Osteonecrosis of the jaws in orally symptomatic postmenopausal female patients with osteoporosis

We aimed to collect and analyze clinical data from a cohort of 76 female patients treated with biphosphonates (BP) for postmenopausal osteoporosis and referred to the Unit of Oral Diagnosis and Day Surgery for diagnosis and treatment. Methods: Each patient received a throughout oral, dental and periodontal examina- tion. Relevant clinical data regarding the BP treatment and comorbidities, oral findings and dental treatment plan, past and present dental therapies were recorded. All individuals had been recalled every three months for clinical examination, oral hygiene instructions and professional scaling; when needed periodontal, restorative and dento- alveolar surgical treatments were provided with strict protocols, according to the international guidelines. Results: Over the last 4 years period, 76 consecutive patients aged 51 to 91 yrs (mean=68,6 yrs) and treated with BP for postmenopausal osteoporosis were referred (alendronate n= 47, clodronate n=16, risedronate n=10, ibandronate n=3 - mean treatment time= 190 wks); at the referral time osteonecrosis of the jaws (ONJ) has been identified in 7 patients (stage I n=3, stage II n=4 - mandibula n=6, both jaws n=1). The duration of BP therapy in ONJ patients ranged from 24 to 432 wks. The triggering events for ONJ were identified as dentoalveolar surgery (n=2), local trauma from dentures (n=3) and periodontal infection (n=2). In the ONJ group, 5 patients were never smokers and 2 had systemic comorbidities. Treatment and control of the ONJ cases was obtained with repeated antibacterial treatments and in 4 patients with surgical debridement of the affected areas. Closure of the exposure and complete remission has been obtained in 4 cases. At present none of the non-ONJ patients submitted to invasive dental treatments developed ONJ signs and/or symptoms. Conclusions: ONJ could be a harmful side effect of BP treatments in postmenopausal osteoporosis patients as well as non-oncologic patients. Oral prevention and appro- priate protocols for invasive oral surgery could minimize the risk of ONJ. Relevance: BP related ONJ prevalence in non-oncologic patients could be further reduced with focused management of oral health and diseases.