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

Common adverse events

- Flu-like symptoms - Fever - Myalgias/ Arthralgias

Uncommon adverse events:

- Renal-function effects - Osteonecrosis of the jaw

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

StudyStudy typePatients treated with BP, nPatients with suspected or proven ONJ, nFrequency %Hoff et al.MDACC ASCO 2006Chart review3,994290.7%Durie et alWeb-based survey1,20315212.6%Pozzi et all italian multicenter studyChart review888161.8%Badros et alChart review/observational340113.2%Tosi et al. Analysis of Bologna 2002 trialRetrospective review of trial data base25993.5%Dimopoulos et alChart review 202157.4%Cafro et alChart review1181411.9%

Risk Factors for ONJ

Periodontal disease

Dento-alveolar surgery

Oral trauma

Corticosteroid therapy

Immuno-compromised state

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

During bisphosphonate treatment

Seek dental maintenance care at least every 6 months

Avoid invasive dental procedures if possible

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

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

ONJ after two years ofBiphosphonate therapyONJ healing after 3 monthsV.H.52 year old man receiving IV Biphosphonate as maintenance therapy for Multiple Myeloma

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

THANK YOU

**ONL annual incidence : 1/300. it dropped to 1/7000 by practicing prevention dental care.