Factors predicting the prognosis of oral alendronate-related osteonecrosis of the jaws: A 4-year cohort study

Background Studies concerning prognostic factors specific for alendronate‐related osteonecrosis of the jaws (ONJ) are rare. Methods We surveyed a cohort of 100 osteoporotic patients with 111 alendronate‐related ONJ lesions treated during a 4‐year period. Prognostic values of clinical variables and s...

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Bibliographic Details
Published in:Head & neck 2013-12, Vol.35 (12), p.1787-1795
Main Authors: Lee, Jang-Jaer, Cheng, Shih-Jung, Wang, Jai-Jen, Chiang, Chun-Pin, Chang, Hao-Hueng, Chen, Hsin-Ming, Kok, Sang-Heng
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
alendronate
Alendronate - adverse effects
Alkaline Phosphatase - blood
Amoxicillin - therapeutic use
Amoxicillin-Potassium Clavulanate Combination - therapeutic use
Anti-Bacterial Agents - therapeutic use
Biomarkers - blood
Bisphosphonate-Associated Osteonecrosis of the Jaw - pathology
Bisphosphonate-Associated Osteonecrosis of the Jaw - therapy
Bone Density Conservation Agents - adverse effects
Bone Remodeling
BSAP
Chlorhexidine - therapeutic use
Clindamycin - therapeutic use
Cohort Studies
Collagen Type I - blood
CTX
Debridement
Female
Humans
Male
Middle Aged
Mouthwashes - therapeutic use
Multivariate Analysis
ONJ
osteoporosis
Osteoporosis - drug therapy
Peptides - blood
Prognosis
Retrospective Studies
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Summary:Background Studies concerning prognostic factors specific for alendronate‐related osteonecrosis of the jaws (ONJ) are rare. Methods We surveyed a cohort of 100 osteoporotic patients with 111 alendronate‐related ONJ lesions treated during a 4‐year period. Prognostic values of clinical variables and serum markers of bone turnover were assessed by univariate and multivariate analyses. Results The cumulative complete response rate at 6 months was 48.65%. Serum bone‐specific alkaline phosphatase (BSAP) level >10 μg/L, lesion depth ≦ 10 mm, and lesions in anterior regions denoted a better chance of healing within 6 months and the adjusted hazard ratios were 2.48 (95% confidence interval [CI], 1.41–4.37), 2.71 (95% CI, 1.57–4.70), and 3.94 (95% CI, 1.87–8.30), respectively. Conclusions Early discovery of lesions and prevention of their deeper extension are crucial for improving the prognosis of alendronate‐related ONJ. A higher pretreatment level of BSAP indicates a better prognosis. © 2013 Wiley Periodicals, Inc. Head Neck 35: 1787–1795, 2013
ISSN:1043-3074
1097-0347
DOI:10.1002/hed.23235