Pamidronate (Aredia) and zoledronate (Zometa) induced avascular necrosis of the jaws: A growing epidemic [1]

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1976 Scopus citations


Indications:An unspecified number of patients with hypercalcemia or osteoporosis. Coexisting diseases included metastatic breast carcinoma and multiple myeloma.

Patients:36 patients. Zometa group: 12 patients. Pamidronate group: 30 patients.

TypeofStudy:Cases of avascular necrosis of the jaw in patients receiving Zometa and pamidronate are reported in a letter.

DosageDuration:4 mg iv monthly. Duration not stated.

Results:Most patients presented with painful exposed avascular bone in the mandible (29 [80.5%]), in the maxilla (5 [14%]), or both (2 [5.5%]). The presentations simulated dental abscesses, "tooth aches", denture sore spots, and osteomyelitis. Removal of painful teeth was often the initiator of the exposed nonhealing bone [28 (77.7%) patients], the remaining 8 patients (22.3%) developed exposed bone spontaneously. Control and limitation of progression has been obtained in most cases with long-term or intermittent courses of penicillin-type antibiotics (erythromycin or tetracyclin if penicillin allergic), 0.12% chlorhexidine mouthwash and periodic minor debridement of soft-textured sequestrating bone and wound irrigation.

AdverseEffects:12 patients experienced avascular necrosis of the jaw.

AuthorsConclusions:Although no definite cause and effect relationship has yet been established, these 2 drugs are the direct factors in a multifactorial etiology leading to avascular necrosis in the jaws. At present, there is no known resolution for this drug-induced avascular necrosis of bone. Prevention by limiting the use of pamidronate (Aredia) and zoledronate (Zometa) to treatment of documented hypercalcemic states and multiple bone metastases with close monitoring seems prudent.

FreeText:Of the 12 patients receiving Zometa, 6 were received pamidronate in the past. 24 patients received pamidronate alone. Pamidronate was given at a dose of 90 mg intravenously monthly. Concomitant medications included dexamethasone and antineoplastic agents. Some patients received radiotherapy in the past

Original languageEnglish (US)
Pages (from-to)1115-1117
Number of pages3
JournalJournal of Oral and Maxillofacial Surgery
Issue number9
StatePublished - Sep 1 2003
Externally publishedYes

ASJC Scopus subject areas

  • Surgery
  • Oral Surgery
  • Otorhinolaryngology


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