Analysis of Inflammatory Jawbone Diseases and Its Etiologic Implication of BRONJ: 7-year Experience of a Referral Center

Sung Ok Hong DDS, Oral and Maxillofacial Surgery, Kyung Hee University School of Dentistry, Seoul, South Korea
Chae Yun Lee DMD, Oral and Maxillofacial Surgery, Kyung Hee University School of Dentistry, Seoul, South Korea
Deog-Yoon Kim MD,PhD, Center for Refractory Jawbone Diseases, Kyung Hee University School of Medicine, Seoul, South Korea
Yong-Dae Kwon DDS, PhD, Oral and Maxillofacial Surgery, Kyung Hee University School of Dentistry, Seoul, South Korea
Purpose:

Osteomyelitis of the jaw is of relatively low incidence, but its prevalence has been on the rise since Marx described it in 2003. Utilization of bisphosphonates have been widened in fields starting from metabolic bone diseases such as osteoporosis and osteopenia to malignancy related skeletal complications due to multiple myeloma, breast cancer, and various solid tumors. Systemic conditions that alter the host's resistance such as diabetes mellitus, autoimmune disorders, agranulocytosis, anemia, especially sickle cell anemia, are predisposing factors in the development of this condition. The purpose of this retrospective study was to find the frequency, annual case trend of bisphosphonate related necrosis (BRONJ), and the ratio of the etiologic factors involved with inflammatory jawbone diseases.

Method & Materials:

All patients with osteomyelitis or osteonecrosis in the jaw treated in the oral and maxillofacial surgery department at Kyung Hee University, Korea from 2007 to 2013 were investigated. History taking, investigation of etiologic factors (BRONJ, osteoradionecrosis(ORN), odontogenic, foreign body, and trauma), and calculation of serum C-terminal peptide (s-CTX), serum osteocalcin (s-OC) were initiated in 289 patients averaging the age of 66.5 years old. Using linear regression and univariate analysis, the annual and age-oriented prevalence rates were found.

Results & Conclusion:

BRONJ occurred more frequently in the older age group (more than 70 years old) than for any other reason and this was statistically significant (Chi-square, p<0.001).  The R2 values for the regression analysis from 2007 to 2013 was R2=0.70715 for BRONJ, and R2=0.05236 for odontogenic etiology. Thus we can conclude that the ratio of BRONJ is increasing and bisphosphonate therapy has become a major etiology for inflammatory jawbone diseases.

References:

  1. Walter C, Sagheb K, Bitzer J, Rahimi-Nedjat R, Taylor KJ. Analysis of reasons for osteonecrosis of the jaws. Clin Oral Investig 2014; Feb 18 
  2. Kwon YD, Kim DY, Ohe JY, Yoo JY, Walter C. Correlation between serum C-terminal cross-linking telopeptide of type I collagen and staging of oral bisphosphonate-related osteonecrosis of the jaws. J Oral Maxillofac Surg 2009 Dec;67(12):2644-8
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