La osteonecrosis de los huesos maxilares asociada al tratamiento con bifosfonatos intravenosos en pacientes oncológicos

Abstract

The osteonecrosis of the jaws is a serious adverse effect associated with bisphosphonate therapy (BFs), especially in patients with tumor pathology, gaining importance by the high morbidity associated with this type of injury. With the main objective of estimating its incidence in cancer patients and secondarily to identify the risk factors influencing its development, an observational historical cohort study was initiated. The study included a total of 206 patients who began or were in treatment with BFs between 1 January 2010 and 31 December 2014. The cohort studied, presented a distribution by gender of 158 women and 48 men, with an average age of 61 years. 63.1% of them were diagnosed with breast cancer, 21.5% Multiple Myeloma (MM), 7.8% of prostate cancer, lung 1.5%, and the percentage remaining, of other tumors. Of the 206 patients included, 17 (8.3%) developed a total of 21 bisphosphonate-related osteonecrosis of the jaw (BRONJ) lesions, during the study period. The cumulative incidence estimation in the presence of competing risks, found that the risk of developing BRONJ after one year of treatment was 0.48%, increasing to 2.54% at two years and 10% at five years. The incidence rates for the reference population were of 0.68 per 100,000 people per year. The only variables that showed a statistically significant association with the development of BRONJ were the periods of treatment with concomitant chemotherapy and the periods of treatment with antiangiogenic drugs and exclusively the latter when considering competing risk of death. Due to the frequency of occurrence of BRONJ found in this study, it objectively finds that it is not a rarity and in fact constitutes a serious complication associated to treatment with BFs with a negative impact on the quality of life and survival of cancer patients, therefore being necessary preventive interventions that minimize its occurrence.