Background: Jaw osteonecrosis has recently been identified as complication in bisphosphonate-treated patients. In a Web-based survey conducted to assess the risk factors for osteonecrosis of the jaw of 1203 respondents, 904 had multiple myeloma (MM) and 299 breast cancer and among them 152 patients had osteonecrosis of the jaw or suspicious findings, including bone erosions and spurs plus exposed bone. It was found that osteonecrosis of the jaws was most strongly associated with use of Aredia and/or Zometa. With data censored at 36 months, the estimated incidence among patients receiving zoledronic acid was 10 percent and that among those receiving pamidronate was 4 percent (Durie et al. N Engl J Med 2005; 353: (1) 99.

The aim of the study was assessment of occurrence of jaw osteonecrosis in 113 MM patients treated with different bisphosphonates which have been evaluated in prospective study performed at our institution.

Methods: Sixty one MM patients received clodronate (Bonefos; Schering AG) per os 2,4g/24 hrs. Median treatment duration amounted to 17 months and in 14 patients treatment duration exceeded 24 months. Forty six MM patients received pamidronate (Aredia; Novartis) intravenously 60 mg monthly. All 46 patients included in pamidronate study were followed up until death or at least for 6 years. Six MM patients received zoledronic acid (Zometa; Novartis) intravenously either 4 or 8 mg every 3 to 4 weeks for 13 months.

Results: In none case treated with clodronate or pamidronate there was observed occurrence of jaw osteonecrosis. Osteonecrosis of the mandible developed in 2 of 6 patients treated with zoledronic acid. The duration of treatment with zoledronic acid in each case was 13 months with a cumulative zoledronic acid dose in one case of 72 mg and in the other of 144 mg. The lesions were refractory to conservative debridement, surgey and antibiotic therapy.

Conclusions: Clinicians should be aware of the potential serious complication of bone necrosis in MM patients receiving long-term treatment with potent bisphosphonates. It is recommended a dental examination to identify and correct predisposing conditions before bisphosphonate treatment is started.

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