Patients Receiving Parenteral Bisphosphonates for Malignant Disease and Having Developed an Atypical Femoral Fracture Are at Risk of Concomitant Osteonecrosis of the Jaw: An Evidence-Based Review

Lindsay L Graves; Susan V Bukata; Nona Aghazadehsanai; Tina I Chang; Neal R Garrett; Arthur H Friedlander

doi:10.1016/j.joms.2016.06.003

Patients Receiving Parenteral Bisphosphonates for Malignant Disease and Having Developed an Atypical Femoral Fracture Are at Risk of Concomitant Osteonecrosis of the Jaw: An Evidence-Based Review

J Oral Maxillofac Surg. 2016 Dec;74(12):2403-2408. doi: 10.1016/j.joms.2016.06.003. Epub 2016 Jun 12.

Authors

Lindsay L Graves¹, Susan V Bukata², Nona Aghazadehsanai¹, Tina I Chang³, Neal R Garrett⁴, Arthur H Friedlander⁵

Affiliations

¹ Research Fellow, Oral and Maxillofacial Surgery/Dental Service, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA.
² Associate Clinical Professor, Department of Orthopaedic Surgery, UCLA Medical Center, Los Angeles, CA.
³ Director, Research Fellowship and Inpatient Oral and Maxillofacial Surgery, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles; Instructor, Department of Oral and Maxillofacial Surgery, UCLA School of Dentistry, Los Angeles, CA.
⁴ Professor Emeritus, Division of Advanced Prosthodontics, UCLA School of Dentistry, Los Angeles, CA.
⁵ Director, Graduate Medical Education, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles; Professor in Residence, Department of Oral and Maxillofacial Surgery, UCLA School of Dentistry, Los Angeles; Director, Quality Assurance, Hospital Dental Service, Ronald Reagan UCLA Medical Center, Los Angeles, CA. Electronic address: Arthur.Friedlander@va.gov.

PMID: 27376180
DOI: 10.1016/j.joms.2016.06.003

Abstract

Purpose: The risk of developing concomitant medication-related osteonecrosis of the jaw (MRONJ) in patients who have sustained an atypical femoral fracture (AFF) in association with parental administration of a bisphosphonate osteoclastic inhibitor medication for malignant disease is unclear. Published data were searched to determine the prevalence of these concomitant adverse medication events, if any.

Materials and methods: A systematic review of published case series in the PubMed database was undertaken to ascertain the prevalence of patients having a concomitant history of AFF and MRONJ. The data were analyzed to provide prevalence rates of these events from the literature.

Results: Two case series were identified that delineated the risk (25 and 33%, respectively) of concomitant development of MRONJ and AFF in recipients of parenteral bisphosphonate medication administered for malignant disease.

Conclusion: The published data suggest that approximately 30% of patients receiving parenteral bisphosphonates and having sustained an AFF could develop comorbid MRONJ.

Published by Elsevier Inc.

Publication types

Review
Systematic Review

MeSH terms

Bisphosphonate-Associated Osteonecrosis of the Jaw / epidemiology
Bisphosphonate-Associated Osteonecrosis of the Jaw / etiology*
Bone Density Conservation Agents / adverse effects*
Bone Density Conservation Agents / therapeutic use
Bone Neoplasms / drug therapy*
Diphosphonates / adverse effects*
Diphosphonates / therapeutic use
Femoral Fractures / chemically induced*
Femoral Fractures / complications
Fractures, Spontaneous / chemically induced*
Fractures, Spontaneous / complications
Humans
Injections, Intravenous
Prevalence
Risk Factors

Substances

Bone Density Conservation Agents
Diphosphonates