Bisphosphonates-associated jaws osteonecrosis . A forty-five patients' 36 months follow-up

Osteonecrosis of the jaw (BRONJ) is an unremitting adverse outcome associated with bisphosphonate therapy, intravenous administered, in patients with bone metastases from solid tumors, multiple myeloma or marked osteoporosis. Objectives: to investigate a group of patients, affected of osteonecrosis related to bisphosphonates treatment, during a period of 36 months. Methods: A cohort of fourty-five patients affected by exposition of necrotic bone of the jaws associated with bisphosphonates were reviewed to determine the type, dosage, and duration of their bisphosphonate therapy, presenting findings, comorbidities, and the event that incited the bone exposure. In each case a strict control of the bone infection was performed by the use of antimicrobial theraphy and local disinfection of the lesions. In selected serious cases, conservative sequestrectomy and/or hyperbaric oxygen therapy were added to the basic treatment protocol.Results: BRONJ occurred after a tooth extraction procedure in most cases.Interruption of bisphosphonates therapy has not reduced the presence of osteonecrosis. To date no one of the 45 patients reported a total remission of BRONJ. Conservative surgical debridment of the involved site, seemed to determine a temporary benefit of clinical conditions, without a susbstantial improvement of underlying bone pathology. Hyperbaric oxygen therapy, which has proven efficacious in other forms of osteonecrosis by establishing an oxygen gradient, didn't gain similar results. Antibiotic therapy was useful to control swelling and exudate production but ineffective on preventing progression of the exposed bone. Efficacious pain management was obtained by administration of pregabalin and paracetamol in patients with VAS scores ranging from 4 to 10. Conclusion: To date, prevention of bone infection represents the only reasonable therapeutic approach to management of acclaimed BRONJ. When possible, invasive oral surgical procedures must to be performed before the beginning of i.v. bisphosphonates therapy.