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Prospective, mono-institutional study of the impact of a systematic prevention program on incidence and outcome of osteonecrosis of the jaw in patients treated with bisphosphonates for bone metastases

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Abstract

The aim of our study was to investigate the occurrence of osteonecrosis of the jaw (ONJ) after implementation of dental preventive measures before starting bisphosphonates (BPs) therapy and during treatment. All consecutive patients with bone lesions eligible for BPs treatment were prospectively evaluated. Before starting BPs, each patient underwent a strict dental preventive program with a specialized odontoiatric team. The odontoiatric evaluation identified patients with oral pathologies or inadequate oral hygiene and provided a dental preventive treatment. From April 2007 to April 2012, 254 patients were enrolled. After excluding patients due to previous BPs treatment, 212 patients with a mean age of 74 years (range 37–95) were included. On average, patients received 9.7 treatment cycles (range 1–48). No ONJ was recorded (0.0 %; 95 % confidence interval [CI] 0.0–1.4). Comparing this risk with that observed in a previous cohort who did not receive dental prevention (16/186, 8.6 %; 95 % CI 4.2–15.3 %), we observed clear efficacy in preventing ONJ (relative risk reduction: 100 %, 95 % CI 86–100 %, P < 0.0001). We developed a strict three-step prevention program that is able to decrease ONJ incidence and the need for destructive surgery with permanent sequelae. We demonstrated that ONJ could be effectively prevented. We recommend a mandatory preventive program involving a multidisciplinary team for all patients starting BPs.

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Acknowledgments

This research was not funded by any sponsor.

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All authors have no conflicts of interest.

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Authors and Affiliations

  1. Department of Oncology, A.O. Fatebenefratelli e Oftalmico, Corso di Porta Nuova 23, 20121, Milan, Italy

    Annalisa Bramati, Serena Girelli, Gabriella Farina, Maria Chiara Dazzani, Anna Moretti, Sheila Piva, Mariastella Dimaiuta & Nicla La Verde

  2. Laboratory of Methodology for Biomedical Research, IRCCS-Istituto di Ricerche Farmacologiche “Mario Negri”, via La Masa 19, 20156, Milan, Italy

    Valter Torri

Authors
  1. Annalisa Bramati
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  2. Serena Girelli
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  3. Gabriella Farina
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  6. Anna Moretti
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Correspondence to Annalisa Bramati.

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Bramati, A., Girelli, S., Farina, G. et al. Prospective, mono-institutional study of the impact of a systematic prevention program on incidence and outcome of osteonecrosis of the jaw in patients treated with bisphosphonates for bone metastases. J Bone Miner Metab 33, 119–124 (2015). https://doi.org/10.1007/s00774-014-0566-x

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  • DOI: https://doi.org/10.1007/s00774-014-0566-x

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