Bisphosphonate-related osteonecrosis of the jaw in randomized clinical trials

  • Athanassios Kyrgidis
Letter to the Editor

One should read with great interest the paper of Mauri et al. [1] in the Online First section of Breast Cancer Research and Treatment. The paper presents a meta-analysis of the existing randomized clinical trials (RCTs) for the overall incidence of bisphosphonates-induced jaw osteonecrosis (ONJ) in adjuvant treatment of breast cancer. This is a well-conducted meta-analysis, which is definitely going to be cited several times in the near future.

However, important information may be missing from the discussion. In their introduction, Mauri et al. characterize ONJ uncommon, with a reported incidence of 5–7.7%. In their discussion, the authors report that ONJ during the adjuvant treatment of breast cancer is a rare event with an incidence of 0.24%. The authors attribute this difference in incidence to the dose intensity of bisphosphonates regimens used in the treatment of primary breast cancer. The low ONJ incidence reported by this meta-analysis of RCTs could be attributable to the...


Breast Cancer Bisphosphonates Adjuvant Treatment Zoledronate Osteonecrosis 
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  1. 1.
    Mauri D, Valachis A, Polyzos IP, Polyzos NP, Kamposioras K, Pesce LL (2009) Osteonecrosis of the jaw and use of bisphosphonates in adjuvant breast cancer treatment: a metanalysis. Breast Cancer Res Treat. doi: 10.1007/s10549-009-0432-z
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    Edwards BJ, Gounder M, McKoy JM, Boyd I, Farrugia M, Migliorati C, Marx R, Ruggiero S, Dimopoulos M, Raisch DW, Singhal S, Carson K, Obadina E, Trifilio S, West D, Mehta J, Bennett CL (2008) Pharmacovigilance and reporting oversight in US FDA fast-track process: bisphosphonates and osteonecrosis of the jaw. Lancet Oncol 9(12):1166–1172CrossRefPubMedGoogle Scholar
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    Walter C, Al-Nawas B, Grotz KA, Thomas C, Thuroff JW, Zinser V, Gamm H, Beck J, Wagner W (2008) Prevalence and risk factors of bisphosphonate-associated osteonecrosis of the jaw in prostate cancer patients with advanced disease treated with zoledronate. Eur Urol 54(5):1066–1072CrossRefPubMedGoogle Scholar
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    Kyrgidis A, Triaridis S, Vahtsevanos K, Antoniades K (2009) Osteonecrosis of the jaw and bisphosphonate use in breast cancer patients. Expert Review of Anticancer Therapy. doi: 10.1586/ERA.09.74
  5. 5.
    Vahtsevanos K, Kyrgidis A, Verrou E, Katodritou E, Triaridis S, Andreadis C, Boukovinas I, Koloutsos G, Teleioudis Z, Kitikidou K, Paraskevopoulos P, Zervas K, Antoniades K (2009) Bisphosphonate related osteonecrosis of the jaws: a longitudinal cohort study of risk factors in cancer patients. J Clin Oncol. doi: 10.1200/JCO.2009.21.9584

Copyright information

© Springer Science+Business Media, LLC. 2009

Authors and Affiliations

  1. 1.Aristotle University of ThessalonikiThessalonikiGreece

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