Über die Inzidenz der Bisphosphonat-assoziierten Osteonekrose der Kiefer (BP-ONJ)im Landkreis Marburg-Biedenkopf und den Kenntnisstand der dort ansässigen Zahnärzte zur zahnärztlichen Behandlung von Patienten unter Bisphosphonattherapie

Purpose: The aim of this study was to detect the incidence of the ‘Bisphosphonate-associated Osteonecrosis of the Jaw’ (BP-ONJ) in association with osteoporosis in the year 2009 in the administrative district of Marburg-Biedenkopf in Hesse, Germany. Additionally, the therapeutic regimen of local dentists in the area was compared to the published guidelines of established international associations as DGZMK and AAOMS. Since the first description of BP-ONJ by Marx in 2003, many publications emphasize the close correlation of intravenous bisphosphonate treatment of malignant diseases and its initialisation of the severe bone disease, including maxilla and mandible. Only a few papers deal with the occurrence of BP-ONJ in patients receiving bisphosphonates for osteoporosis, mostly via oral application. Methodology: A pilot postal survey including 129 dental offices within the investigation area was conducted. Besides, the dentists were invited to contribute on a continuing education. Finally 107 returned questionnaires were included in this study, out of which 95 survey forms were evaluated statistically. Results: 20 of 107 questionnaires revealed a total amount of 37 cases of BP-ONJ, 23 of whom (62.6%) were linked to osteoporosis, whereby 14/23 (60.9%) of these were associated with oral bisphosphonate use and 9/23 (30.1%) with an intravenous one. 14/37 cases (37.4%) were related to malignant diseases, all with intravenous application of the agent. In summary, 23/37 cases (62.6%) were associated with intravenous bisphosphonate treatment and 14/37 (37.4%) with its oral application. 1.014 patients under bisphosphonate treatment because of osteoporosis were calculated in the investigation area in 2009. Consequently the incidence of BP-ONJ in connection with this disease got settled with 2.27%. The therapeutic regimen of the participants in this study correlated mostly with the internationally published guidelines of AAOMS and DGZMK. According to the oral application of the agent, still 20 dentists who reported cases of BP-ONJ conducted significantly less non-surgical periodontal interventions than the comparison group. Conclusions: This dissertation reveals that the incidence of BP-ONJ in association with osteoporosis has presumably been underrated since, linked as well to oral and intravenous bisphosphonate treatment. Precise reasons for this observance could not be defined sufficiently within the therapeutic regimen of the participating dentists. Still, inflammation prophylaxis could be identified as a probable central aspect of reducing the risk of BP-ONJ.