RESUMO
OBJECTIVE: To evaluate the frequency, risk factors, and clinical presentation of bisphosphonate (BP)-related osteonecrosis of the jaw (BRONJ). STUDY DESIGN: We performed a retrospective analysis of 576 patients with cancer treated with intravenous pamidronate and/or zoledronate between January, 2003 and December, 2007 at the University of Minnesota Masonic Cancer Center and Park Nicollet Institute. RESULTS: Eighteen of 576 identified patients (3.1%) developed BRONJ including 8 of 190 patients (4.2%) with breast cancer, 6 of 83 patients (7.2%) with multiple myeloma, 2 of 84 patients (2.4%) with prostate cancer, 1 of 76 patients (1.3%) with lung cancer, 1 of 52 patients (1.9%) with renal cell carcinoma, and in none of the 73 patients with other malignancies. Ten patients (59%) developed BRONJ after tooth extraction, whereas 7 (41%) developed it spontaneously (missing data for 1 patient). The mean number of BP infusions (38.1 ± 19.06 infusions vs. 10.5 ± 12.81 infusions; P<0.001) and duration of BP treatment (44.3 ± 24.34 mo vs. 14.6 ± 18.09 mo; P<0.001) were significantly higher in patients with BRONJ compared with patients without BRONJ. Multivariate Cox proportional hazards regression analysis showed that diabetes [hazard ratio (HR)=3.40; 95% confidence interval (CI), 1.14-10.11; P=0.028], hypothyroidism (HR=3.59; 95% CI, 1.31-9.83; P=0.013), smoking (HR=3.44; 95% CI, 1.28-9.26; P=0.015), and higher number of zoledronate infusions (HR=1.07; 95% CI, 1.03-1.11; P=0.001) significantly increased the risk of developing BRONJ. CONCLUSIONS: Increased cumulative doses and long-term BP treatment are the most important risk factors for BRONJ development. Type of BP, diabetes, hypothyroidism, smoking, and prior dental extractions may play a role in BRONJ development.
Assuntos
Conservadores da Densidade Óssea/efeitos adversos , Difosfonatos/efeitos adversos , Imidazóis/efeitos adversos , Doenças Maxilomandibulares/induzido quimicamente , Neoplasias/tratamento farmacológico , Osteonecrose/induzido quimicamente , Feminino , Humanos , Incidência , Injeções Intravenosas , Doenças Maxilomandibulares/epidemiologia , Doenças Maxilomandibulares/mortalidade , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Osteonecrose/epidemiologia , Osteonecrose/mortalidade , Pamidronato , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida , Ácido ZoledrônicoRESUMO
The frequency of acute purulent inflammatory diseases of maxillofacial area and their complications (thrombosis of the cavernous sinus, abscess of the brain, sepsis) were investigated. These complications are responsible for 0.56% of lethal outcomes. Early diagnosis and intensive treatment of such conditions are a must.