Bisphosphonate-Related Osteonecrosis of the Jaw: Preventive Strategies and Clinical Implications. A Review of 282 Patients.

Objective:  To describe and evaluate the effectiveness of oral and dental prevention strategies for cancer patients who were about to begin bisphosphonate (BP) intravenous therapy with zoledronate.

Methods:  Patients were divided into 2 groups according to their history with BPs: group PA (preventive approach) and group OB (observation). Group PA patients had never been previously treated with BPs, and group OB patients had already undergone therapy with BPs. All patients received a complete oral and dental examination and had a panoramic radiograph. If necessary, oral hygiene, and restorative and rehabilitation therapy were offered to patients. All patients participated in regular checkups every 6 months. Group PA patients underwent oral surgical procedures, as needed.

Results:  A total of 282 patients (162 women, 120 men) were included in this analysis (PA: n = 217; OB: n = 65). In group OB, 4.6% of patients presented with osteonecrosis of the jaw (ONJ) at first visit and 10.8% developed new ONJ during the 18-month follow-up period. No patients in group PA had ONJ. Anti-angiogenic therapy was associated with ONJ (p < 0.01) and patients with a higher number of zoledronate infusions were significantly more likely to develop ONJ (p < 0.01).

Conclusion:  Although the incidence of BP-related ONJ is fairly low, it remains a painful and difficult complication to treat. An interdisciplinary preventive approach is essential to prevent and manage this condition.