Management of Bisphosphonate-related Osteonecrosis of the Jaw in Cancer Patients

Purpose:In the treatment of multiple myeloma,bone metastatic tumor of malignant tumors and hypercalcemia, bisphosphonate (BP) administrates according to the BP injection formulation. Since the potency ratio of the bone through intravenous administration is higher than that of the oral medication, and due to the healing delay trendency and immunological deterioration from the effects of steroids and anti-cancer drugs used in the treatment of cancer,bisphosphonate-related osteonecrosis of the jaw(BRONJ) occurs in cancer patients at a high probability.The treatment for BRONJ of patients with cancer is often carried out conservatively, for first priority to suppression of the cancer , and life prognosis.　However , the decision often deteriorates the quality of life of the patients.Therefore the optimal treatment strategy is not decided.　We report the clinical examination for BRONJ occurred in cancer patients in our department.Subjectives: 13 patients diagnosed as BRONJ in cancer patients treated with BP injectable preparation visited our hospital were retrospectively subjected. They were total number thirteen, 4　male and 9 female in gender ,51.7 ± 11.8 years old in age.Results:Primary sites of their cancers were 1 esophageal cancer,  1 multiple myeloma, 2 prostate cancer, 9 breast cancers and 12 patients associated bone metastasis after each surgery. All Zoledronic acid employed injection formulation and average period was 36.8 ± 21.1 months from 10 to72 months. Before BRONJ arised, three were performed tooth extraction. The risk factors for onset of BRONJ, three diabetes merger, cancer chemotherapy has been carried out in all patients. Based on staging,one was stage 0, 3 were stage 1, 9 were stage 2 at initial examination. The withdrawal of the BP preparation (just after start of therapy) were 12 cases.Subsequently,2cases were resumed. In choice of the treatment of BRONJ, all patients were selected as conservative treatment (oral health care and medication) and of 3 were underwent curettage, sequestrum removal were performed. 3 of 13 were selected surgical treatment respectively.Conclusion:On the Management of BRONJ including the prophylaxis of BRONJ, the oral health care before and after the treatment with BP injectable preparation is very important. However , in the case of extension of BRONJ disturbs quality of life, We should choose the surgical treatment .