516.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
M. J. Somerman and L. K. McCauley
Bisphosphonates: Sacrificing the Jaw to Save the Skeleton?
IBMS BoneKEy,
September 1, 2006;
3(9):
12 - 18.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
B. Mehrotra and S. Ruggiero
Bisphosphonate Complications Including Osteonecrosis of the Jaw
Hematology,
January 1, 2006;
2006(1):
356 - 360.
[Abstract]
[Full Text]
[PDF]
|
 |
|
|