Osteonecrosis of the jaw associated with pamidronate therapy

Zarychanski R, Elphee E, Walton P, Johnston J
Section  of Haematology/Oncology, Department of Internal Medicine, University of  Manitoba, Winnipeg, Canada.

We report the occurrence  of osteonecrosis of the jaw associated with pamidronate therapy in 12 patients  diagnosed with multiple myeloma, breast carcinoma, or renal cell carcinoma, all  involving bone. At the
onset of jaw osteonecrosis, pamidronate therapy was the  single medication common to all 12 patients. The duration of therapy varied from  12 to 77 months before osteonecrosis was observed; 92% (11/12) of cases involved the posterior mandible and all cases have been refractory to a variety of  medical therapies, including surgical debridement and systemic antibiotics.  Available tissue biopsies revealed inflammation consistent with osteomyelitis.  In one biopsy,
Actinomyces spp. were recovered from culture, but treatment with  an extended course of clindamycin conferred no clinical benefit. The persistence of exposed bone remains a significant source of morbidity and pain for each surviving patient. Discontinuation of pamidronate therapy has not helped reverse  the presence of osteonecrosis, and surgical manipulation of the involved site appears to worsen the underlying bone pathology. ONJ is an important adverse outcome associated with bisphosphonate therapy, and physicians prescribing
pamidronate or zoledronate must be aware of the association between these drugs and this serious clinical entity. Failure to recognize the signs of ONJ can lead to unnecessary surgical procedures, which ultimately exacerbate the condition  and impact quality of life. The unremitting nature of this clinical development, and the long-lasting morbidity associated with it suggests that patients should  be counseled regarding the possible occurrence of ONJ prior to initiating  therapy with pamidronate. Am. J. Hematol. 81:73-75, 2006. (c) 2005
Wiley-Liss,  Inc.

PMID: 16369966 [PubMed - as supplied by publisher]