Use of a combined protocol to treatbisphosphonate-associated jawboneosteomyelitis: a 12-month follow-up

Introduction and Objectives: Treatment of bisphosphonateassociatedjawbone osteomyelitis represents an emerging challengein our practice. Although use of antibiotic treatment,chlorhexidine mouth rinses and bone debridement have beensuggested, results are disappointing and frequently fail withdisease progression.Based on the clinical, radiological and histological features of thedisease, we developed a combined treatment protocol. The resultsof the use of this protocol, at 3, 6 and 12 months follow-up arepresented.Methods: Fifty consecutive patients with bisphosphonateassociatedjawbone osteomyelitis were studied. The combinedprotocol consisted of: temporary bisphosphonate discontinuation,25 sessions of HOT, complete resection of the diseased bone andjaw reconstruction if needed, per-op 10-day cycle of antibiotictherapy, and 25 post-op sessions of HOT. Inclusion criteria ofthe study population considered were: (1) absence of jawbonelocalisation of metastatic disease or multiple myeloma; (2) sufficientstability of the primary disease; (3) unmanageable painwith antibiotic therapy and debridements; (4) rapid progressionof disease. Patients who completed the protocol were assessed at3, 6 and 12 months.Results: 14/50 patients completed the protocol and reached1-year follow-up. Histologically, 11/14 patients had normal bonearchitecture at the resection margins. 13/ 14 pts had completepain relief at one year. No recurrent bone disease was seen at CTand MRI at 1 year in 12/14 cases. No progression of the primarydisease was seen after bisphosphonate discontinuation.Conclusions: Despite the limited number of the study population,the proposed protocol seem to treat effectively bisphosphonateassociatedjawbone osteomyelitis in selected patients.