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Majety P, Malabanan AO. “Drug Holidays”: When and How? OSTEOPOROSIS 2021:173-184. [DOI: 10.1007/978-3-030-83951-2_15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
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Kün-Darbois JD, Fauvel F. Medication-related osteonecrosis and osteoradionecrosis of the jaws: Update and current management. Morphologie 2020; 105:170-187. [PMID: 33281055 DOI: 10.1016/j.morpho.2020.11.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 11/12/2020] [Accepted: 11/14/2020] [Indexed: 12/19/2022]
Abstract
Medication related osteonecrosis of the jaws (MRONJ) and osteoradionecrosis of the jaws (ORNJ) are two different diseases of quite similar appearance. MRONJ is mainly due to antiresorptive or antiangiogenic drug therapy and ORNJ to radiotherapy. The present work aimed at presenting and comparing the current knowledge on MRONJ and ORNJ. They both present as an exposure of necrotic bone and differ in some clinical or radiological characteristics, clinical course and mostly in treatment. They share similar risk factors. A tooth extraction is more frequently found as a triggering factor in MRONJ. The frequency of a maxillary localisation seems higher for MRONJ. On computed tomographic images, a periosteal reaction seems characteristic of MRONJ. More frequent pathological fractures seem to occur in ORNJ. It is mandatory, for ORNJ diagnosis, to exclude a residual or recurrent tumour using histological examination. Both MRONJ and ORNJ are challenging to treat and cannot be managed similarly. For both, it would still be worth to optimise awareness within the medical community, patients' oral hygiene and dental cares to improve their prevention and make their incidences decrease. Conservative therapy is more frequently achieved for MRONJ than ORNJ and surgical resection is more often performed for ORNJ. For both diseases, the last treatment possible in refractory cases is a surgical extensive resection with free flap reconstruction. A MRONJ classification is widely used today, whereas no consensus exists to date for ORNJ classification. We propose a classification that could play this role.
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Affiliation(s)
- J-D Kün-Darbois
- Department of oral and maxillofacial surgery, CHU d'Angers, 4, rue Larrey, 49933 Angers cedex, France; Groupe études remodelage osseux et bioMatériaux, GEROM, SFR 4208, UNIV Angers, IRIS-IBS institut de biologie en Santé, CHU d'Angers, 4, rue Larrey, 49933 Angers cedex, France.
| | - F Fauvel
- Department of oral and maxillofacial surgery, CHU de Nantes, 1, place Alexis-Ricordeau, 44093 Nantes cedex 1, France; Department of oral and maxillofacial surgery, CH de Saint-Nazaire, 11, boulevard Georges-Charpak, 44606 Saint-Nazaire cedex, France
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53
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Wei LY, Kok SH, Lee YC, Chiu WY, Wang JJ, Cheng SJ, Chang HH, Lee JJ. Prognosis of medication-related osteonecrosis of the jaws in metastatic prostate cancer patients. Oral Dis 2020; 28:182-192. [PMID: 33254278 DOI: 10.1111/odi.13737] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 07/29/2020] [Accepted: 11/27/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The aim of this study was to find out the prognosis of medication-related osteonecrosis of the jaws (MRONJ) in prostate cancer patients who received two different types of antiresorptive agents for bone metastasis. MATERIALS AND METHODS We retrospectively surveyed a cohort of 95 metastatic prostate cancer patients with 122 MRONJ lesions treated in a single medical center. Treatment outcomes and prognostic factors were investigated. The cumulative complete response rate was calculated with the Kaplan-Meier method, and significance was examined with the log-rank and Breslow tests. Cox regression was used for the univariate and multivariate analyses of prognostic factors. RESULTS The cumulative complete response rate of all patients at 12 months was 37.8%, and that of patients treated with zoledronic acid and denosumab was 22.9% and 70.5%, respectively. Denosumab, pretreatment C-terminal telopeptide of collagen I (CTX) level > 150 pg/ml, and anemia were identified as independent prognostic factors in a multivariate analysis with adjusted hazard ratios of 3.18 (95% confidence interval [CI], 1.24-8.11), 3.24 (95% CI, 1.39-7.53), and 0.42 (95% CI, 0.19-0.93), respectively. CONCLUSION A higher pretreatment level of CTX, using denosumab as the antiresorptive agent and without anemia, indicates a better treatment outcome of MRONJ in prostate cancer patients.
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Affiliation(s)
- Ling-Ying Wei
- Division of Oral and Maxillofacial Surgery, Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan.,Department of Dentistry, Bei-hu Branch of National Taiwan University Hospital, Taipei, Taiwan
| | - Sang-Heng Kok
- Division of Oral and Maxillofacial Surgery, Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan.,Department of Dentistry, School of Dentistry, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yen-Ching Lee
- Division of Oral and Maxillofacial Surgery, Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan
| | - Wei-Yih Chiu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Jai-Jen Wang
- Department of Finance, Feng Chia University, Taichung, Taiwan
| | - Shih-Jung Cheng
- Division of Oral and Maxillofacial Surgery, Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan.,Department of Dentistry, School of Dentistry, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Hao-Hueng Chang
- Division of Oral and Maxillofacial Surgery, Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan.,Department of Dentistry, School of Dentistry, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Jang-Jaer Lee
- Division of Oral and Maxillofacial Surgery, Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan.,Department of Dentistry, School of Dentistry, College of Medicine, National Taiwan University, Taipei, Taiwan
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Alqhtani NR, Almalki AK, Zuhair FA, Alenazi AA, Nabhan AB, Alqahtani M. Knowledge, Attitude, and Management of General Dentist toward Medication-related Osteonecrosis of the Jaws. J Pharm Bioallied Sci 2020; 12:S151-S154. [PMID: 33149447 PMCID: PMC7595487 DOI: 10.4103/jpbs.jpbs_47_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 02/24/2020] [Accepted: 03/09/2020] [Indexed: 11/23/2022] Open
Abstract
Background: Medication-related osteonecrosis of the jaw (MRONJ) is an intense negative drug response causing increasing bone destruction in the maxillofacial area of patients. Aims and Objectives: To evaluate the knowledge and attitude of dental practitioner regarding risk factors of MRONJ in Saudi Arabia. Materials and Methods: A cross-sectional, questionnaire survey was carried out in King Khalid Hospital, Al-Kharj among dental practioners. Results: Approximately 60% of the practioners had a poor knowledge and there was a weak positive correlation with work experience. Conclusion: Poor knowledge regarding the MRONJ invites a continuing dental education specially to focus on general practioners.
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Affiliation(s)
- Nasser R Alqhtani
- Department of Oral and Maxillofacial Surgery and Diagnostic Science, College of Dentistry, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Abdulrahman K Almalki
- Intern, College of Dentistry, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi-Arabia
| | - Faisal A Zuhair
- Intern, College of Dentistry, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi-Arabia
| | - Adel A Alenazi
- Department of Oral and Maxillofacial Surgery and Diagnostic Science, College of Dentistry, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Abdullah Bin Nabhan
- Department of Oral Medicine and Orofacial Pain, College of Dentistry, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Mana Alqahtani
- Department of Prosthodontics and Implantology, Faculty of Medicine, University of Tabuk, Al-Kharj, Saudi Arabia
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Halloran D, Durbano HW, Nohe A. Bone Morphogenetic Protein-2 in Development and Bone Homeostasis. J Dev Biol 2020; 8:jdb8030019. [PMID: 32933207 PMCID: PMC7557435 DOI: 10.3390/jdb8030019] [Citation(s) in RCA: 124] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 09/01/2020] [Accepted: 09/11/2020] [Indexed: 12/11/2022] Open
Abstract
Bone morphogenetic proteins (BMPs) are multi-functional growth factors belonging to the Transforming Growth Factor-Beta (TGF-β) superfamily. These proteins are essential to many developmental processes, including cardiogenesis, neurogenesis, and osteogenesis. Specifically, within the BMP family, Bone Morphogenetic Protein-2 (BMP-2) was the first BMP to be characterized and has been well-studied. BMP-2 has important roles during embryonic development, as well as bone remodeling and homeostasis in adulthood. Some of its specific functions include digit formation and activating osteogenic genes, such as Runt-Related Transcription Factor 2 (RUNX2). Because of its diverse functions and osteogenic potential, the Food and Drug Administration (FDA) approved usage of recombinant human BMP-2 (rhBMP-2) during spinal fusion surgery, tibial shaft repair, and maxillary sinus reconstructive surgery. However, shortly after initial injections of rhBMP-2, several adverse complications were reported, and alternative therapeutics have been developed to limit these side-effects. As the clinical application of BMP-2 is largely implicated in bone, we focus primarily on its role in bone. However, we also describe briefly the role of BMP-2 in development. We then focus on the structure of BMP-2, its activation and regulation signaling pathways, BMP-2 clinical applications, and limitations of using BMP-2 as a therapeutic. Further, this review explores other potential treatments that may be useful in treating bone disorders.
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Affiliation(s)
| | | | - Anja Nohe
- Correspondence: ; Tel.: +1-302-831-6977
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Abstract
This article explores how to prevent and manage complications of dentoalveolar surgery. Many complications are avoidable. Surgical skills and knowledge of anatomy play an important role in prevention of complications. Prevention starts with detailed history and physical examination of the patient. Key to perioperative management of patients is risk assessment. Without a proper history and physical examination, the clinician is unable to assess the risk of performing surgery and anesthesia for each patient. Some illnesses and medications increase the risk of complications. The following complications are discussed: alveolar osteitis, displacement, fracture, hemorrhage, infection, nonhealing wound, oroantral communication, swelling, and trismus.
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Affiliation(s)
- Patrick J Louis
- Department of Oral and Maxillofacial Surgery, University of Alabama at Birmingham, 1919 7th Avenue South, SDB 419, Birmingham, AL 35294, USA.
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Wiziack Zago PM, Oliveira Sousa IM, Servat-Medina L, Jorge MP, Lima Neto LG, Hass V, Li X, Tasca Gois Ruiz AL, Saxena D, Foglio MA. Standardized Arrabidaea chica Extract Shows Cytoprotective Effects in Zoledronic Acid-Treated Fibroblasts and Osteoblasts. Clin Cosmet Investig Dent 2020; 12:327-333. [PMID: 32848479 PMCID: PMC7429228 DOI: 10.2147/ccide.s259158] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 06/26/2020] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Osteonecrosis of the jaw is a condition associated with intraoral ulceration and bone necrosis induced by antiresorptive medications, such as zoledronic acid, a bisphosphonate. Previous data on Arrabidaea chica (H&B.) Verlot wound healing activity prompted the study reported herein on A. chica standardized hydro alcoholic extract in vitro cytoprotective activity data on epithelial and osteoblastic cells exposed to zoledronic acid (ZA). METHODS Primary human gingival fibroblasts and murine pre-osteoblasts were treated with ZA 10 µM together with 5 or 10 µg.mL-1 A. chica extract for 24h and 48 h. At both times, cells were submitted to viability assay and caspase 3/7 activation evaluation. Statistical analysis used one-way ANOVA and p=0.05. RESULTS In cell viability assay, a drastic damage effect of ZA appeared after 48 h in both epithelial (55.8%) and pre-osteoblastic cells (39.7%). When treated with ZA in combination with A. chica extract, cells showed higher viability values: 74.1%-82.3% for fibroblasts and 66% for pre-osteoblasts. Furthermore, the combined treatment presented lower caspase 3/7 activation in fibroblasts and pre-osteoblasts. CONCLUSION At low concentrations, A. chica extract showed promising cytoprotective effects against ZA-induced damage actions; however, further in vitro and in vivo studies are required to establish the mechanism of action.
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Affiliation(s)
| | | | - Leila Servat-Medina
- Faculty of Pharmaceutical Sciences at University of Campinas, Campinas, São Paulo, Brazil
| | - Michelle Pedroza Jorge
- Faculty of Pharmaceutical Sciences at University of Campinas, Campinas, São Paulo, Brazil
| | | | - Viviane Hass
- School of Dentistry, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Xin Li
- College of Dentistry, New York University, New York, NY, USA
| | | | - Deepak Saxena
- College of Dentistry, New York University, New York, NY, USA
| | - Mary Ann Foglio
- Faculty of Pharmaceutical Sciences at University of Campinas, Campinas, São Paulo, Brazil
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Lesclous P, Cloitre A, Catros S, Devoize L, Louvet B, Châtel C, Foissac F, Roux C. Alendronate or Zoledronic acid do not impair wound healing after tooth extraction in postmenopausal women with osteoporosis. Bone 2020; 137:115412. [PMID: 32404281 DOI: 10.1016/j.bone.2020.115412] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 04/29/2020] [Accepted: 05/07/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Bisphosphonates (BPs) are widely used for the prevention or treatment of osteoporosis. One of the most serious complications associated with BPs is medication-related osteonecrosis of the jaw (MRONJ) but its incidence in patients with osteoporosis is very low ranging from 0.001-0.15%. A major predisposing factor for MRONJ is tooth extraction (TE). Controversies persist about the influence of current BP therapy regarding socket healing after TE. The aims of this study were to investigate prospectively, (i) alveolar bone healing, i.e., filling of the bony socket by new bone and (ii) mucosal healing, i.e., closure of the overlying mucosa, after TE in women receiving current BP therapy for the prevention or the treatment of postmenopausal osteoporosis. METHODS Women with osteoporosis under current treatment with BPs (BP+ group) or other anti-osteoporotic medications (BP- group) undergoing single TE were included in this study. No antibiotic prophylaxis was prescribed solely for the BP therapy, but antibiotic treatment may have been required for local infectious conditions. Chlorohexidine mouthwashes were systematically prescribed in all study patients for one week after TE. New bone height (NBH) and rate of socket filling (RSF) were recorded using intraoral standardized radiographs one month and 3 months after TE (T30 and T90 respectively). The closure of the overlying mucosa was assessed by measuring the wound extent with an electronic caliper at 1 week and at 1 month after TE (T7 and T30 respectively). RESULTS At T30, NBH was not statistically different between the BP+ and BP- groups (p = .76). At T90, more than a two-fold in NBH increase was recorded for both groups with no statistically significant difference between them (p = .76). At T30 and T90, RSF was similar in both groups (p = .58 and p = .32 respectively). More than a two-fold RSF increase was founded between T30 and T90 in both groups. No demographic or BPs-related factors were correlated with the RSF at T90. At T7, the mucosa wound extent was reduced by more than two-fold with no statistically significant difference between both groups (p = .80). At this time, mucosa healing was achieved in 11.9% of the BP+ group and 10% of the BP- group (p = .99). At T30, mucosal healing was achieved in all patients but two, and at T90 it was achieved in all patients. CONCLUSION This study provides new insights into bone and mucosal healing in patients with osteoporosis taking BPs after TE. In this population, TE can be managed successfully with an appropriate surgical protocol and without discontinuation of BP treatment.
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Affiliation(s)
- Philippe Lesclous
- Inserm, UMR 1229, RMeS, Regenerative Medicine and Skeleton, Université de Nantes, UFR Odontologie, CHU de Nantes, Unité Fonctionnelle de Chirurgie Orale, PHU4 OTONN, ONIRIS, Nantes F-44042, France.
| | - Alexandra Cloitre
- Inserm, UMR 1229, RMeS, Regenerative Medicine and Skeleton, Université de Nantes, UFR Odontologie, CHU de Nantes, Unité Fonctionnelle de Chirurgie Orale, PHU4 OTONN, ONIRIS, Nantes F-44042, France
| | - Sylvain Catros
- Inserm, UMR 1026, BioTis, Tissue Bioengineering, Service de Chirurgie Orale, Université de Bordeaux, UFR Odontologie, CHU de Bordeaux, F-33076, France
| | - Laurent Devoize
- Université Clermont Auvergne, Neuro-Dol BP 10448, Clermont-Ferrand & Inserm U1107, F-63001 Clermont Ferrand, France
| | | | - Cécile Châtel
- Service de Chirurgie Plastique et Maxillo-Faciale, CHU Grenoble, Grenoble F-38000, France
| | | | - Christian Roux
- Inserm UMR 1153 Clinical epidemiology and biostatistics, Université Paris Descartes, PRES Sorbone Paris-Cité Service de Rhumatologie-Hôpital Cochin, AP -HP centre, Université de Paris, Paris, France
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Şahin O, Tatar B, Ekmekcioğlu C, Aliyev T, Odabaşı O. Prevention of medication related osteonecrosis of the jaw after dentoalveolar surgery: An institution's experience. J Clin Exp Dent 2020; 12:e771-e776. [PMID: 32913575 PMCID: PMC7474936 DOI: 10.4317/jced.56837] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 05/14/2020] [Indexed: 11/29/2022] Open
Abstract
Background Dentoalveolar surgery is a predisposing factor for medication related osteonecrosis of the jaw (MRONJ). The aim of our study was to evaluate the described surgical procedures to prevent the development of MRONJ after dentoalveolar surgery in patients receiving bisphosphonates.
Material and Methods In this retrospective study, sixty-three dentoalveolar surgeries were performed on 44 patients taking bisphosphonate in accordance with the treatment procedures we described. The following procedures were applied to patients 1) use of antibiotics 2) performed dentoalveolar surgical procedures 3) fill the socket with leukocyte- and platelet-rich fibrin (L-PRF) 4) post-operative application of low level laser therapy through Nd: YAG laser 5) sutures were removed on post-op 14th day 6) long-term results were evaluated.
Results Healing of all patients was uneventful. Complete mucosal healing was achieved in all patients at 1 month. There is no failure was observed in long-term follow-up.
Conclusions Because of the pathophysiology of MRONJ is not fully understood and has many risk factors, definitive protocols on prevention and treatment have not been established yet. Personal risk assessment is required for the prevention and treatment of MRONJ. The described surgical protocol may be considered to reduce the risk of developing MRONJ after dentoalveolar surgery due to its high success rate. Key words:Tooth extraction, medication related osteonecrosis of the jaw, preventive dentistry, L-PRF, low level laser therapy.
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Affiliation(s)
- Onur Şahin
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, İzmir Katip Çelebi University, İzmir, Türkiye
| | - Birkan Tatar
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, İzmir Katip Çelebi University, İzmir, Türkiye
| | - Ceren Ekmekcioğlu
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, İzmir Katip Çelebi University, İzmir, Türkiye
| | - Toghrul Aliyev
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, İzmir Katip Çelebi University, İzmir, Türkiye
| | - Onur Odabaşı
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Ankara Yıldırım Beyazıt University Ankara, Türkiye
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Therapeutic approach and management algorithms in medication-related osteonecrosis of the jaw (MONJ): recommendations of a multidisciplinary group of experts. Arch Osteoporos 2020; 15:101. [PMID: 32623599 DOI: 10.1007/s11657-020-00761-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 05/18/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND The justification for this consensus is the absence of local protocols on Medication-Related Osteonecrosis of the Jaws (MONJ), for prevention, evaluation, and treatment, involving physicians and dentists, leading to suspension of antiresorptive treatments, despite their benefit in the prevention of fragility fractures (40-70%). These fractures cause disability and mortality (80% and 20-30%, respectively), as opposed to the low risk associated with MONJ in osteoporotic (0.01-0.03%) and oncological patients (1.3-1.8%). PURPOSE To provide management recommendations through algorithms that guide health professionals to prevent, diagnose, and treat MONJ in different clinical scenarios. METHOD A technical multidisciplinary team composed of specialists with extensive experience in osteoporosis or osteonecrosis of the jaw from Fundación Santa Fé (Bogotá, Colombia) and the Asociación Colombiana de Osteoporosis y Metabolismo Mineral was selected. Three rounds were carried out: definition of questions, answers using Delphi methodology, and the discussion of questions in order to have an agreement. The whole group participated in two phases, and the developer group in the total number of rounds. A literature review was conducted to obtain academic support to design questions with clinical relevance. RESULTS AND CONCLUSIONS The consensus group generated definitions and recommendations useful for doctors and dentists, following clinical algorithms involving four scenarios: osteoporosis patient who requires dental procedures and has not received antiresorptives, osteoporosis patient who are under treatment with antiresorptives, cancer patients, and MONJ-instituted patients. The therapeutic approach in osteoporosis and cancer patients, in invasive dental procedures, must be relied on the risk-benefit treatment.
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Momesso GAC, Lemos CAA, Santiago-Júnior JF, Faverani LP, Pellizzer EP. Laser surgery in management of medication-related osteonecrosis of the jaws: a meta-analysis. Oral Maxillofac Surg 2020; 24:133-144. [PMID: 32056052 DOI: 10.1007/s10006-020-00831-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 01/10/2020] [Indexed: 06/10/2023]
Abstract
PURPOSE The aim of this study was to perform a systematic review and meta-analysis to evaluate the efficacy of laser therapy on medication-related osteonecrosis of the jaw (MRONJ) treatment. METHODS This study followed PRISMA standards, and an electronic search was performed on the PubMed/MEDLINE, Scopus, and Cochrane databases. Eighty-nine articles were found. After reading the manuscripts, 15 articles remained for the review. Three of them were selected for meta-analysis. RESULTS Female gender was predominant (72.5%), and mean age was 66.5 years. Follow-up varied between 3 and 80 months, and the most used bisphosphonate was zoledronic acid (71.6%). Stage II of MRONJ was the most prevalent (68.9%), and the mandible was the most affected site (64.5%). Qualitative data showed that treatment with laser surgery (Er:YAG) was most effective regarding complete healing of the lesion (90%) compared with other treatments. Meta-analysis data showed that low-level laser therapy (LLLT) was more effective than medical treatment (P = 0.006), and surgical treatment was more effective than LLLT (P = 0.008). CONCLUSION Laser surgery was significantly superior to LLLT (p < 0.00001). Therefore, laser surgical therapy seems to be a great management strategy for MRONJ treatment from stage II. LLLT was shown to improve conservative management in earlier MRONJ stages.
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Affiliation(s)
| | - Cleidiel Aparecido Araújo Lemos
- Department of Dental Materials and Prosthodontics, School of Dentistry, São Paulo State University (UNESP), Sao Paulo, Brazil
| | | | - Leonardo Perez Faverani
- Department of Diagnosis and Surgery, Aracatuba Dental School, São Paulo State University (UNESP), Sao Paulo, Brazil.
| | - Eduardo Piza Pellizzer
- Department of Dental Materials and Prosthodontics, School of Dentistry, São Paulo State University (UNESP), Sao Paulo, Brazil
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Singh M, Gonegandla GS. Bisphosphonate-Induced Osteonecrosis of the Jaws (BIONJ). J Maxillofac Oral Surg 2020; 19:162-167. [PMID: 32346224 PMCID: PMC7176749 DOI: 10.1007/s12663-019-01211-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 03/13/2019] [Indexed: 10/27/2022] Open
Abstract
INTRODUCTION The risk of osteonecrosis of the jaw is greater for patients receiving intravenous bisphosphonates for cancer than for patients receiving oral bisphosphonates for osteoporosis or Paget's disease. MATERIALS AND METHODS This article provides a review of the treatment of Bisphosphonate induced osteonecrosis of jaws. CONCLUSION Bisphonates associated jaw necrosis and its relation to dentisitry and maxillofacial surgery has become common now a days. Proper diagnosis and treatment may help the patients health getting worsen.
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Affiliation(s)
- Madhumati Singh
- RajaRajeswari Dental College and Hospital, Ramohalli Cross, Mysore Road, (p.o), Kumbalgodu, Bengaluru, 560074 India
| | - Giriraj Sandeep Gonegandla
- RajaRajeswari Dental College and Hospital, Ramohalli Cross, Mysore Road, (p.o), Kumbalgodu, Bengaluru, 560074 India
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63
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McCusker S, May C. A cutaneous presentation of bisphosphonate-related osteonecrosis of the jaw. Clin Exp Dermatol 2020; 45:932-934. [PMID: 32412657 DOI: 10.1111/ced.14240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 03/31/2020] [Indexed: 11/30/2022]
Affiliation(s)
- S McCusker
- Department of Dermatology, Royal Alexandra Hospital, NHS Greater Glasgow & Clyde, Glasgow, UK
| | - C May
- Department of Dermatology, Royal Alexandra Hospital, NHS Greater Glasgow & Clyde, Glasgow, UK
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64
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Simpione G, Caldas RJ, Soares MQS, Rubira-Bullen IRF, Santos PSS. Tomographic study of Jaw bone changes in patients with bisphosphonate-related osteonecrosis. J Clin Exp Dent 2020; 12:e285-e290. [PMID: 32190200 PMCID: PMC7071540 DOI: 10.4317/jced.56265] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 01/08/2020] [Indexed: 11/11/2022] Open
Abstract
Background Bisphosphonates (BP) are synthetic pyrophosphate-like substances with antiresorptive properties and specifically affect osteoclastic activity. In 2007, the American Association of Oral and Maxillofacial Surgeons (AAOMS) defined diagnostic criteria for Osteonecrosis of the Jaws Associated with Bisphosponates (BRONJ). BRONJ is mainly diagnosed by clinical features, but the detection of early bone changes by imaging may help prevent and better understand the disease. The objective of this study was to evaluate maxillary changes in CBCT in patients using BP.
Material and Methods All included patients were diagnosed with osteonecrosis and received bisphosphonate drugs in the last ten years. All imaging examinations were obtained by I-CAT and 3D Accuitomo. The multiplanar reconstructions were analyzed by an examiner without knowledge of the clinical aspects and location of the lesions.
Results The study sample consisted of 21 patients, the majority of the sample represented patients with cancer (76.2%), the other patients had osteoporosis (23.8%). Only four patients (19.04%) received alendronate, while intravenous bisphosphonates, such as zoledronate and pamidronate, represented the treatment of most of our sample. Most of our patients presented stage 1 and 2 MRONJ (85.7%), whose lesions were mainly observed in the mandible (52.4%). Fifty-seven percent of the patients had at least one bone change.
Conclusions In BRONJ, bone changes vary between exposed and non-exposed areas and one aspect of the study was: persistent extraction cavities in the BRONJ lesion region and high frequency of periodontal ligament space widening in areas that are not involved in BRONJ lesions. This reflects the very important role of dental and periodontal diseases in the pathophysiology of BRONJ. Thus, preventive measures should be prioritized for patients exposed to anti-resorptive drugs. Key words:Cone-Beam computed tomography, osteonecrosis, bisphosphonate-associated osteonecrosis of the jaw.
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Affiliation(s)
- Guilherme Simpione
- Master student, Bauru School of Dentistry, University of Sao Paulo, Brazil
| | | | - Mariana Q S Soares
- Post-doctoral student Bauru School of Dentistry, University of Sao Paulo, Brazil
| | - Izabel R F Rubira-Bullen
- Associate Professor, Department of Surgery, Stomatology, Radiology and Pathology, Faculty of Dentistry of Bauru - USP
| | - Paulo S S Santos
- Associate Professor, Department of Surgery, Stomatology, Radiology and Pathology, Faculty of Dentistry of Bauru - USP
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Shin JW, Kim JE, Huh KH, Yi WJ, Heo MS, Lee SS, Choi SC. Computed tomography imaging features of osteomyelitis of the jaw: comparison between antiresorptive medication-related conditions and medication-unrelated conditions. Oral Surg Oral Med Oral Pathol Oral Radiol 2019; 129:629-634. [PMID: 31983632 DOI: 10.1016/j.oooo.2019.11.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 11/07/2019] [Accepted: 11/09/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVES The aim of this study was to analyze and compare the imaging features of osteomyelitis according to the presence or absence of antiresorptive medications by using computed tomography (CT). STUDY DESIGN We retrospectively reviewed the records of 270 patients with osteomyelitis (83 males and 187 females; average age 66.6 years). CT imaging features were analyzed, and imaging and demographic features were compared between the medication-related osteomyelitis (MROM) group and the medication-unrelated osteomyelitis (MUOM) group. RESULTS Trabecular defects, cortical defects, sclerosis, and sequestra were detected in the majority of patients, whereas periosteal new bone formation was less common. The MROM group exhibited sequestra and periosteal new bone formation more frequently on CT images, but the size and appearance of the sequestra and type of periosteal new bone were not significantly different between the 2 groups. CONCLUSIONS Sequestra and periosteal new bone formation were characteristic CT features of osteomyelitis more commonly found in the medication-related condition. These findings may be useful in the evaluation of osteomyelitis and medication-related osteonecrosis of the jaw.
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Affiliation(s)
- Jeong Won Shin
- Clinical Assistant Professor, Department of Orthodontics, Institute of Oral Health Science, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Jo-Eun Kim
- Clinical Assistant Professor, Department of Oral and Maxillofacial Radiology, Seoul National University Dental Hospital, Seoul, Republic of Korea.
| | - Kyung-Hoe Huh
- Professor, Department of Oral and Maxillofacial Radiology and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Republic of Korea
| | - Won-Jin Yi
- Professor, Department of Oral and Maxillofacial Radiology, School of Dentistry, Seoul National University, Seoul, Republic of Korea
| | - Min-Suk Heo
- Professor, Department of Oral and Maxillofacial Radiology, School of Dentistry, Seoul National University, Seoul, Republic of Korea
| | - Sam-Sun Lee
- Professor, Department of Oral and Maxillofacial Radiology, School of Dentistry, Seoul National University, Seoul, Republic of Korea
| | - Soon-Chul Choi
- Professor, Department of Oral and Maxillofacial Radiology, School of Dentistry, Seoul National University, Seoul, Republic of Korea
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66
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Follow-Up of an Implant-Supported Rehabilitation After Long-Term Use of Alendronate. J Craniofac Surg 2019; 30:e793-e796. [DOI: 10.1097/scs.0000000000005782] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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67
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Song M. Dental care for patients taking antiresorptive drugs: a literature review. Restor Dent Endod 2019; 44:e42. [PMID: 31799170 PMCID: PMC6875544 DOI: 10.5395/rde.2019.44.e42] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 10/04/2019] [Accepted: 10/09/2019] [Indexed: 12/13/2022] Open
Abstract
Antiresorptive drugs (ARDs), such as bisphosphonates or denosumab, that prevent bone resorption are widely used in patients with osteoporosis or with cancer that has metastasized to the bones. Although osteonecrosis of the jaw (ONJ) is a well-documented complication of ARD use, the benefits ARDs outweigh the complication. Thus, research has focused on finding ways to prevent or reduce the risk of developing ONJ. Dentists, as part of a multi-professional team, have a critical role in preventing ONJ. However, many dentists tend to hesitate to provide dental care to patients with ONJ, or tend to think that it is a problem to be dealt with by oral surgeons. This review gives an overview of ARD-related ONJ and provides the guidelines for dental care in patients taking ARDs to lower the risk of developing ONJ.
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Affiliation(s)
- Minju Song
- Department of Conservative Dentistry, College of Dentistry, Dankook University, Cheonan, Korea
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Zandi M, Dehghan A, Talimkhani I, Rezaeian L, Mohammad Gholi Mezerji N. Histological evaluation of the healing process of autografted mandibular bone defects in rats under treatment with zoledronate. J Craniomaxillofac Surg 2019; 47:1779-1786. [PMID: 31635981 DOI: 10.1016/j.jcms.2019.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 08/13/2019] [Accepted: 08/14/2019] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE This study aims to evaluate the healing process of autografted mandibular bone defects in rats treated with zoledronate (ZOL). SUBJECTS AND METHODS A total of 180 Wistar rats were divided into four groups: group L received intravenous infusion of two doses of 0.06 mg/kg ZOL, nine weeks apart; group H received 0.06 mg/kg ZOL, while groups C and NC received normal saline at three-week intervals for nine weeks. Three weeks following the last infusion, a unilateral mandibular bone defect (5 mm) was created. Except in the NC group, all defects were repaired with autologous iliac bone graft. Fifteen animals from each group were sacrificed on postoperative Day 20, Day 40, and Day 60. Graft healing was scored using a histological grading system (ranging from 1 to 6). RESULTS Histological evaluations performed on postoperative Day 60 showed that the mandibular defects were mainly repaired with fibrous tissue in the NC and H groups (93.00% ± 7.51% and 82.67% ± 13.08%, respectively) and with bone in the C and L groups (75.33% ± 14.20% and 92.67% ± 8.84%, respectively). The percentage of fibrous tissue and bone as well as the healing score of the NC and H groups were significantly different (P = 0.001) from those of the C and L groups. However, these were not different between neither the NC and H groups nor the C and L groups. CONCLUSION Based on the results of the present study the hypothesis can be established that there also might be a dose-dependent effect of ZOL on the healing of bone grafts in humans. This hypothesis has to be verified or rejected in clinical trials.
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Affiliation(s)
- Mohammad Zandi
- Department of Oral and Maxillofacial Surgery, Hamadan University of Medical Sciences, Hamadan, Iran; Dental Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Arash Dehghan
- Department of Pathology, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Ideh Talimkhani
- Department of Oral and Maxillofacial Surgery, Hamadan University of Medical Sciences, Hamadan, Iran.
| | - Leila Rezaeian
- Dental Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
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Evaluation of therapeutic effects of teriparatide in a rat model of zoledronic acid-induced bisphosphonate-related osteonecrosis. JOURNAL OF ORAL AND MAXILLOFACIAL SURGERY, MEDICINE, AND PATHOLOGY 2019. [DOI: 10.1016/j.ajoms.2019.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Prevalence and risk factors of medication-related osteonecrosis of the jaw in osteoporotic and breast cancer patients: a cross-sectional study. Support Care Cancer 2019; 28:2265-2271. [PMID: 31468192 DOI: 10.1007/s00520-019-05044-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 08/16/2019] [Indexed: 12/18/2022]
Abstract
PURPOSE Medication-related osteonecrosis of the jaw (MRONJ) has been reported as a side effect of bisphosphonate (BP). The aim of this study was to identify the prevalence of MRONJ in women taking BP for osteoporosis and for metastatic breast cancer and correlate it with risk factors and biochemical markers of bone metabolism. METHODS Patients taking oral or intravenous BP with osteoporosis (G1; n = 153; median 72.8 years) and with metastatic breast cancer (G2; n = 134; median 58.2 years) had their hospital charts reviewed, were submitted to dental inspection, and answered a health questionnaire. Fasting blood samples were randomly collected from both groups to measure osteocalcin, carboxy-terminal cross-linking telopeptide of type I collagen, intact parathyroid hormone and procollagen type 1 amino-terminal propeptide (P1NP), 25 hydroxyvitamin D (25OHD), creatinine, and total calcium. RESULTS G1 was older (p = 0.001) and had more cases of diabetes (p = 0.043). P1NP was higher (p = 0.022) and 25OHD lower (p = 0.004) in G2 compared with G1. MRONJ was not found in the G1, whereas 4 cases (3%) were detected in G2. Positive risk factors for MRONJ were number of BP doses and number of visits to the dentist and dental extractions. The biochemical parameters, however, could not identify those who developed MRONJ. CONCLUSIONS The prevalence of MRONJ was 3% in women with metastatic breast cancer receiving BP. No cases were identified in women receiving oral BP chronically for osteoporosis. P1NP was higher in women with metastatic breast cancer, even during treatment with antiresorptives, but could not differentiate those with MRONJ.
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Kim JY, Park JH, Jung HD, Jung YS. Treatment of Medication-Related Osteonecrosis of the Jaw Around the Dental Implant With a Once-Weekly Teriparatide: A Case Report and Literature Review. J ORAL IMPLANTOL 2019; 45:403-407. [PMID: 31429640 DOI: 10.1563/aaid-joi-d-19-00040] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Managing medication-related osteonecrosis of the jaw (MRONJ) around a dental implant can be difficult. Although conservative treatment of MRONJ is recommended as the first-line form of management, many patients exhibit no improvement. The human recombinant parathyroid hormone teriparatide has recently been introduced for the management of MRONJ. Teriparatide is effective in the treatment of postmenopausal osteoporosis and is the only US Food and Drug Administration-approved anabolic agent that directly affects osteoblast function and contributes to bone remodeling. Herein we describe a case of MRONJ in an 85-year-old woman who was successfully treated with teriparatide. Teriparatide was administered once per week without any surgical interventions such as a sequestrectomy. Compared with most recently reported cases involving daily treatment with teriparatide, once-weekly administration of teriparatide may minimize side effects and patient discomfort. Once-weekly teriparatide application without sequestrectomy may be effective in the management of MRONJ around a dental implant.
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Affiliation(s)
- Jun-Young Kim
- Department of Oral & Maxillofacial Surgery, Oral Science Research Center, Yonsei University College of Dentistry, Seoul, Korea
| | - Jin Hoo Park
- Department of Oral & Maxillofacial Surgery, Oral Science Research Center, Yonsei University College of Dentistry, Seoul, Korea
| | - Hwi-Dong Jung
- Department of Oral & Maxillofacial Surgery, Oral Science Research Center, Yonsei University College of Dentistry, Seoul, Korea
| | - Young-Soo Jung
- Department of Oral & Maxillofacial Surgery, Oral Science Research Center, Yonsei University College of Dentistry, Seoul, Korea
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72
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Gil IG, Ponte BM, Mateo ST, García JJ. Treatment of Bisphosphonate-Related Osteonecrosis of the Jaw With Plasma Rich in Growth Factors After Dental Implant Surgery: A Case Report. J ORAL IMPLANTOL 2019; 45:289-296. [DOI: 10.1563/aaid-joi-d-18-00254] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Oral bisphosphonates are commonly used to improve bone density in patients who suffer from a variety of pathologies. However, they have also been known to cause bisphosphonate-related osteonecrosis of the jaws (BRONJ). The aim of this clinical case presentation is to (1) determine whether the currently recommended length of time that oral bisphosphonates should be discontinued, before performing dental implant surgery, is sufficient to prevent BRONJ and (2) to describe an alternative treatment for BRONJ. A 65-year-old female patient developed BRONJ after receiving mandibular dental implants 5 months after discontinuing alendronic acid (Fosamax). The BRONJ was treated by surgical osteotomy and plasma rich in growth factors (PRGF), and the patient was followed up with biweekly examinations, which included 0.2% chlorhexidine mouthwashes and removal of any remaining necrotic bone. The dental implants were loaded 41 weeks after surgery and followed up with periapical radiographs and implant stability quotient measurements at 3, 6, 12, and 24 months postloading. Although the Association of Oral and Maxillofacial Surgeons protocols for suspension of presurgical oral bisphosphonates were followed, this patient still developed BRONJ after implant surgery. While a multitude of treatments have been described in the literature, there is not enough scientific evidence to support any one treatment. Based on this clinical case, it can be concluded that the potential adverse effects of oral bisphosphonates on the jaws could be greater than expected and that treatment with PRGF produces promising results, although more long-term studies are necessary to confirm these findings.
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Affiliation(s)
| | | | | | - Jaime Jiménez García
- Private practice, Madrid, Spain
- Department of Implantology, European University of Madrid, Madrid, Spain
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73
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Yarom N, Shapiro CL, Peterson DE, Van Poznak CH, Bohlke K, Ruggiero SL, Migliorati CA, Khan A, Morrison A, Anderson H, Murphy BA, Alston-Johnson D, Mendes RA, Beadle BM, Jensen SB, Saunders DP. Medication-Related Osteonecrosis of the Jaw: MASCC/ISOO/ASCO Clinical Practice Guideline. J Clin Oncol 2019; 37:2270-2290. [PMID: 31329513 DOI: 10.1200/jco.19.01186] [Citation(s) in RCA: 179] [Impact Index Per Article: 35.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To provide guidance regarding best practices in the prevention and management of medication-related osteonecrosis of the jaw (MRONJ) in patients with cancer. METHODS Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology (MASCC/ISOO) and ASCO convened a multidisciplinary Expert Panel to evaluate the evidence and formulate recommendations. Guideline development involved a systematic review of the literature and a formal consensus process. PubMed and EMBASE were searched for studies of the prevention and management of MRONJ related to bone-modifying agents (BMAs) for oncologic indications published between January 2009 and December 2017. Results from an earlier systematic review (2003 to 2008) were also included. RESULTS The systematic review identified 132 publications, only 10 of which were randomized controlled trials. Recommendations underwent two rounds of consensus voting. RECOMMENDATIONS Currently, MRONJ is defined by (1) current or previous treatment with a BMA or angiogenic inhibitor, (2) exposed bone or bone that can be probed through an intraoral or extraoral fistula in the maxillofacial region and that has persisted for longer than 8 weeks, and (3) no history of radiation therapy to the jaws or metastatic disease to the jaws. In patients who initiate a BMA, preventive care includes comprehensive dental assessments, discussion of modifiable risk factors, and avoidance of elective dentoalveolar surgery (ie, surgery that involves the teeth or contiguous alveolar bone) during BMA treatment. It remains uncertain whether BMAs should be discontinued before dentoalveolar surgery. Staging of MRONJ should be performed by a clinician with experience in the management of MRONJ. Conservative measures comprise the initial approach to MRONJ treatment. Ongoing collaboration among the dentist, dental specialist, and oncologist is essential to optimal patient care.
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Affiliation(s)
- Noam Yarom
- Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.,Tel Aviv University, Tel Aviv, Israel
| | | | | | | | - Kari Bohlke
- American Society of Clinical Oncology, Alexandria, VA
| | - Salvatore L Ruggiero
- Hofstra North Shore-LIJ School of Medicine, Hempstead, NY.,Stony Brook School of Dental Medicine, Stony Brook, NY.,New York Center for Orthognathic and Maxillofacial Surgery, New York, NY
| | | | - Aliya Khan
- McMaster University, Hamilton, Ontario, Canada
| | - Archie Morrison
- Dalhousie University, Halifax, Nova Scotia, Canada.,Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
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Jørgensen V, Slettahjell HB, Skavberg Roaldsen K, Kostovski E. Carboxy terminal collagen crosslinks as a prognostic risk factor for fall-related fractures in individuals with established spinal cord injury. Spinal Cord 2019; 57:985-991. [PMID: 31308468 PMCID: PMC6892418 DOI: 10.1038/s41393-019-0322-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 05/29/2019] [Accepted: 06/15/2019] [Indexed: 11/09/2022]
Abstract
Study design Prospective cohort study. Objective To study associations between specific bone turnover markers and fall-related fractures in individuals with spinal cord injury (SCI). Setting Rehabilitation Hospital. Methods Carboxy terminal collagen crosslinks (CTX), type-1 procollagen N-terminal (P1NP), albumin-corrected calcium (Ca2+), parathyroid hormone (PTH) and vitamin D were examined in a cohort of 106 participants with SCI at least 1 year post injury. The participants were followed for 1 year monitoring fall-related fractures. Results In total, 29 out of 106 reported having experienced a fall-related fracture post-injury at baseline, and 5 out of 100 had experienced a fall-related bone fracture during the 1 year follow-up. Our main findings were that high levels of serum CTX increased the odds of being in the fracture group, and that 25-hydroxy vitamin D (25 OHD) levels, Ca2+, PTH or P1NP were not associated with being in the fracture group. Conclusions We here present an association between high-CTX plasma levels at baseline and fall-related fractures reported during a 1-year follow-up among individuals with established SCI. We recommend studies with larger SCI populations before further clinical implications can be drawn.
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Affiliation(s)
- Vivien Jørgensen
- Department of Research, Sunnaas Rehabilitation Hospital, University of Oslo, Oslo, Norway
| | | | - Kirsti Skavberg Roaldsen
- Department of Research, Sunnaas Rehabilitation Hospital, University of Oslo, Oslo, Norway.,Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,Faculty of Health Sciences, Department of Physiotherapy, Oslo Metropolitan University, Oslo, Norway
| | - Emil Kostovski
- Department of Research, Sunnaas Rehabilitation Hospital, University of Oslo, Oslo, Norway
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Komiya R, Wada T, Tsushima F, Sakamoto K, Ikeda T, Yamaguchi A, Harada H, Uo M. Quantitation and distribution of metallic elements in sequestra of medication-related osteonecrosis of jaw (MRONJ) using inductively coupled plasma atomic emission spectroscopy and synchrotron radiation X-ray fluorescence analysis. J Bone Miner Metab 2019; 37:676-684. [PMID: 30465092 DOI: 10.1007/s00774-018-0975-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 10/25/2018] [Indexed: 10/27/2022]
Abstract
Medication-related osteonecrosis of the jaw (MRONJ) is a serious adverse effect of antiresorptive agents like bisphosphonates. Abnormal concentrations of various trace metallic elements contained in bone minerals have been associated with MRONJ. In this study, we focused on trace metallic elements contained in the MRONJ sequestrum; their content and distribution were compared to those in osteomyelitis and non-inflammatory bones using inductively coupled plasma atomic emission spectroscopy (ICP-AES) and synchrotron radiation X-ray fluorescence analysis (SR-XRF). On ICP-AES analyses, various trace elements (Co, Cr, Cu, Fe, K, Mg, Ni, Sb, Ti, V, Pb) were significantly more in MRONJ sequestra than non-inflammatory bones. The Cu content was significantly higher in MRONJ sequestra than osteomyelitis and non-inflammatory bones. The Cu content in MRONJ sequestra was high even after decalcification. Additionally, Cu was distributed along the trabecular structures in decalcified MRONJ specimens, as observed using SR-XRF analysis. Therefore, this study was indicative of the characteristic behavior of Cu in MRONJ.
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Affiliation(s)
- Ruri Komiya
- Department of Oral and Maxillofacial Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, Japan
| | - Takahiro Wada
- Department of Advanced Biomaterials, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, Japan
| | - Fumihiko Tsushima
- Department of Oral and Maxillofacial Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, Japan
| | - Kei Sakamoto
- Department of Oral Pathology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, Japan
| | - Tohru Ikeda
- Department of Oral Pathology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, Japan
| | - Akira Yamaguchi
- Department of Oral Pathology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, Japan
- Oral Health Science Center, Tokyo Dental College, 2-9-18, Misakicho, Chiyoda-Ku, Tokyo, 101-0061, Japan
| | - Hiroyuki Harada
- Department of Oral and Maxillofacial Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, Japan
| | - Motohiro Uo
- Department of Advanced Biomaterials, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, Japan.
- Department of Materials Engineering, Graduate School of Engineering, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, Japan.
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Şahin O, Odabaşı O, Demiralp KÖ, Kurşun-Çakmak EŞ, Aliyev T. Comparison of findings of radiographic and fractal dimension analyses on panoramic radiographs of patients with early-stage and advanced-stage medication-related osteonecrosis of the jaw. Oral Surg Oral Med Oral Pathol Oral Radiol 2019; 128:78-86. [DOI: 10.1016/j.oooo.2019.03.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 02/28/2019] [Accepted: 03/02/2019] [Indexed: 01/09/2023]
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Awad ME, Sun C, Jernigan J, Elsalanty M. Serum C-terminal cross-linking telopeptide level as a predictive biomarker of osteonecrosis after dentoalveolar surgery in patients receiving bisphosphonate therapy: Systematic review and meta-analysis. J Am Dent Assoc 2019; 150:664-675.e8. [PMID: 31256803 DOI: 10.1016/j.adaj.2019.03.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 03/01/2019] [Accepted: 03/05/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND The authors' aim in this systematic review was to evaluate the validity of using preoperative serum C-terminal cross-linking telopeptide (CTX) levels as a predictive factor of increased risk of developing medication-related osteonecrosis of the jaw (MRONJ) in patients receiving bisphosphonate (BP) therapy who underwent invasive dental procedures. TYPES OF STUDIES REVIEWED The authors searched PubMed, MEDLINE, and Web of Science and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and the Cochrane Handbook for Systematic Reviews of Interventions. The authors conducted a meta-analysis on the risk ratio. The authors used the methodological index for nonrandomized studies and Quality Appraisal of Reliability Studies checklist to assess quality. RESULTS The authors included 18 clinical trials involving 2,301 patients. Most patients received alendronate or risedronate for an average of 62.14 months. The average serum CTX level in patients who received BP before surgery was 198.25 picograms per milliliter. Meta-analysis results showed that the cutoff in CTX level (150 pg/mL) was not predictive of MRONJ risk. The sensitivity of CTX values lower than 150 pg/mL was 34.26%, and the specificity was 77.08%. CONCLUSIONS AND PRACTICAL IMPLICATIONS The use of CTX levels to diagnose MRONJ risk after dental procedures in patients receiving BP is not justified. The cutoff of 150 pg/mL in serum CTX levels is not predictive of MRONJ. Further studies are needed to develop other reliable biomarkers.
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Salgueiro M, Stribos M, Zhang LF, Stevens M, Awad ME, Elsalanty M. Value of pre-operative CTX serum levels in the prediction of medication-related osteonecrosis of the jaw (MRONJ): a retrospective clinical study. EPMA J 2019; 10:21-29. [PMID: 30984311 PMCID: PMC6459452 DOI: 10.1007/s13167-019-0160-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 01/11/2019] [Indexed: 12/21/2022]
Abstract
OBJECTIVES The low incidence yet severe presentation of medication-related osteonecrosis of the jaw (MRONJ) makes it necessary to develop reliable predictive and preventive strategies. This study explored the value of pre-operative carboxy-terminal collagen crosslinks (CTX) serum level in the prediction of osteonecrosis-related complications in patients on bisphosphonate therapy. PATIENTS AND METHODS We examined patient records over 4 years (a total of 137 patients). Biometric data were extracted, in addition to type of treatment, CTX levels, drug holiday, procedure, complications, and co-morbidities. Non-parametric Wilcoxon two-sample tests were used to test the effect of initial CTX level in IV or PO and whether it was predictive of complications. Two independent proportion tests were used for testing the two different complication incident rates before or after the drug holiday. RESULTS A total of 93 patients were included in the study, of whom 88.17% were female. A total of 11 patients were receiving IV bisphosphonates at the time of initial presentation, 82 oral bisphosphonates. Out of 64 patients who underwent invasive dental procedure (IDP) before a drug holiday, eight were on IV bisphosphonates. Three patients in this group experienced osteonecrosis-related complications (37.5%). Out of the remaining 56 patients on oral bisphosphonates, four (7.14%) developed complications, significantly lower than the IV bisphosphonate group (p = 0.0364). On the other hand, of the 34 patients placed on a drug holiday prior to IDP, only one subject developed complications related to osteonecrosis. Five subjects who had operations both before and after drug holiday did not experience any complications. No statistical difference was detected in complication rates based on initial CTX level (above versus below 150 pg/ml), gender, comorbidities, or total duration of bisphosphonate treatment (p = 0.2675). The sensitivity and specificity of CTX cutoff of 150 pg/ml in predicting osteonecrosis were 37.5% and 57.7, respectively. CONCLUSIONS Serum levels of CTX by itself are not reliable as a predictive or preventive measure for such complications. Our data also suggested that a drug holiday of 5 months was not helpful in preventing osteonecrosis-related complications in patients on intravenous bisphosphonates. Further studies are urgently needed to develop adequate predictive and preventive strategies of MRONJ.
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Affiliation(s)
- Martin Salgueiro
- Oral and Maxillofacial Surgery Department, Dental College of Georgia, Augusta University, Augusta, GA USA
| | - Michael Stribos
- Medical Student, Medical College of Georgia, Augusta University, Augusta, GA USA
| | - Li Fang Zhang
- Department of Biostatistics and Epidemiology, Medical College of Georgia, Augusta University, Augusta, GA USA
| | - Mark Stevens
- Oral and Maxillofacial Surgery Department, Dental College of Georgia, Augusta University, Augusta, GA USA
| | - Mohamed E. Awad
- Department of Oral Biology and Diagnostic Sciences, Dental College of Georgia, Augusta University, Augusta, GA USA
| | - Mohammed Elsalanty
- Department of Oral Biology and Diagnostic Sciences, Dental College of Georgia, Augusta University, Augusta, GA USA
- Department of Oral Biology, Dental College of Dentistry, Augusta University, 1120 15th Street, Room #2404E, Augusta, GA 30809 USA
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Mendes V, Dos Santos GO, Calasans-Maia MD, Granjeiro JM, Moraschini V. Impact of bisphosphonate therapy on dental implant outcomes: An overview of systematic review evidence. Int J Oral Maxillofac Surg 2019; 48:373-381. [PMID: 30314708 DOI: 10.1016/j.ijom.2018.09.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 09/15/2018] [Accepted: 09/21/2018] [Indexed: 10/28/2022]
Abstract
The purpose of this overview was to assess the methods, quality, and outcomes of systematic reviews conducted to evaluate the impact of bisphosphonates on dental implants and the risk of developing bisphosphonate-related osteonecrosis of the jaw after dental implant surgery. An electronic search without date or language restriction was performed in the PubMed/MEDLINE, Cochrane CENTRAL, Web of Science, and LILACS databases (to January 2018). Eligibility criteria included systematic reviews that evaluated the impact of bisphosphonates on implant outcomes. The quality assessment of the included reviews was done using AMSTAR 2 guidelines. The protocol of this overview was registered in PROSPERO (CRD42018089617). The search and selection process yielded seven reviews, published between 2009 and 2017. None of the systematic reviews included in this study obtained the maximum score in the quality assessment. The scientific evidence available demonstrates that patients with a history of bisphosphonate use do not present a higher risk of dental implant failure or marginal bone loss compared to patients who have not used bisphosphonates. The literature also suggests that patients who undergo surgical trauma during the installation of dental implants may be more susceptible to bisphosphonate-related osteonecrosis of the jaw.
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Affiliation(s)
- V Mendes
- Department of Integrated Clinics, School of Dentistry, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil
| | - G O Dos Santos
- Department of Integrated Clinics, School of Dentistry, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil
| | - M D Calasans-Maia
- Department of Oral Surgery, School of Dentistry, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil
| | - J M Granjeiro
- National Institute of Metrology, Quality and Technology, Rio de Janeiro, Brazil; Cell Therapy Centre, Clinical Research Unit and Department of Dental Techniques, School of Dentistry, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil
| | - V Moraschini
- Department of Periodontology, School of Dentistry, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil.
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Moraschini V, de Almeida DCF, Figueredo CM, Calasans-Maia MD. Association between biomarkers and medication-related osteonecrosis of the jaws: a systematic review. Oral Surg Oral Med Oral Pathol Oral Radiol 2019; 127:504-515. [PMID: 30962171 DOI: 10.1016/j.oooo.2019.02.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 01/14/2019] [Accepted: 02/12/2019] [Indexed: 01/29/2023]
Abstract
OBJECTIVES Our aim was to conduct a systematic review (SR) of the literature assessing the role of human biomarkers in the diagnosis or prognostication of medication-related osteonecrosis of the jaws (MRONJ). STUDY DESIGN An electronic search without date or language restriction was carried out in PubMed/MEDLINE, the Cochrane Central Register of Controlled Trials, Web of Science, and LILACS for publications until March 2018. In addition, a manual search in the gray literature was conducted. The search process was performed by 2 independent reviewing authors. Eligibility criteria included randomized and nonrandomized clinical trials, prospective or retrospective cohorts, case controls, and case series evaluating the association between biomarkers and MRONJ. The protocol of this SR was registered in PROSPERO under number CRD42018095886. RESULTS The search and selection process yielded 19 studies (2 case series, 6 case-control studies, 9 prospective cohort studies, and 2 retrospective studies) published between 2008 and 2018. Twenty-four biomarkers collected from serum, saliva, and urine were investigated by these studies. Eleven biomarkers were possibly related to MRONJ; however, no consensus is observed in the literature with regard to the sensitivity and clinical effectiveness of these biomarkers. CONCLUSIONS Although many biomarkers have been associated with MRONJ, the present SR found scarce clinical evidence supporting the use of these biomarkers for the diagnosis and prognosis of MRONJ.
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Affiliation(s)
- Vittorio Moraschini
- Fluminense Federal University, Department of Periodontology, School of Dentistry, Salgado de Oliveira University, Rio de Janeiro, Brazil.
| | | | - Carlos Marcelo Figueredo
- Department of Periodontology, Faculty of Dentistry and Oral Health, Griffith University, Queensland, Australia
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McGowan K, Acton C, Ivanovski S, Johnson NW, Ware RS. Systemic comorbidities are associated with medication‐related osteonecrosis of the jaws: Case–control study. Oral Dis 2019; 25:1107-1115. [DOI: 10.1111/odi.13046] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 01/15/2019] [Accepted: 01/18/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Kelly McGowan
- School of Dentistry and Oral Health Griffith University Southport Queensland Australia
- School of Dentistry University of Queensland Herston Queensland Australia
| | - Caroline Acton
- Oral & Maxillofacial Surgery Department Royal Brisbane and Women’s Hospital Herston Queensland Australia
| | - Saso Ivanovski
- School of Dentistry University of Queensland Herston Queensland Australia
| | - Newell W. Johnson
- School of Dentistry and Oral Health Griffith University Southport Queensland Australia
- Menzies Health Institute QueenslandGriffith University Southport Queensland Australia
- Dental Institute King’s College London London UK
| | - Robert S. Ware
- Menzies Health Institute QueenslandGriffith University Southport Queensland Australia
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Lorenzo-Pouso AI, Pérez-Sayáns M, González-Palanca S, Chamorro-Petronacci C, Bagán J, García-García A. Biomarkers to predict the onset of biphosphonate-related osteonecrosis of the jaw: A systematic review. Med Oral Patol Oral Cir Bucal 2019; 24:e26-e36. [PMID: 30595601 PMCID: PMC6344011 DOI: 10.4317/medoral.22763] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 11/15/2018] [Indexed: 11/23/2022] Open
Abstract
Background The goal of this paper was to identify available biomarkers to predict the onset of biphosphonate-related osteonecrosis of the jaw (BRONJ). Material and Methods Case-control studies comparing the different concentrations of a series of molecules detected in serum and urine as matrices of BRONJ affected patients vs. non-affected were included. PRISMA guidelines for systematic reviews were used for the present paper. Two reviewers independently screened electronic databases (Medline, Web of science, and The Cochrane Library) and performed hand searches. Risk of bias assessment of selected studies was performed by the Newcastle-Ottawa Scale. This study is registered as PROSPERO CRD42017078149. Results From a total of 601 identified studies, 7 (4 articles with high methodological quality and 3 with medium) articles were included. They investigate 2623 patients, of whom 91 (3.47%) developed BRONJ. A total of 7 biomarkers were identified and classified into 3 groups: bone turnover, angiogenesis and endocrine markers. Conflicting results were found in relation to most biomarkers. Conclusions The present review suggests that no useful markers are currently available to evaluate BRONJ risk. Nevertheless, the present paper indicates that a paradigm shift from bone turnover biomarkers to angiogenesis and endocrine markers could shed light on this search. Key words:Biphosphonate, jaw, osteonecrosis, osteoporosis.
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Affiliation(s)
- A-I Lorenzo-Pouso
- Oral Medicine, Oral Surgery and Implantology Unit, Faculty of Medicine and Odontology, University of Santiago de Compostela, Rúa Entrerríos S/N, 15782 - Santiago de Compostela, (Spain),
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Kün-Darbois JD, Libouban H, Mabilleau G, Pascaretti-Grizon F, Chappard D. Bone mineralization and vascularization in bisphosphonate-related osteonecrosis of the jaw: an experimental study in the rat. Clin Oral Investig 2018; 22:2997-3006. [PMID: 29453497 DOI: 10.1007/s00784-018-2385-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 02/07/2018] [Indexed: 12/31/2022]
Abstract
OBJECTIVES Pathogenesis of bisphosphonate-related osteonecrosis of the jaws (BRONJ) is not fully explained. An antiangiogenic effect of bisphosphonates (BPs) or an altered bone quality have been advocated. The aims of the present study were to analyze alveolar mandibular vascularization and bone quality in rats with BRONJ. MATERIALS AND METHODS Thirty-eight Sprague-Dawley rats were randomized into two groups: zoledronic acid (ZA), n = 27, and control (CTRL) n = 11. The ZA group received a weekly IV injection of ZA (100 μg/kg) during 10 weeks. The CTRL group received saline. After 6 weeks, extraction of the right mandibular molars was performed. Rats were sacrificed after 14 weeks. Microtomography characterized bone lesions and vascularization after injection of a radio-opaque material. Raman microspectroscopy evaluated bone mineralization. RESULTS Fifty-five percent of ZA rats presented bone exposure and signs of BRONJ. None sign was found at the left hemimandible in the ZA group and in the CTRL group. Vascular density appeared significantly increased in the right hemimandibles of the CTRL group compared to the left hemimandibles. Vascularization was reduced in the ZA group. A significantly increased of the mineral-to-amide ratio was found in the alveolar bone of ZA rats by Raman microspectroscopy. CONCLUSIONS In a rat model of BRONJ, microtomography evidenced osteonecrosis in BRONJ. Raman spectroscopy showed an increased mineralization. Vascularization after tooth extraction was impaired by ZA. CLINICAL RELEVANCE Prolonged BP administration caused an increase in the mineralization and a quantitative reduction of the vascularization in the alveolar bone; both factors might be involved concomitantly in the BRONJ pathophysiology.
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Affiliation(s)
- Jean-Daniel Kün-Darbois
- Groupe d'Etude Remodelage Osseux et bioMatériaux GEROM, SFR 42-08, IRIS-IBS Institut de Biologie en Santé, Université d'Angers, CHU d'Angers 4, rue Larrey, 49933, Angers Cedex, France
- Service de chirurgie maxillo-faciale et stomatologie, CHU d'Angers, 4, rue Larrey, 49933, Angers Cedex, France
| | - Hélène Libouban
- Groupe d'Etude Remodelage Osseux et bioMatériaux GEROM, SFR 42-08, IRIS-IBS Institut de Biologie en Santé, Université d'Angers, CHU d'Angers 4, rue Larrey, 49933, Angers Cedex, France
| | - Guillaume Mabilleau
- Groupe d'Etude Remodelage Osseux et bioMatériaux GEROM, SFR 42-08, IRIS-IBS Institut de Biologie en Santé, Université d'Angers, CHU d'Angers 4, rue Larrey, 49933, Angers Cedex, France
- SCIAM Service Commun d'Imagerie et Analyses Microscopiques, IRIS-IBS Institut de Biologie en Santé, Université d'Angers, CHU d'Angers 4, rue Larrey, 49933, Angers Cedex, France
| | - Florence Pascaretti-Grizon
- Groupe d'Etude Remodelage Osseux et bioMatériaux GEROM, SFR 42-08, IRIS-IBS Institut de Biologie en Santé, Université d'Angers, CHU d'Angers 4, rue Larrey, 49933, Angers Cedex, France
| | - Daniel Chappard
- Groupe d'Etude Remodelage Osseux et bioMatériaux GEROM, SFR 42-08, IRIS-IBS Institut de Biologie en Santé, Université d'Angers, CHU d'Angers 4, rue Larrey, 49933, Angers Cedex, France.
- SCIAM Service Commun d'Imagerie et Analyses Microscopiques, IRIS-IBS Institut de Biologie en Santé, Université d'Angers, CHU d'Angers 4, rue Larrey, 49933, Angers Cedex, France.
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84
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Kim DW, Kim H, Nam W, Kim HJ, Cha IH. Machine learning to predict the occurrence of bisphosphonate-related osteonecrosis of the jaw associated with dental extraction: A preliminary report. Bone 2018; 116:207-214. [PMID: 29698784 DOI: 10.1016/j.bone.2018.04.020] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 04/08/2018] [Accepted: 04/23/2018] [Indexed: 10/17/2022]
Abstract
INTRODUCTION The aim of this study was to build and validate five types of machine learning models that can predict the occurrence of BRONJ associated with dental extraction in patients taking bisphosphonates for the management of osteoporosis. PATIENTS & METHODS A retrospective review of the medical records was conducted to obtain cases and controls for the study. Total 125 patients consisting of 41 cases and 84 controls were selected for the study. Five machine learning prediction algorithms including multivariable logistic regression model, decision tree, support vector machine, artificial neural network, and random forest were implemented. The outputs of these models were compared with each other and also with conventional methods, such as serum CTX level. Area under the receiver operating characteristic (ROC) curve (AUC) was used to compare the results. RESULTS The performance of machine learning models was significantly superior to conventional statistical methods and single predictors. The random forest model yielded the best performance (AUC = 0.973), followed by artificial neural network (AUC = 0.915), support vector machine (AUC = 0.882), logistic regression (AUC = 0.844), decision tree (AUC = 0.821), drug holiday alone (AUC = 0.810), and CTX level alone (AUC = 0.630). CONCLUSIONS Machine learning methods showed superior performance in predicting BRONJ associated with dental extraction compared to conventional statistical methods using drug holiday and serum CTX level. Machine learning can thus be applied in a wide range of clinical studies.
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Affiliation(s)
- Dong Wook Kim
- Department of Oral & Maxillofacial Surgery, Yonsei University College of Dentistry, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea.
| | - Hwiyoung Kim
- Department of Radiological Science, Yonsei University College of Medicine, Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea.
| | - Woong Nam
- Department of Oral & Maxillofacial Surgery, Yonsei University College of Dentistry, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea; Oral Cancer Research Institute, Yonsei University College of Dentistry, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea.
| | - Hyung Jun Kim
- Department of Oral & Maxillofacial Surgery, Yonsei University College of Dentistry, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea; Oral Cancer Research Institute, Yonsei University College of Dentistry, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea.
| | - In-Ho Cha
- Department of Oral & Maxillofacial Surgery, Yonsei University College of Dentistry, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea; Oral Cancer Research Institute, Yonsei University College of Dentistry, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea.
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85
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Steybe D, Voss PJ, Ermer MA, Fuessinger MA, Schmelzeisen R, Poxleitner P. Necrotizing fasciitis as a complication of osteonecrosis of the jaw related to oral bisphosphonate application in a patient with osteoporosis: a case report. Oral Maxillofac Surg 2018; 23:83-89. [PMID: 30288621 DOI: 10.1007/s10006-018-0725-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 09/26/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Necrotizing fasciitis has been reported as a complication secondary to bisphosphonate-related osteonecrosis of the jaw (BRONJ) in a low number of patients. The only report of such a case in an osteoporosis patient found in current literature was related to short-term bisphosphonate but long time corticosteroid and methotrexate treatment. CASE PRESENTATION In this article, we report a case of necrotizing fasciitis secondary to osteonecrosis of the jaw related to long-term oral bisphosphonate treatment in an osteoporosis patient additionally suffering from poorly controlled type 2 diabetes. Diabetes mellitus not only has been reported to be a systemic risk factor regarding BRONJ but also to be the most common comorbidity in patients presenting with necrotizing fasciitis and to increase mortality of this condition. Necrotizing fasciitis and BRONJ in the patient could eventually be resolved by a surgical approach and intravenous antibiotic therapy. CONCLUSIONS The case presented suggests diabetes mellitus potentially having been an important factor in the particularly unfavorable course of therapy. It emphasizes the importance of an adequate therapy and surveillance of modifiable systemic risk factors like diabetes mellitus in patients being at risk for development of BRONJ. If necrotizing fasciitis is suspected, early diagnosis and aggressive surgical and medical management are essential to minimize morbidity and mortality.
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Affiliation(s)
- David Steybe
- Department of Oral and Craniomaxillofacial Surgery, Center for Dental Medicine, University Medical Center Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany.
| | - Pit Jacob Voss
- Department of Oral and Craniomaxillofacial Surgery, Center for Dental Medicine, University Medical Center Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
| | - Michael Andreas Ermer
- Department of Oral and Craniomaxillofacial Surgery, Center for Dental Medicine, University Medical Center Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
| | - Marc Anton Fuessinger
- Department of Oral and Craniomaxillofacial Surgery, Center for Dental Medicine, University Medical Center Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
| | - Rainer Schmelzeisen
- Department of Oral and Craniomaxillofacial Surgery, Center for Dental Medicine, University Medical Center Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
| | - Philipp Poxleitner
- Department of Oral and Craniomaxillofacial Surgery, Center for Dental Medicine, University Medical Center Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
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Gelazius R, Poskevicius L, Sakavicius D, Grimuta V, Juodzbalys G. Dental Implant Placement in Patients on Bisphosphonate Therapy: a Systematic Review. EJOURNAL OF ORAL MAXILLOFACIAL RESEARCH 2018; 9:e2. [PMID: 30429962 PMCID: PMC6225599 DOI: 10.5037/jomr.2018.9302] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 09/26/2018] [Indexed: 01/05/2023]
Abstract
Objectives The review aims to study dental implant placement purposefulness for patients who have been treated or are on treatment with bisphosphonate medication. Material and Methods Structured search strategy was applied on electronic databases: MEDLINE, PubMed, PubMed Central and ResearchGate. Scientific publications in English between 2006 and 2017 were identified in accordance with inclusion, exclusion criteria. Publication screening, data extraction, and quality assessment were performed. Outcome measures included implant failure or implant-related osteonecrosis of the jaw. Results In total, 32 literature sources were reviewed, and 9 of the most relevant articles that are suitable to the criteria were selected. Heterogeneity between the studies was found and no meta-analysis could be done. Five studies analysed intraoral bisphosphonate medication in relation with implant placement, three studies investigated intravenous bisphosphonate medication in relation with implant placement and one study evaluated both types of medication given in relation with implant placement. Patients with intraoral therapy appeared to have a better implant survival (5 implants failed out of 423) rate at 98.8% vs. patients treated intravenously (6 implants failed out of 68) at 91%; the control group compared with intraoral bisphosphonate group appeared with 97% success implant survival rate (27 implants failed out of 842), showing no significant difference in terms of success in implant placement. Conclusions Patients treated with intravenous bisphosphonates seemed to have a higher chance of developing implant-related osteonecrosis of the jaw. The intraorally treated patient group appeared to have more successful results. Implant placement in patients treated intraorally could be considered safe with precautions.
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Affiliation(s)
- Rokas Gelazius
- Department of Maxillofacial Surgery, Lithuanian University of Health Sciences, KaunasLithuania
| | - Lukas Poskevicius
- Department of Maxillofacial Surgery, Lithuanian University of Health Sciences, KaunasLithuania
| | - Dalius Sakavicius
- Department of Maxillofacial Surgery, Lithuanian University of Health Sciences, KaunasLithuania
| | - Vaidas Grimuta
- Department of Maxillofacial Surgery, Lithuanian University of Health Sciences, KaunasLithuania
| | - Gintaras Juodzbalys
- Department of Maxillofacial Surgery, Lithuanian University of Health Sciences, KaunasLithuania
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Jonasson G, Skoglund I, Rythén M. The rise and fall of the alveolar process: Dependency of teeth and metabolic aspects. Arch Oral Biol 2018; 96:195-200. [PMID: 30292055 DOI: 10.1016/j.archoralbio.2018.09.016] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 09/11/2018] [Accepted: 09/25/2018] [Indexed: 11/25/2022]
Abstract
The alveolar bone has a unique capacity to follow the teeth's movements. It is formed around erupting teeth and their periodontal ligaments: the more the teeth have erupted, the larger the alveolar process. Throughout life the teeth erupt and migrate in an occlusal and mesial direction to compensate for attrition, an evolutionary trait. After tooth extraction, the alveolar process is resorbed to varying degrees. The mandibular alveolar bone mirrors skeletal bone condition. Due to fast bone turnover (which is the fastest in the whole skeleton), low bone mass and increased fracture risk may first be seen here. If a periapical radiograph of the mandibular premolars shows a dense trabeculation with well-mineralized trabeculae and small intertrabecular spaces, it is a reliable sign of normal skeletal bone density (BMD) and low skeletal fracture risk, whereas a sparse trabecular pattern indicates osteopenia and high fracture risk. The bone turnover rate in the mandible is twice that of the maxilla, and may, hypothetically, play a role in the development of osteonecrosis of the jaw (ONJ), which has been found mainly in the mandibular alveolar process?
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Affiliation(s)
- Grethe Jonasson
- R & D Public Dental Service, Region Västra Götaland, Sweden; Dept. of Behavioral and Community Dentistry, Institute of Odontology at the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Ingmarie Skoglund
- R & D Public Dental Service, Region Västra Götaland, Sweden; Department of Public Health and Community Medicine/Primary Health Care, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Marianne Rythén
- R & D Public Dental Service, Region Västra Götaland, Sweden; Specialist Clinic for Pediatric Dentistry, Public Dental Service, Mölndal, Sweden.
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88
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Khominsky A, Lim MAWT. “Spontaneous” medication-related osteonecrosis of the jaw; two case reports and a systematic review. Aust Dent J 2018; 63:441-454. [DOI: 10.1111/adj.12648] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2018] [Indexed: 11/30/2022]
Affiliation(s)
- A Khominsky
- Dental Unit; The Alfred Hospital; Prahran Victoria Australia
| | - MAWT Lim
- Dental Unit; The Alfred Hospital; Prahran Victoria Australia
- Melbourne Dental School; Royal Dental Hospital of Melbourne; Carlton Victoria Australia
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Khojasteh A, Dehghan MM, Nazeman P. Immediate implant placement following 1-year treatment with oral versus intravenous bisphosphonates: a histomorphometric canine study on peri-implant bone. Clin Oral Investig 2018; 23:1803-1809. [PMID: 30187256 DOI: 10.1007/s00784-018-2579-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 08/16/2018] [Indexed: 12/26/2022]
Abstract
OBJECTIVES Bisphosphonates (BPs) are anti-resorptive medications with inhibitory effects on osteoclasts which decrease bone turnover. The present study aimed to assess the early effects of BPs on peri-implant bone. MATERIALS AND METHODS Twelve female mongrel dogs were assigned to one control and two experimental groups as follows: 12 months of oral alendronate (ALN, 3.5 mg/kg/week) or intravenous (IV) pamidronate (PAM, 1 mg/kg/week) for experimental groups. Following 8 weeks after implant insertion, the specimens were sacrificed, histological evaluation was performed, and C-terminal telopeptide of collagen I (CTx) analysis was performed on serums. RESULTS PAM demonstrated the greatest marginal bone level (MBL), 2.64 ± 0.48, followed by ALN and control, 2.5 ± 0.4 and 0.66 ± 0.5 respectively. The least bone-implant contact was observed in PAM group (%39 ± 0.03) while it was significantly greater in the control group (p < 0.05). PAM and ALN demonstrated < 10 CTx levels versus > 300 in controls. CONCLUSION It is assumed that long-term oral or IV BP therapy decreases marginal bone resorption and osseointegration. These changes were more accentuated in IV BP administration. CTx does not seem to be a precise predictor for bisphosphonate-related osteonecrosis of the jaw. CLINICAL RELEVANCE BPs impair peri-implant bone remodeling and this phenomena may be effective for reducing resorption at esthetic zone implants; however, decrease in osseointegration may be a concern for implant treatment in patients receiving BPs.
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Affiliation(s)
- Arash Khojasteh
- Department of Tissue Engineering and Applied Cell Sciences, School of Advanced Technologies in Medicine, Shahid Beheshti University of Medical Sciences, Daneshjou Boulevard, Evin, P.O. 19839, Tehran, Iran.
| | - Mohammad Mehdi Dehghan
- Department of Surgery and Radiology, Center of Excellence for Cell Therapy and Tissue Engineering, Faculty of Veterinary Medicine, University of Tehran, Tehran, Iran
| | - Pantea Nazeman
- Research Institute of Dental Sciences, Dental School, Shahid Behehshti University of Medical Sciences, Tehran, Iran
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90
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Cross-Sectional Study of four Serological Bone Turnover Markers for the Risk Assessment of Medication-Related Osteonecrosis of the Jaw. J Craniofac Surg 2018; 29:e137-e140. [PMID: 29215447 DOI: 10.1097/scs.0000000000004224] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Despite the benefits related to the use of bisphosphonates and denosumab, medication-related osteonecrosis of the jaw (MRONJ) is a serious complication. The purpose of this study was to investigate the utility of 4 biochemical markers including serum c-terminal telopeptide cross-link of type I collagen (s-CTX), serum osteocalcin (s-OC), serum parathormon (s-PTH), and serum bone-specific alkaline phosphatase (s-BAP) as useful clinical tools to help assess the risk for MRONJ prior to invasive oral surgery. MATERIALS AND METHODS Twenty patients diagnosed with MRONJ and 20 controls who have been on antiresorptive therapies with no occurrence of MRONJ were included in this 2-arm cross-sectional study. The s-CTX, s-OC, s-PTH, and s-BAP values were measured. Mann-Whitney U test compared the s-CTX, s-OC, s-PTH, and s-BAP values of the MRONJ group and the controls (P < 0.05). RESULTS Lower values were observed in the MRONJ group compared with the control group for s-CTX (130.00 pg/mL versus 230.0 pg/mL; P = 0.12) and for s-OC (10.6 ng/mL versus 14.80 ng/mL; P = 0.051) both without significance and for s-BAP (0.23 μkat/L versus 0.31 μkat/L; P = 0.002) with significance. By contrast, the median s-PTH value of the MRONJ group was higher (30.65 ng/L versus 25.50 ng/L; P = 0.89), but without significance. CONCLUSIONS The evaluation of the 4 biochemical markers showed that only the value of s-BAP was significantly decreased in the MRONJ patients compared with the controls. Presently, because of the lack of evidence, a routine check prior to oral surgery for the risk assessment of MRONJ cannot be recommended.
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91
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Kwak EJ, Cha IH, Nam W, Yook JI, Park YB, Kim HJ. Effects of locally administered rhBMP-2 and bisphosphonate on bone regeneration in the rat fibula. Oral Dis 2018; 24:1042-1056. [DOI: 10.1111/odi.12864] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 02/23/2018] [Accepted: 03/16/2018] [Indexed: 12/25/2022]
Affiliation(s)
- E-J Kwak
- Department of Oral and Maxillofacial Surgery; College of Dentistry; Yonsei University; Seoul Korea
| | - I-H Cha
- Department of Oral and Maxillofacial Surgery; College of Dentistry; Yonsei University; Seoul Korea
| | - W Nam
- Department of Oral and Maxillofacial Surgery; College of Dentistry; Yonsei University; Seoul Korea
| | - JI Yook
- Department of Oral Pathology; College of Dentistry; Yonsei University; Seoul Korea
| | - Y-B Park
- Department of Prosthodontics; College of Dentistry; Yonsei University; Seoul Korea
| | - HJ Kim
- Department of Oral and Maxillofacial Surgery; College of Dentistry; Yonsei University; Seoul Korea
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92
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Manzano-Moreno FJ, Ramos-Torrecillas J, de Luna-Bertos E, Illescas-Montes R, Arnett TR, Ruiz C, García-Martínez O. Influence of pH on osteoclasts treated with zoledronate and alendronate. Clin Oral Investig 2018; 23:813-820. [PMID: 29876664 DOI: 10.1007/s00784-018-2505-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Accepted: 05/30/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The objectives of this study were to analyze the effect of pH on the growth and activity of osteoclasts treated with different doses of two nitrogen-containing BPs, zoledronate and alendronate. MATERIALS AND METHODS Murine osteoclasts cultured on dentine disks were treated with zoledronate (50 or 500 nM) or alendronate (500 or 5 μM) at two different pH values (7.4 or 7.0). Osteoclasts were counted with transmitted light microscopy, apoptosis/necrosis was studied with flow cytometry and confocal microscopy, and resorption pit number and depth were calculated using reflected light and scanning electron microscopy. RESULTS The osteoclast count on dentine disks was significantly (p < 0.001) reduced by zoledronate or alendronate treatment at pH 7.0 in comparison to treatment with the same doses at pH 7.4 and untreated disks (controls). The percentage of apoptotic cells was significantly increased by treatment with 500 nM zoledronate or 5 μM alendronate at pH 7.0 in comparison to the same doses at pH 7.4. The number and depth of resorption pits were significantly lower in disks treated at each BP dose studied than in untreated controls at pH 7.0. CONCLUSIONS Zoledronate and alendronate at therapeutic doses have an adverse effect on the viability and resorptive activity of osteoclasts when the local medium pH is reduced. CLINICAL RELEVANCE These findings suggest that periodontal or peri-implant oral cavity infection may be a key trigger of the cascade of events that lead to BRONJ.
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Affiliation(s)
| | - Javier Ramos-Torrecillas
- Instituto Investigación Biosanitaria, ibs.Granada, Granada, Spain.,Biomedical Group (BIO277), Department of Nursing, Faculty of Health Sciences, University of Granada, Avda. De la Ilustración 60, 18016, Granada, Spain
| | - Elvira de Luna-Bertos
- Instituto Investigación Biosanitaria, ibs.Granada, Granada, Spain.,Biomedical Group (BIO277), Department of Nursing, Faculty of Health Sciences, University of Granada, Avda. De la Ilustración 60, 18016, Granada, Spain
| | - Rebeca Illescas-Montes
- Instituto Investigación Biosanitaria, ibs.Granada, Granada, Spain.,Biomedical Group (BIO277), Department of Nursing, Faculty of Health Sciences, University of Granada, Melilla, Spain
| | - Timothy R Arnett
- Department of Cell and Developmental Biology, University College London, Bloomsbury, London, UK
| | - Concepción Ruiz
- Instituto Investigación Biosanitaria, ibs.Granada, Granada, Spain. .,Biomedical Group (BIO277), Department of Nursing, Faculty of Health Sciences, University of Granada, Avda. De la Ilustración 60, 18016, Granada, Spain. .,Institute of Neuroscience, Parque Tecnológico Ciencias de la Salud, Armilla (Granada), University of Granada, Granada, Spain.
| | - Olga García-Martínez
- Instituto Investigación Biosanitaria, ibs.Granada, Granada, Spain.,Biomedical Group (BIO277), Department of Nursing, Faculty of Health Sciences, University of Granada, Avda. De la Ilustración 60, 18016, Granada, Spain
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93
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Saad F, Sternberg CN, Mulders PFA, Niepel D, Tombal BF. The role of bisphosphonates or denosumab in light of the availability of new therapies for prostate cancer. Cancer Treat Rev 2018; 68:25-37. [PMID: 29787892 DOI: 10.1016/j.ctrv.2018.04.014] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 04/27/2018] [Accepted: 04/28/2018] [Indexed: 12/28/2022]
Abstract
Most men with advanced prostate cancer will develop bone metastases, which have a substantial impact on quality of life. Bone metastases can lead to skeletal-related events (SREs), which place a burden on patients and healthcare systems. For men with castration-resistant prostate cancer (CRPC) and bone metastases, the treatment landscape has evolved rapidly over the past few years. The relatively recent approvals of the hormonal agents abiraterone acetate and enzalutamide, second-line chemotherapy cabazitaxel, and the radiopharmaceutical radium-223 dichloride (radium-223), have provided clinicians with a greater choice of treatments. These compounds have benefits in terms of overall survival based on the results of pivotal phase 3 studies. The bisphosphonate zoledronic acid and the RANK ligand inhibitor denosumab are indicated for the prevention of SREs in men with metastatic CRPC but studies of these compounds have not demonstrated a survival benefit. The important question of the role of bisphosphonates or denosumab in combination with these new agents has thus materialised. Current and emerging evidence from clinical studies of abiraterone acetate, enzalutamide and radium-223, suggest that addition of bisphosphonates or denosumab to these new therapies may provide further clinical benefits for patients with prostate cancer and bone metastases. This evidence may help to shape clinical practice but are based largely on post hoc analyses of clinical trial data. It is therefore apparent that further data are required from both clinical studies and real-world settings to enable physicians to understand the efficacy and safety of combination therapy with the new agents plus bisphosphonates or denosumab.
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Affiliation(s)
- Fred Saad
- Division of Urology, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Cora N Sternberg
- Department of Medical Oncology, San Camillo-Forlanini Hospital, Rome, Italy
| | | | | | - Bertrand F Tombal
- Service d'Urologie, Institut de Recherche Clinique, Université Catholique de Louvain, Brussels, Belgium.
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94
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Lee OL, Horvath N, Lee C, Joshua D, Ho J, Szer J, Quach H, Spencer A, Harrison S, Mollee P, Roberts AW, Talaulikar D, Brown R, Augustson B, Ling S, Jaksic W, Gibson J, Kalff A, Johnston A, Kalro A, Ward C, Prince HM, Zannettino A. Bisphosphonate guidelines for treatment and prevention of myeloma bone disease. Intern Med J 2018; 47:938-951. [PMID: 28782211 DOI: 10.1111/imj.13502] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 04/26/2017] [Accepted: 05/15/2017] [Indexed: 01/10/2023]
Abstract
Multiple myeloma (MM) is a haematological malignancy characterised by the clonal proliferation of plasma cells in the bone marrow. More than 80% of patients with MM display evidence of myeloma bone disease (MBD), characterised by the formation of osteolytic lesions throughout the axial and appendicular skeleton. MBD significantly increases the risk of skeletal-related events such as pathologic fracture, spinal cord compression and hypercalcaemia. MBD is the result of MM plasma cells-mediated activation of osteoclast activity and suppression of osteoblast activity. Bisphosphonates (BP), pyrophosphate analogues with high bone affinity, are the only pharmacological agents currently recommended for the treatment and prevention of MBD and remain the standard of care. Pamidronate and zoledronic acid are the most commonly used BP to treat MBD. Although generally safe, frequent high doses of BP are associated with adverse events such as renal toxicity and osteonecrosis of the jaw. As such, optimal duration and dosing of BP therapy is required in order to minimise BP-associated adverse events. The following guidelines provide currently available evidence for the adoption of a tailored approach when using BP for the management of MBD.
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Affiliation(s)
- Oi Lin Lee
- Department of Haematology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Noemi Horvath
- Department of Haematology, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,Medical and Scientific Advisory Group, Myeloma Australia, Melbourne, Victoria, Australia
| | - Cindy Lee
- Medical and Scientific Advisory Group, Myeloma Australia, Melbourne, Victoria, Australia.,Department of Haematology, Queen Elizabeth Hospital, Adelaide, South Australia, Australia
| | - Doug Joshua
- Medical and Scientific Advisory Group, Myeloma Australia, Melbourne, Victoria, Australia.,Department of Haematology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Department of Cancer and Haematology, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Joy Ho
- Medical and Scientific Advisory Group, Myeloma Australia, Melbourne, Victoria, Australia.,Department of Haematology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Department of Cancer and Haematology, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Jeff Szer
- Medical and Scientific Advisory Group, Myeloma Australia, Melbourne, Victoria, Australia.,Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia.,Department of Clinical Haematology and BMT, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Hang Quach
- Medical and Scientific Advisory Group, Myeloma Australia, Melbourne, Victoria, Australia.,Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia.,Department of Haematology, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Andrew Spencer
- Medical and Scientific Advisory Group, Myeloma Australia, Melbourne, Victoria, Australia.,Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia.,Department of Haematology, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Simon Harrison
- Medical and Scientific Advisory Group, Myeloma Australia, Melbourne, Victoria, Australia.,Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia.,Department of Haematology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Peter Mollee
- Medical and Scientific Advisory Group, Myeloma Australia, Melbourne, Victoria, Australia.,Department of Haematology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Andrew W Roberts
- Medical and Scientific Advisory Group, Myeloma Australia, Melbourne, Victoria, Australia.,Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia.,Department of Clinical Haematology and BMT, Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria, Australia
| | - Dipti Talaulikar
- Medical and Scientific Advisory Group, Myeloma Australia, Melbourne, Victoria, Australia.,Department of Haematology, Canberra Hospital, Canberra, Australian Capital Territory, Australia.,College of Medicine, Biology and Environment, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Ross Brown
- Medical and Scientific Advisory Group, Myeloma Australia, Melbourne, Victoria, Australia.,Department of Haematology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Bradley Augustson
- Medical and Scientific Advisory Group, Myeloma Australia, Melbourne, Victoria, Australia.,Department of Haematology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Silvia Ling
- Medical and Scientific Advisory Group, Myeloma Australia, Melbourne, Victoria, Australia.,Department of Haematology, Liverpool Hospital, Sydney, New South Wales, Australia.,South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Wilfrid Jaksic
- Medical and Scientific Advisory Group, Myeloma Australia, Melbourne, Victoria, Australia.,Department of Haematology, Queen Elizabeth Hospital, Adelaide, South Australia, Australia
| | - John Gibson
- Medical and Scientific Advisory Group, Myeloma Australia, Melbourne, Victoria, Australia.,Department of Haematology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Department of Cancer and Haematology, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Anna Kalff
- Medical and Scientific Advisory Group, Myeloma Australia, Melbourne, Victoria, Australia.,Department of Haematology, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Anna Johnston
- Medical and Scientific Advisory Group, Myeloma Australia, Melbourne, Victoria, Australia.,Department of Haematology, Royal Hobart Hospital, Hobart, Tasmania, Australia.,Faculty of Health, University of Tasmania, Hobart, Tasmania, Australia
| | - Akash Kalro
- Medical and Scientific Advisory Group, Myeloma Australia, Melbourne, Victoria, Australia.,Department of Haematology, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Chris Ward
- Medical and Scientific Advisory Group, Myeloma Australia, Melbourne, Victoria, Australia.,Department of Cancer and Haematology, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,Department of Medicine, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - H Miles Prince
- Medical and Scientific Advisory Group, Myeloma Australia, Melbourne, Victoria, Australia.,Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia.,Department of Haematology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Andrew Zannettino
- Medical and Scientific Advisory Group, Myeloma Australia, Melbourne, Victoria, Australia.,Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia.,Cancer Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
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95
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Treatment of systemic diseases and oral focal infection. INFECTION INTERNATIONAL 2018. [DOI: 10.2478/ii-2018-0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
AbstractOral lesions are highly correlated with the occurrence and development of many diseases. In addition, the treatment of systemic diseases may aggravate oral focal infections, affect the life quality of patients, interfere with the treatment of systemic diseases, and even cause systemic infection in serious cases. Treatment strategies for systemic diseases may induce or aggravate oral local lesion infections. In specific, administration of oral antiepileptic drugs and immunosuppressive drugs may induce gingivitis, radiotherapy or chemotherapy for malignant tumors may cause oral mucositis, long-term use of bisphosphonates for inhibition of tumor bone metastasis or prevention of osteoporosis may cause osteonecrosis of the jaw, and allogeneic hematopoietic stem cell transplantation may cause oral rejection reactions.
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96
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Merigo E, Cella L, Oppici A, Cristina Arbasi M, Clini F, Fontana M, Fornaini C. Combined Approach to Treat Medication-Related Osteonecrosis of the Jaws. J Lasers Med Sci 2018; 9:92-100. [PMID: 30026893 DOI: 10.15171/jlms.2018.19] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Introduction: The proper therapeutic plan for medication-related osteonecrosis of the Jaw (MRONJ) is still lacking long-term data up to today. They were several high-technological appliances proposed for the different intervention steps, in addition to tissue repair promoters. The reason for proposing an integrated technique is justified, beyond better compliance of the patients associated to the pain and inflammation reduction and bleeding control, there is also achieving better hard and soft tissues healing. Methods: Patients diagnosed with bisphosphonates-related osteonecrosis of the jaws (BRONJ) at the Odontostomatology and Maxillo-Facial Surgery Unit of the Hospital of Piacenza undergone surgical intervention. The intervention was performed by using different devices: Piezosurgery for removing the necrotic bone tissue and for obtaining the bone specimen essential for histological analysis; Er:YAG laser (2940 nm) to vaporize necrotic hard tissue until reaching the bleeding bone; platelet-rich plasma (PRP) to stimulate hard and soft tissue healing; and finally diode laser (808 nm) to perform a biostimulation of the surgical site. Results: All treated patients demonstrated a good postoperative comfort even without using painkillers, no bleeding, and a fast healing process. Most of the patients (92.85%) reached complete healing with a minimum follow up at 6 months. Histological exams demonstrated a good quality without artifacts. Conclusion: Sequential utilization of different high-technologies devices during all the steps of MRONJ treatment allows to perform a faster and less invasive surgery with a more comfortable postoperative healing process and it may represent a new and original approach for treating this severe adverse event.
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Affiliation(s)
- Elisabetta Merigo
- MICORALIS Laboratory EA7354, Faculty of Dentistry, Université "Côte d'Azur", 24 Avenue des Diables Bleus, 06357 Nice, France.,Odontostomatology and Maxillo-Facial Surgery Unit - "Special care dentistry", "Guglielmo da Saliceto" Hospital - Via Taverna, 10 - 29100, Piacenza, Italy
| | - Luigi Cella
- Odontostomatology and Maxillo-Facial Surgery Unit - "Special care dentistry", "Guglielmo da Saliceto" Hospital - Via Taverna, 10 - 29100, Piacenza, Italy
| | - Aldo Oppici
- Odontostomatology and Maxillo-Facial Surgery Unit - "Special care dentistry", "Guglielmo da Saliceto" Hospital - Via Taverna, 10 - 29100, Piacenza, Italy
| | - Maria Cristina Arbasi
- Immunohematology and Transfusion Medicine "Guglielmo da Saliceto" Hospital - via Taverna, 10 - 29100, Piacenza, Italy
| | - Fabio Clini
- Odontostomatology and Maxillo-Facial Surgery Unit - "Special care dentistry", "Guglielmo da Saliceto" Hospital - Via Taverna, 10 - 29100, Piacenza, Italy
| | - Matteo Fontana
- Odontostomatology and Maxillo-Facial Surgery Unit - "Special care dentistry", "Guglielmo da Saliceto" Hospital - Via Taverna, 10 - 29100, Piacenza, Italy
| | - Carlo Fornaini
- MICORALIS Laboratory EA7354, Faculty of Dentistry, Université "Côte d'Azur", 24 Avenue des Diables Bleus, 06357 Nice, France.,Odontostomatology and Maxillo-Facial Surgery Unit - "Special care dentistry", "Guglielmo da Saliceto" Hospital - Via Taverna, 10 - 29100, Piacenza, Italy
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97
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Vargas-Franco JW, Castaneda B, Rédiní F, Gómez DF, Heymann D, Lézot F. Paradoxical side effects of bisphosphonates on the skeleton: What do we know and what can we do? J Cell Physiol 2018; 233:5696-5715. [PMID: 29323712 DOI: 10.1002/jcp.26465] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 01/05/2018] [Indexed: 12/15/2022]
Abstract
Bisphosphonates are considered the most effective drugs for controlling adult and pediatric osteolytic diseases. Although they have been used successfully for many years, several side effects, such as osteonecrosis of the jaw, delayed dental eruption, atypical femoral fracture, and alterations to the bone growth system, have been described. After an overview of nitrogenous bisphosphonate, the purpose of this article is to describe their mechanisms of action and current applications, review the preclinical and clinical evidence of their side effects in the skeleton ("what we know"), and describe current recommendations for preventing and managing these effects ("what we can do"). Finally, promising future directions on how to limit the occurrence of these side effects will be presented.
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Affiliation(s)
- Jorge W Vargas-Franco
- UMR-1238, INSERM, Equipe 1, Faculté de Médecine de l'Université de Nantes, Nantes, France.,Department of Basic Studies, Faculty of Odontology, University of Antioquia, Medellin, Colombia
| | - Beatriz Castaneda
- INSERM, UMR-1138, Equipe 5, Centre de Recherche des Cordeliers, Paris, France
| | - Françoise Rédiní
- UMR-1238, INSERM, Equipe 1, Faculté de Médecine de l'Université de Nantes, Nantes, France
| | - David F Gómez
- Department of Basic Studies, Faculty of Odontology, University of Antioquia, Medellin, Colombia
| | - Dominique Heymann
- INSERM, LEA Sarcoma Research Unit, Department of Oncology and Human Metabolism, Medical School, University of Sheffield, Sheffield, UK.,UMR-1232, Institut de Cancérologie de l'Ouest, Site René Gauducheau, INSERM, Boulevard Professeur Jacques Monod, Saint-Herblain, France
| | - Frédéric Lézot
- UMR-1238, INSERM, Equipe 1, Faculté de Médecine de l'Université de Nantes, Nantes, France
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98
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Mathai PC, Andrade NN, Aggarwal N, Nerurkar S, Kapoor P. Low-dose methotrexate in rheumatoid arthritis: a potential risk factor for bisphosphonate-induced osteonecrosis of the jaw. Oral Maxillofac Surg 2018; 22:235-240. [PMID: 29508096 DOI: 10.1007/s10006-018-0688-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 02/23/2018] [Indexed: 10/17/2022]
Abstract
Bisphosphonate-induced osteonecrosis of the jaw [BIONJ] is a relatively new pathological condition which was first described in the year 2003. The prevalence of BIONJ in patients on oral formulations is around 0.05% within the first 3 years and increases up to 0.2% after 4 years of consumption. Proven systemic risk factors like anemia, uncontrolled diabetes, corticosteroid therapy, and chemotherapy in neoplastic diseases [e.g., high doses of methotrexate up to 30 mg daily] significantly increase the chances of acquiring BIONJ. We present three patients with osteoporosis and rheumatoid arthritis [RA] who consumed oral bisphosphonates [alendronate] for less than 1 year and developed BIONJ within 2 to 5 months of undergoing a traumatic dental procedure. The patients also gave a history of consuming low doses of methotrexate [disease-modifying anti-rheumatic drugs] up to 20 mg weekly for 4 to 10 years. No history of steroid consumption was given by any of the patients. This case series highlights the possibility of rheumatoid arthritis and low-dose methotrexate being potential risk factors for BIONJ. This may be on account of the synergistic effect of methotrexate and bisphosphonates and the pro-inflammatory state created by RA which increased the risk of acquiring BIONJ.
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Affiliation(s)
- Paul C Mathai
- Department of Oral and Maxillofacial Surgery, Nair Hospital Dental College, Mumbai Central, Mumbai, 400008, India
| | - Neelam N Andrade
- Department of Oral and Maxillofacial Surgery, Nair Hospital Dental College, Mumbai Central, Mumbai, 400008, India.
| | - Neha Aggarwal
- Department of Oral and Maxillofacial Surgery, Nair Hospital Dental College, Mumbai Central, Mumbai, 400008, India
| | - Shibani Nerurkar
- Department of Oral and Maxillofacial Surgery, Nair Hospital Dental College, Mumbai Central, Mumbai, 400008, India
| | - Prathmesh Kapoor
- Department of Oral and Maxillofacial Surgery, Nair Hospital Dental College, Mumbai Central, Mumbai, 400008, India
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99
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Manzano-Moreno FJ, Ramos-Torrecillas J, Melguizo-Rodríguez L, Illescas-Montes R, Ruiz C, García-Martínez O. Bisphosphonate Modulation of the Gene Expression of Different Markers Involved in Osteoblast Physiology: Possible Implications in Bisphosphonate-Related Osteonecrosis of the Jaw. Int J Med Sci 2018; 15:359-367. [PMID: 29511371 PMCID: PMC5835706 DOI: 10.7150/ijms.22627] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 01/05/2018] [Indexed: 12/28/2022] Open
Abstract
The aim of the present study was to elucidate the role of osteoblasts in bisphosphonates-related osteonecrosis of the jaw (BRONJ). The specific objective was to evaluate the effect on osteoblasts of two nitrogen-containing BPs (zoledronate and alendronate) and one non-nitrogen-containing BP (clodronate) by analyzing modulations in their expression of genes essential for osteoblast physiology. Real-time polymerase chain reaction (RT-PCR) was used to study the effects of zoledronate, alendronate, and clodronate at doses of 10-5, 10-7, or 10-9 M on the expression of Runx-2, OSX, ALP, OSC, OPG, RANKL, Col-I, BMP-2, BMP-7, TGF-β1, VEGF, TGF-βR1, TGF-βR2, and TGF-βR3 by primary human osteoblasts (HOBs) and MG-63 osteosarcoma cells. Expression of these markers was found to be dose-dependent, with no substantive differences between these cell lines. In general, results demonstrated a significant increase in TFG-β1, TGF-βR1, TGF-βR2, TGF-βR3, and VEGF expressions and a significant reduction in RUNX-2, Col-1, OSX, OSC, BMP-2, BMP-7, ALP, and RANKL expressions, while OPG expression varied according to the dose and cell line. The results of this in vitro study of HOBS and MG-63 cell lines indicate that low BP doses can significantly affect the expression of genes essential for osteoblast growth and differentiation and of genes involved in regulating osteoblast-osteoclast interaction, possibly by increasing TGF-β1 production. These findings suggest that osteoblasts may play an important role in BRONJ development, without ruling out other factors.
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Affiliation(s)
- Francisco Javier Manzano-Moreno
- Biomedical Group (BIO277), Department of Stomatology, School of Dentistry, University of Granada, Spain
- Instituto Investigación Biosanitaria, ibs.Granada (Spain)
| | - Javier Ramos-Torrecillas
- Instituto Investigación Biosanitaria, ibs.Granada (Spain)
- Biomedical Group (BIO277), Department of Nursing, Faculty of Health Sciences. University of Granada, Spain
| | - Lucia Melguizo-Rodríguez
- Instituto Investigación Biosanitaria, ibs.Granada (Spain)
- Biomedical Group (BIO277), Department of Nursing, Faculty of Health Sciences. University of Granada, Spain
| | - Rebeca Illescas-Montes
- Instituto Investigación Biosanitaria, ibs.Granada (Spain)
- Biomedical Group (BIO277), Department of Nursing, Faculty of Nursing, Melilla. University of Granada, Spain
| | - Concepción Ruiz
- Instituto Investigación Biosanitaria, ibs.Granada (Spain)
- Biomedical Group (BIO277), Department of Nursing, Faculty of Health Sciences. University of Granada, Spain
- Institute of Neuroscience, Parque Tecnológico Ciencias de la Salud, Armilla (Granada), University of Granada, Spain
| | - Olga García-Martínez
- Instituto Investigación Biosanitaria, ibs.Granada (Spain)
- Biomedical Group (BIO277), Department of Nursing, Faculty of Health Sciences. University of Granada, Spain
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Patients' osteometabolic control improves the management of medication-related osteonecrosis of the jaw. Oral Surg Oral Med Oral Pathol Oral Radiol 2018; 125:147-156. [DOI: 10.1016/j.oooo.2017.10.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2017] [Revised: 09/03/2017] [Accepted: 10/18/2017] [Indexed: 12/18/2022]
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