The use of intravenous
bisphosphonates (
pamidronate or
zoledronic acid) is the cornerstone for the management of
multiple myeloma-(MM-) related
bone disease. However,
osteonecrosis of the jaw (ONJ) is a rare, but sometimes difficult to manage, adverse effect of
bisphosphonates therapy. A retrospective review of all MM patients who were treated with
bisphosphonates in our department, from 2003 to 2013, and developed ONJ was performed. According to inclusion criteria, 38 patients were studied. All these patients were treated as conservatively as possible according to the American Association of Oral and Maxillofacial Surgeons criteria. Patients were managed with observation, oral antibacterial
mouth rinse with
chlorhexidine, oral
antibiotics,
pain control with
analgesics, nonsurgical sequestrectomy with or without simultaneous administration of
antibiotics, or major surgery with or without
antibiotics. Healing of the lesions was achieved in 23 (60%) patients who were treated with conservative measures; the median time to healing was 12 months (95% CI: 4-21). The number of
bisphosphonates infusions influenced the time to healing: the median time to healing for patients who received <16 infusions was 7 months and for those with >16 infusions was it 14 months (P = 0.017). We conclude that a primarily nonsurgical approach appears to be a successful management strategy for
bisphosphonate-related ONJ.