BOF: Malignant (Multiple Myeloma)

Which of the following statements is true regarding osteonecrosis of the jaw (ONJ) relating to bisphosphonate use for multiple myeloma?

a) Bisphosphonates are absolutely contraindicated in a patient who has previous suffered from ONJ

b) Greater than 80% of patients suffering from ONJ have undergone recent dental or oral procedures

c) More commonly develops in patients treated with zolendronic acid than those treated with sodium pamidronate.

d) More commonly develops in the maxilla than the mandible

e) There should be a delay of at least three months between an invasive dental procedure and commencement of a bisphosphonate

Answer:

c) More commonly develops in patients treated with zolendronic acid than those treated with sodium pamidronate

Explanation:

Osteonecrosis of the jaw is a poorly understood but pathological process for which treatment strategies appear unsatisfactory for the majority of patients. Severe pain and permanent disability often ensue. Seen in the mandible in 60% of cases. Recent dental or oral surgical procedures in the context of bisphosphonate therapy are implicated in the majority of cases and comprehensive dental review is recommended before starting bisphosphonate therapy, with a delay of at least one month after dental procedures before starting. Dental complications during therapy should be managed conservatively if possible, aiming to avoid dental extraction. Given that the risk of osteonecrosis of the jaw appears related to duration of therapy, their prolonged use should be re-evaluated as clinical conditions change. Bisphosphonates may be restarted in prior ONJ sufferers as long as complete healing has occurred.

References:

Badros A, Weikel D, Salama A et al. Osteonecrosis of the jaw in multiple myeloma patients: clinical features and risk factors. J Clin Oncol. 2006;24:945-952