Conservative management of bisphosphonate-related osteonecrosis of the jaws: Staging and treatment outcomes

Objective: Bisphosphonate-related osteonecrosis of the jaws is a well-established disorder in which patients treated with bisphosphonates develop exposed necrotic bone in the oral cavity. The objective of this study was to report staging and treatment outcomes in a large cohort of patients with bisphosphonate-related osteonecrosis of the jaws managed primarily with non-surgical measures. Patients and methods: A retrospective medical record review was conducted from 1998 to 2010 of all patients referred for the management of bisphosphonate-related osteonecrosis of the jaws. Clinical findings and staging were assessed at initial consultation and each follow-up visit. Management was provided to minimize symptoms and/or achieve resolution of lesions. Treatment responses were defined based on symptoms and/or change in staging. Results: There were 120 records reviewed and 97 patients seen for follow-up (median 12 months); 90% were cancer patients. Bisphosphonate-related osteonecrosis of the jaws was managed with observation (16%), antibiotics (55%), non-surgical sequestrectomy +/- antibiotics (14%), or surgery +/- antibiotics (14%). There were 14 patients (12%) who presented with stage 0 disease; 41%, 43%, and 5% of patients presented at stages 1, 2, and 3, respectively. Greater than 70% of patients improved, remained asymptomatic, and/or showed complete re-epithelialization when evaluated at 0-3, 3-6, 6-9, 9-12, and/or > 12 months. Seventeen patients developed non-infectious complications of BONJ including neuropathy (N = 9), painful tongue ulcers (N = 7), or pathologic fracture (N = 1). Twelve patients with multiple myeloma underwent hematopoietic cell transplantation without infectious complications. Conclusions: A primarily non-surgical approach appears to be a successful management strategy for bisphosphonate-related osteonecrosis of the jaws. Overall, 71-80% of patients improved or remained asymptomatic with a median follow-up of 12 months. (C) 2013 Elsevier Ltd. All rights reserved.