Bisphosphonate - Related Osteonecrosis of the Jaw – Five Years Experience

Background. Osteonecrosis related to bisphosphonate therapy is a challenging disease with complicated treatment. It is well known among the maxillofacial surgeons all around the world since 2003. Despite of it, the incidence is still rising, because of the lack of prevention before using bisphosphonates. Disturbing the bone metabolism leads by even a small trauma to enormous defects, that is despite of intensive therapy irreversible. Treatment of this disease is commonly joint with losing the bone tissue and badly affects the quality of life. Often is necessary the combined therapy, surgery, antibiotics and antimycotics. The discontinuation of bisphosphonate treatment during the osteonecrosis therapy is also recommended if it is possible.

Methods and results. We examined and treated 79 patients with bisphosphonate related osteonecrosis of the jaw. The comparison of several methods of treatment was made in all stages of disease, with research of the therapy length, complications together with the need of reoperation and following up all the patients during five years. The results of the therapy were in most cases satisfactory; only two patients had problems that persisted. None of the patients died because of this disease.

Conclusions. Bisphosphonate related osteonecrosis of the jaw is a disease that is difficult to treat. For patient it costs too much, not because of using the expensive antibiotics, but mostly because it leads to the defects in patient’s jaw, it is affecting the oral intake and the life of the patient at all. Prevention is the best way to discontinuation of the rising incidence, but it requires a cooperation of interested specialists and also perfect education of the patient.