ONJ Osteonecrosis of the Jaw in BisphosphonateTreated Cancer Patients

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ONJ (Osteonecrosis of the Jaw) in
Bisphosphonate-Treated Cancer Patients
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• Bisphosphonates effectively manage bone
  complications from cancer
• Approved for treatment of malignant bone disease
  from solid tumors and multiple myeloma
• Zoledronic acid (Zometa) is approved for the
  treatment of any advanced malignancy involving
  bone

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• ? Common adverse events
• - Flu-like symptoms
• - Fever
• - Myalgias/ Arthralgias
• ? Uncommon adverse events
• - Renal-function effects
• - Osteonecrosis of the jaw

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ONJ

• Etiology and pathogenesis are not well
  characterized
• The clinical identification of ONJ is usually
  made on the basis of visual inspection and/or
  radiographic appearance

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• Risk Factors for ONJ
• Periodontal disease
• Dento-alveolar surgery
• Oral trauma
• Corticosteroid therapy
• Immuno-compromised state

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Recommendations for the Management of ONJ

• Prevention of ONJ
• Prior to treatment with bisphosphonates
• Dental exam with appropriate preventive
  dentistry
• Remove abscessed teeth, and teeth with poor
  long-term prognosis
• Educate patients on oral hygiene and signs
  and symptoms of ONJ

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• During bisphosphonate treatment
• Seek dental maintenance care at least every
  6 months
• Avoid invasive dental procedures if possible

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• In case of ONJ
• Refer to dental professional as soon as
  possible
• Reassess benefit/risk of continued
  bisphosphonate therapy
• No prospective data exist to withhold
  therapyConservative management

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• ONJ Outcomes
• Emerging data indicate that stability /
  improvement of lesions occurs in the majority of
  patients with conservative management
• With preventive measures and conservative
  management, deterioration occurs only in a
  minority of patients

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ONJ personal clinical case
V.H.52 year old man receiving IV Biphosphonate as
maintenance therapy for Multiple Myeloma
ONJ healing after 3 months
ONJ after two years of Biphosphonate therapy
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• Summary
• - ONJ is an uncommon event
• - Most patients can be managed conservatively
  according to guidelines with minimal impact on
  quality of life
• - Ongoing studies will increase the
  understanding of ONJ

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• THANK YOU