Osteonecrosis of the jaws and bisphosphonates : report of fifteen cases: therapeutic recommendations

Recently there have been reports of osteonecrosis of the jaw (ONJ) in patients with chronic therapy with bisphosphonates (Bps). So far three drugs have been linked: Pamidronate of disodium, Zoledronic acid and Alendronate of sodium. It is due to a non detected side effect in clinical trials before commercialization, and reverberates significantly in the quality of life of these patients. Most of the cases are seen in oncology patients that have received long term concurrent antineoplasic therapy and were treated sporadically with steroids, together with Bps endovenous, for treatment of cancer and its symptoms. Among these cases we find the reported by R.E. Marx (1), S.L. Ruggiero (2) and J. V. Bagán (3). In this report fifteen cases diagnosed, treated and followed up at the author´s surgery department are presented and some suggestions are given in order to reduce the incidence in patients with cancer who are going to receive Bps, as well as in patients with established ONJ being treated with these drugs who may need a surgical intervention.