Osteonecrosis of the myeloma patients treated with bisphosphonates.

Osteonecrosis of the jaw (ONJ) has been reported as uncommon but well recognised complication associated with bisphosphonate treatment. Multiple Myeloma (MM) is the pathology most frequently associated with ONJ in the medical and dental papers published over the last years (45% of the ONJ published cases). ONJ appears to be time-dependent with higher risk after long-term use of intravenous (i.v.) nitrogen containing bisphosphonates (eg, pamidronate, zoledronate) in older MM patients. The most frequent site of ONJ is the mandible and previous dental procedures may be a precipitating factor. Most of the ONJ cases presented clinical evidence of bone exposure and pain. There was no significant association between the occurrence of ONJ and the presence of osteolytic lesions, disease status and the use of thalidomide. Different treatments have been proposed, associated or not: medical therapy (eg, antimicrobial oral rinses, antibiotic and antimicotic), surgical therapy (eg, curettage or sequestrectomy) showing low healing rates and uncertain impact on the prognosis and on the outcome.