Decreasing Frequency of Osteonecrosis of the Jaw in Cancer and Myeloma Patients Treated with Bisphosphonates: The Experience of the Oncology Network of Piedmont and Aosta Valley (North-Western Italy)
Background. Data concerning frequency of Osteonecrosis of Jaws (ONJ) are mostly based on single center experiences. Patients and Methods. Since 2005 a multidisciplinary study group collected data of cases of ONJ in patients treated with Bisphosphonates (BP) and observed in oncology and hematology centers of a regional network. Results. By December 2008, 221 cases were registered. We report details of 200 cases, identified after cross-checking reports from centres of medical oncology, haematology, and oral care. Primary neoplasm was breast cancer (39%), myeloma (32%), prostate cancer (16%), and other types of cancer (8%). In about 50% of the cases a history of dental extraction was present. Zoledronic acid was administered (alone or with other BP) to 178 patients (89%). Median time from first infusion to ONJ diagnosis was 21.0 (zoledronic acid only) and 39.0 months (pamidronate only). The number of ONJ cases per year was 3 in 2003, 21 in 2004, 58 in 2005, 60 in 2006, 37 in 2007, and 21 in 2008. Conclusion. The number of new ONJ cases in cancer and myeloma patients increased until 2006 and then reduced. The possible reasons of this trend (introduction of zoledronic acid; increase of ONJ awareness; diffusion of preventive dental measures; late modifications of BP prescription) are herein discussed. 1. Introduction Bisphosphonates (BPs) are widely prescribed at different doses, way of administration (oral versus IV) and treatment durations, for a range of bone diseases including cancer-induced bone disease, osteoporosis, and Paget’s disease. Most of IV prescriptions of more potent BPs are written for patients affected by myeloma or bone metastases from solid cancer [1]. Despite the optimal duration of treatment with BPs is unknown, several recommendations and position papers suggested in the past that administration of BP should be carried on indefinitely [2–4]. Osteonecrosis of the Jaws (ONJ) was first reported in patients treated with BPs in North American literature in 2003 [5, 6]. Ever since a large amount of case reports and case series have been published worldwide [6, 7], although, quite surprisingly, no cases were reported in previously published randomized controlled trials (RCT) that led to the introduction of BP in the therapy armamentarium. The paucity of data from well-designed prospective trials do not allow to estimate the precise incidence of ONJ among subjects exposed to BPs [8–11]. According to several published reports (cohort studies, case series, usually based on single centre experience), the frequency of ONJ in cancer patients
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