Prevalence of bisphosphonate associated osteonecrosis of the jaws in multiple myeloma patients

Head Face Med. 2010 Jul 8:6:11. doi: 10.1186/1746-160X-6-11.


Background: Bisphosphonate-associated osteonecrosis of the jaws (BP-ONJ) is an adverse effect of bisphosphonate treatment with varying reported incidence rates.

Methods: In two neighboring German cities, prevalence and additional factors of the development of BP-ONJ in multiple myeloma patients with bisphosphonates therapy were recorded using a retrospective (RS) and cross-sectional study (CSS) design. For the RS, all patients treated from Jan. 2000--Feb. 2006 were contacted by letter. In the CSS, all patients treated from Oct. 2006--Mar. 2008 had a physical and dental examination. Additionally, a literature review was conducted to evaluate all articles reporting on BP-ONJ prevalence. PubMed search terms were: bisphosphonat, diphosphonate, osteonecrosis, prevalence and incidence.

Results: In the RS, data from 81 of 161 patients could be obtained; four patients (4.9%) developed BP-ONJ. In the CSS, 16 of 78 patients (20.5%) developed BP-ONJ. All patients with BP-ONJ had received zoledronate; 12 of these had had additional bisphosphonates. All except one had an additional trigger factor (tooth extraction [n = 14], dental surgical procedure [n = 2], sharp mylohyoid ridge [n = 3]).

Conclusion: The prevalence of BP-ONJ may have been underestimated to date. The oral examination of all patients in this CSS might explain the higher prevalence, since even early asymptomatic stages of BP-ONJ and previously unnoticed symptomatic BP-ONJ were recorded. Since nearly all patients with BP-ONJ had an additional trigger factor, oral hygiene and dental care might help to reduce BP-ONJ incidence.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Bone Density Conservation Agents / adverse effects*
  • Bone Density Conservation Agents / therapeutic use
  • Cross-Sectional Studies
  • Diphosphonates / adverse effects*
  • Diphosphonates / therapeutic use
  • Female
  • Humans
  • Male
  • Middle Aged
  • Multiple Myeloma / drug therapy*
  • Osteonecrosis / chemically induced*
  • Osteonecrosis / epidemiology*
  • Prevalence
  • Retrospective Studies
  • Treatment Outcome


  • Bone Density Conservation Agents
  • Diphosphonates