Osteonecrosis of the jaw in oncology patients treated with bisphosphonates: prospective experience of a dental oncology referral center Ourania Nicolatou-Galitis, DDS, a Erofili Papadopoulou, DDS, b Triantafyllia Sarri, DDS, b Polyxeni Boziari, DDS, b Aikaterini Karayianni, DDS, c Marie-Christine Kyrtsonis, MD, d Panagiotis Repousis, MD, e Vassilios Barbounis, MD, f and Cesar A. Migliorati, DDS, MS, PhD, g Athens and Pireaus, Greece, and Memphis, TN UNIVERSITY OF ATHENS, “METAXA” CANCER HOSPITAL, GENERAL HOSPITAL OF ATHENS “IPPOKRATIO,” AND UNIVERSITY OF TENNESEE HEALTH SCIENCE CENTER Objectives. The objectives of this study were to define the incidence, pain, and healing in cancer patients treated with intravenous bisphosphonates. Study design. The study included long-term follow-up of 99 bisphosphonate-using patients (group A) and conservative treatment of 67 patients with bisphosphonate-related osteonecrosis of the jaw (BRONJ, group B) using 3 antibiotic schemes and oral hygiene. Results. The frequency of zoledronic acid single-agent use was 85.9% and 69.8% in group A and B, respectively. Median follow-up was 13 months (group A) and 16 months (group B). Two patients in group A developed BRONJ (2%). Of those with BRONJ in group B who completed follow-up, healing occurred in 14.9% (7/47) and pain subsided in 80.9% (38/47). Healing was significant in patients who received pamidronate followed by zoledronic acid (P = .023) and with BRONJ stages 0 and stage I (P = .003). Conclusions. This case series suggests that oral hygiene and conservative antibiotic therapy play a role in healing and pain alleviation in BRONJ. Oral hygiene and follow-up may decrease incidence of BRONJ. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2011;112:195-202) Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is defined as the presence of necrotic bone persisting for more than 8 weeks in the oral cavity of an individual exposed to bisphosphonate therapy with no history of head and neck radiation. 1-3 Depending on the severity and extent of the necrotic bone, pain, and/or local infection, 3 stages of BRONJ (stages I, II, and III) have been described. Patients with no obvious exposed bone, but with symptoms, such as sinus tracts, pain not ex- plained by an odontogenic cause, and characteristic radiographic findings, such as osseous condensation of the lamina dura are considered as stage 0 of BRONJ. Dentoalveolar surgery, including dental extractions, and the use of dentures are considered the most com- mon local factors associated with risk of BRONJ. 4-17 The prevalence of BRONJ in oncology patients varies from as low as 1.2% to as high as 28.0%, depending on the study design, the type and duration of bisphosphonate therapy, the cancer population, the definition of BRONJ used, and the clinical parameters assessed. 9-13,15,17-25 A weighed prevalence, resulting from a systematic literature a Head, Dental Oncology Unit, Clinic of Hospital Dentistry, School of Dentistry, University of Athens, Athens, Greece. b Graduate Student, Dental Oncology Unit, Clinic of Hospital Den- tistry, School of Dentistry, University of Athens, Athens, Greece. c Professor, Clinic of Oral Diagnosis and Radiology, School of Den- tistry, University of Athens, Athens, Greece. d Hematologist, Assistant Professor, “Laiko” Hospital, 1st Depart- ment of Propaideutic Clinic of Internal Medicine, Medical School, University of Athens, Athens, Greece. e Hematologist, “Metaxa” Cancer Hospital, Clinic of Hematology, Pireaus, Greece. f Medical Oncologist, General Hospital of Athens “Ippokratio,” Ath- ens, Greece. g Professor, University of Tennessee Health Science Center, College of Dentistry, Memphis, TN. Conflict of interest: Cesar A. Migliorati is a consultant for Amgen, Inc. 1079-2104/$ - see front matter © 2011 Mosby, Inc. All rights reserved. doi:10.1016/j.tripleo.2011.02.037 195 Vol. 112 No. 2 August 2011 ORAL MEDICINE Editor: Craig S. Miller