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Rabelo GD, Assunção JNR, Chavassieux P, Soares HA, Alves FA, Lemos CA. Bisphosphonate-Related Osteonecrosis of the Jaws and Its Array of Manifestations. J Maxillofac Oral Surg 2014. [PMID: 26225065 DOI: 10.1007/s12663-014-0707-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
PURPOSE Bisphosphonate (BP) therapy in the treatment of bone diseases and malignancy may induce a major side effect known as bisphosphonate-related osteonecrosis of the jaws (BRONJ). A particular view of this condition is reported in this case series investigating eight patients. The aim of the study was to evaluate the BRONJ lesions concerning their aspects and progression. Also, identify if it is possible to predict the degree of severity in these cases. METHODS Patients were evaluated by their condition and systemic health. The lesions were evaluated in clinical and radiographic aspects. The patients were followed-up for 2 years. RESULTS The patients presented with specific peculiarities, and the BRONJ lesions varied in several characteristics. The BRONJ lesions ranged from simple to severe conditions, and the complicated cases presented with major pain, swelling, secondary infection and an extensive necrotic area, classified with high grade of severity. CONCLUSIONS The patients presented here confirm the existence of a relation between multiple features and BRONJ and to understand the whole process of aggravation, all systemic and local information have to be taken into account, together with all data related to the BP utilized. Regardless of the low incidence of this side effect in relation to osteoporosis treatment, in some cases, the BRONJ may become a severe condition and compromise the patient's quality of life.
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Affiliation(s)
- Gustavo Davi Rabelo
- UFR de Médecine Lyon-Est Domaine Laennec, INSERM UMR 1033, Université de Lyon, 7-11 Rue Guillaume Paradin, 69372 Lyon Cedex 08, France ; Department of Stomatology, Faculty of Dentistry, University of São Paulo, Av. Prof. Lineu Prestes, 2227, Cidade Universitária, São Paulo, CEP 05508-000 Brazil ; A. C. Camargo Cancer Center, Fundação Antonio Prudente, Rua Professor Antônio Prudente 211, São Paulo, 01509-900 Brazil
| | - José Narciso Rosa Assunção
- Department of Stomatology, Faculty of Dentistry, University of São Paulo, Av. Prof. Lineu Prestes, 2227, Cidade Universitária, São Paulo, CEP 05508-000 Brazil ; Santos Metropolitan University, Rua da Constituição 374, Vila Nova, Santos, 11015-470 Brazil
| | - Pascale Chavassieux
- UFR de Médecine Lyon-Est Domaine Laennec, INSERM UMR 1033, Université de Lyon, 7-11 Rue Guillaume Paradin, 69372 Lyon Cedex 08, France
| | - Haroldo Arid Soares
- Santos Metropolitan University, Rua da Constituição 374, Vila Nova, Santos, 11015-470 Brazil
| | - Fabio Abreu Alves
- Department of Stomatology, Faculty of Dentistry, University of São Paulo, Av. Prof. Lineu Prestes, 2227, Cidade Universitária, São Paulo, CEP 05508-000 Brazil ; A. C. Camargo Cancer Center, Fundação Antonio Prudente, Rua Professor Antônio Prudente 211, São Paulo, 01509-900 Brazil
| | - Celso Augusto Lemos
- Department of Stomatology, Faculty of Dentistry, University of São Paulo, Av. Prof. Lineu Prestes, 2227, Cidade Universitária, São Paulo, CEP 05508-000 Brazil
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O'Halloran M, Boyd NM, Smith A. Denosumab and osteonecrosis of the jaws - the pharmacology, pathogenesis and a report of two cases. Aust Dent J 2014; 59:516-9. [DOI: 10.1111/adj.12217] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2014] [Indexed: 11/29/2022]
Affiliation(s)
- M O'Halloran
- Department of Oral Surgery; School of Dentistry; The University of Western Australia
| | - NM Boyd
- Department of Oral Pathology; School of Dentistry; The University of Western Australia
| | - A Smith
- Oral and Maxillofacial Surgery Private Practice; Perth Western Australia
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de Almeida FCS, Moreira MS, Marcucci M, Marques MM, de Araujo ME, da Silva DP. New Uses for Rehabilitation Protocol for Oral Sinus Communications in ARONJ Patients. J Prosthodont 2014; 23:649-53. [DOI: 10.1111/jopr.12157] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2013] [Indexed: 11/29/2022] Open
Affiliation(s)
| | | | | | - Marcia Martins Marques
- Department of Restorative Dentistry; School of Dentistry; Universidade de São Paulo; Brazil
| | | | - Dorival Pedroso da Silva
- Department of Maxillofacial Surgery; Prosthesis and Traumatology; School of Dentistry; Universidade de São Paulo; Brazil
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Coleman R, Body JJ, Aapro M, Hadji P, Herrstedt J. Bone health in cancer patients: ESMO Clinical Practice Guidelines. Ann Oncol 2014; 25 Suppl 3:iii124-37. [PMID: 24782453 DOI: 10.1093/annonc/mdu103] [Citation(s) in RCA: 347] [Impact Index Per Article: 34.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
There are three distinct areas of cancer management that make bone health in cancer patients of increasing clinical importance. First, bone metastases are common in many solid tumours, notably those arising from the breast, prostate and lung, as well as multiple myeloma, and may cause major morbidity including fractures, severe pain, nerve compression and hypercalcaemia. Through optimum multidisciplinary management of patients with bone metastases, including the use of bone-targeted treatments such as potent bisphosphonates or denosumab, it has been possible to transform the course of advanced cancer for many patients resulting in a major reduction in skeletal complications, reduced bone pain and improved quality of life. Secondly, many of the treatments we use to treat cancer patients have effects on reproductive hormones, which are critical for the maintenance of normal bone remodelling. This endocrine disturbance results in accelerated bone loss and an increased risk of osteoporosis and fractures that can have a significant negative impact on the lives of the rapidly expanding number of long-term cancer survivors. Finally, the bone marrow micro-environment is also intimately involved in the metastatic processes required for cancer dissemination, and there are emerging data showing that, at least in some clinical situations, the use of bone-targeted treatments can reduce metastasis to bone and has potential impact on patient survival.
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Affiliation(s)
- R Coleman
- Weston Park Hospital, Cancer Research-UK/Yorkshire Cancer Research Sheffield Cancer Research Centre, Sheffield, UK
| | - J J Body
- CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - M Aapro
- Multidisciplinary Oncology Institute, Genolier, Switzerland
| | - P Hadji
- Department of Gynecology, Endocrinology and Oncology, Philipps-University of Marburg, Marburg, Germany
| | - J Herrstedt
- Department of Oncology, Odense University Hospital, Odense, Denmark
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Campisi G, Fedele S, Fusco V, Pizzo G, Di Fede O, Bedogni A. Epidemiology, clinical manifestations, risk reduction and treatment strategies of jaw osteonecrosis in cancer patients exposed to antiresorptive agents. Future Oncol 2014; 10:257-75. [PMID: 24490612 DOI: 10.2217/fon.13.211] [Citation(s) in RCA: 95] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
ABSTRACT: Osteonecrosis of the jaws (ONJ) is an adverse side event of bisphosphonates and denosumab, antiresorptive agents that effectively reduce the incidence of skeletal-related events in patients with metastatic bone cancer and multiple myeloma. Available data suggest that 0–27.5% of individuals exposed to antiresorptive agents can develop ONJ. There is increasing evidence that avoidance of surgical trauma and infection to the jawbones can minimize the risk of ONJ, but there are still a significant number of individuals who develop ONJ in the absence of these risk factors. Bone necrosis is almost irreversible and there is no definitive cure for ONJ with the exclusion, in certain cases, of surgical resection. However, most ONJ individuals are affected by advanced incurable cancer and are often managed with minimally invasive nonsurgical interventions in order to control jawbone infections and painful symptoms. This article summarizes current knowledge of ONJ epidemiology, manifestations, risk-reduction and therapeutic strategies. Further research is needed in order to determine individual predisposition to ONJ and clarify the effectiveness of available treatments.
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Affiliation(s)
- Giuseppina Campisi
- Unit of Oral Medicine, Department of Surgical, Oncological & Oral Sciences, University of Palermo, Palermo, Italy
| | - Stefano Fedele
- University College London, UCL Eastman Dental Institute, & NIHR University College London Hospitals Biomedical Research Centre, London, UK
| | - Vittorio Fusco
- Unit of Oncology, Department of Oncology & Hematology, Azienda Ospedaliera di Alessandria (City Hospital), Alessandria, Italy
| | - Giuseppe Pizzo
- Unit of Oral Medicine, Department of Surgical, Oncological & Oral Sciences, University of Palermo, Palermo, Italy
| | - Olga Di Fede
- Unit of Oral Medicine, Department of Surgical, Oncological & Oral Sciences, University of Palermo, Palermo, Italy
| | - Alberto Bedogni
- Unit of Oral & Maxillofacial Surgery, Department of Surgery, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
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Yoshiga D, Nakamichi I, Yamashita Y, Yamamoto N, Yamauchi K, Nogami S, Kaneuji T, Mitsugi S, Tanaka K, Kataoka Y, Sakurai T, Kiyomiya H, Miyamoto I, Takahashi T. Prognosis factors in the treatment of bisphosphonate-related osteonecrosis of the jaw - Prognostic factors in the treatment of BRONJ. J Clin Exp Dent 2014; 6:e22-8. [PMID: 24596631 PMCID: PMC3935901 DOI: 10.4317/jced.51213] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2013] [Accepted: 10/19/2013] [Indexed: 11/08/2022] Open
Abstract
Objectives: Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a relatively rare but serious side effect of bisphosphonate (BP)-based treatments. This retrospective study aimed to investigate the risk factors and predictive markers in cases where patients were refractory to a recommended conservative treatment offered in our hospital.
Patients and Methods: This single-center study collated the medical records of all patients treated for BRONJ between 2004 and 2011. A complete medical history, including detailed questionnaires, was collected for all patients, focusing on identifying underlying risk factors, clinical features, location and bone marker levels of BRONJ.
Results: The mean BRONJ remission rate was 57.6%, and the median duration of remission was seven months. Eighteen patients (34.6%) had persistent or progressive disease with a recommended conservative treatment for BRONJ. Notably, urinary cross-linked N-terminal telopeptide of type 1 collagen (NTX) levels in those resistant to conservative treatment tended to be lower than in patients that healed well.
Conclusions: We confirm that a significant proportion of BRONJ sufferers are refractory to a recommended conservative treatment and find that anticancer drugs, periodontal disease, the level of bone exposure and the dosage of intravenous BPs (e.g. zoledronate) represent specific risk factors in BRONJ that may determine the success of a recommended conservative treatment. Additionally, the NTX levels might be able to be a prognostic factor for the conservative treatment of BRONJ; additional research is necessary.
Key words:Bisphosphonate, osteonecrosis, jaw, prognostic, retrospective.
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Affiliation(s)
- Daigo Yoshiga
- Division of Oral and Maxillofacial Reconstructive Surgery, Department of Oral and Maxillofacial Surgery, Kyushu Dental University, Fukuoka, Japan
| | - Ikuo Nakamichi
- Division of General Internal Medicine, Department of Health Promotion, Kyushu Dental University, Fukuoka, Japan
| | - Yoshihiro Yamashita
- Section of Oral Surgery, Department of Oral and Maxillofacial Surgery, Fukuoka Dental College, Fukuoka, Japan
| | - Noriaki Yamamoto
- Department of Oral and Maxilla-facial Surgery, Faculty of Medicine, Oita University, Oita, Japan
| | - Kensuke Yamauchi
- Division of Oral and Maxillofacial Surgery, Department of Oral Medicine and Surgery, Tohoku University Graduate School of Dentistry, Sendai, Japan
| | - Shinnosuke Nogami
- Division of Oral and Maxillofacial Reconstructive Surgery, Department of Oral and Maxillofacial Surgery, Kyushu Dental University, Fukuoka, Japan
| | - Takeshi Kaneuji
- Division of Oral and Maxillofacial Reconstructive Surgery, Department of Oral and Maxillofacial Surgery, Kyushu Dental University, Fukuoka, Japan
| | - Sho Mitsugi
- Division of Oral and Maxillofacial Reconstructive Surgery, Department of Oral and Maxillofacial Surgery, Kyushu Dental University, Fukuoka, Japan
| | - Kenkou Tanaka
- Division of Oral and Maxillofacial Surgery, Department of Oral Medicine and Surgery, Tohoku University Graduate School of Dentistry, Sendai, Japan
| | - Yoshihiro Kataoka
- Division of Oral and Maxillofacial Reconstructive Surgery, Department of Oral and Maxillofacial Surgery, Kyushu Dental University, Fukuoka, Japan
| | - Takuma Sakurai
- Division of Oral and Maxillofacial Reconstructive Surgery, Department of Oral and Maxillofacial Surgery, Kyushu Dental University, Fukuoka, Japan
| | - Hiroyasu Kiyomiya
- Division of Oral and Maxillofacial Reconstructive Surgery, Department of Oral and Maxillofacial Surgery, Kyushu Dental University, Fukuoka, Japan
| | - Ikuya Miyamoto
- Division of Oral and Maxillofacial Reconstructive Surgery, Department of Oral and Maxillofacial Surgery, Kyushu Dental University, Fukuoka, Japan
| | - Tetsu Takahashi
- Division of Oral and Maxillofacial Reconstructive Surgery, Department of Oral and Maxillofacial Surgery, Kyushu Dental University, Fukuoka, Japan ; Division of Oral and Maxillofacial Surgery, Department of Oral Medicine and Surgery, Tohoku University Graduate School of Dentistry, Sendai, Japan
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Boyce AM, Tosi LL, Paul SM. Bisphosphonate treatment for children with disabling conditions. PM R 2013; 6:427-36. [PMID: 24368091 DOI: 10.1016/j.pmrj.2013.10.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Revised: 10/11/2013] [Accepted: 10/22/2013] [Indexed: 01/09/2023]
Abstract
Fractures are a frequent source of morbidity in children with disabling conditions. The assessment of bone density in this population is challenging, because densitometry is influenced by dynamic forces affecting the growing skeleton and may be further confounded by positioning difficulties and surgical hardware. First-line treatment for pediatric osteoporosis involves conservative measures, including optimizing the management of underlying conditions, maintaining appropriate calcium and vitamin D intake, encouraging weight-bearing physical activity, and monitoring measurements of bone mineral density. Bisphosphonates are a class of medications that increase bone mineral density by inhibiting bone resorption. Although bisphosphonates are commonly prescribed for treatment of adult osteoporosis, their use in pediatric patients is controversial because of the lack of long-term safety and efficacy data.
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Affiliation(s)
- Alison M Boyce
- Division of Endocrinology and Diabetes, Children's National Medical Center, 111 Michigan Ave NW, Washington, DC 20010; and Bone Health Program, Division of Orthopaedics and Sports Medicine, Children's National Medical Center, Washington, DC(∗).
| | - Laura L Tosi
- Bone Health Program, Division of Orthopaedics and Sports Medicine, Children's National Medical Center, Washington, DC(†)
| | - Scott M Paul
- Rehabilitation Medicine Department, Mark O. Hatfield Clinical Research Center, National Institutes of Health, Bethesda, MD(‡)
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Rathbone EJ, Brown JE, Marshall HC, Collinson M, Liversedge V, Murden GA, Cameron D, Bell R, Spensley S, Agrawal R, Jyothirmayi R, Chakraborti P, Yuille F, Coleman RE. Osteonecrosis of the Jaw and Oral Health–Related Quality of Life After Adjuvant Zoledronic Acid: An Adjuvant Zoledronic Acid to Reduce Recurrence Trial Subprotocol (BIG01/04). J Clin Oncol 2013; 31:2685-91. [DOI: 10.1200/jco.2012.46.4792] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose In patients with early breast cancer, adjuvant zoledronic acid (zoledronate) may reduce recurrence and improve survival. However, zoledronate is associated with the occasional development of osteonecrosis of the jaw (ONJ). We report on the frequency of ONJ and investigate oral health–related quality of life (Oral-QoL) in a large randomized trial (Adjuvant Zoledronic Acid to Reduce Recurrence [AZURE]). Patients and Methods Three thousand three hundred sixty women with stage II or III breast cancer were randomly assigned to receive standard adjuvant systemic therapy alone or with zoledronate administered at a dose of 4 mg for 19 doses over 5 years. All potential occurrences of ONJ were reported as serious adverse events and centrally reviewed. Additionally, we invited 486 study participants to complete the Oral Health Impact Profile-14 (OHIP-14) to assess Oral-QoL around the time the patients completed 5 years on study. Multivariable linear regression was used to calculate mean scores and 95% CIs in addition to identifying independent prognostic factors. Results With a median follow-up time of 73.9 months (interquartile range, 60.7 to 84.2 months), 33 possible cases of ONJ were reported, all in the zoledronate-treated patients. Twenty-six cases were confirmed as being consistent with a diagnosis of ONJ, representing a cumulative incidence of 2.1% (95% CI, 0.9% to 3.3%) in the zoledronate arm. Three hundred sixty-two patients (74%) returned the OHIP-14 questionnaire. Neither the prevalence nor severity of impacts on Oral-QoL differed significantly between zoledronate patients and control patients. Conclusion Adjuvant zoledronate used in the intensive schedule studied in the AZURE trial is associated with a low incidence of ONJ but does not seem to adversely affect Oral-QoL.
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Affiliation(s)
- Emma J. Rathbone
- Emma J. Rathbone, Janet E. Brown, and Robert E. Coleman, Weston Park Hospital, Academic Unit of Clinical Oncology, Cancer Research UK (CRUK)/Yorkshire Cancer Research Sheffield Cancer Research Centre, Sheffield; Emma J. Rathbone and Janet E. Brown, St James' Institute of Oncology, CRUK Leeds Cancer Research Centre, University of Leeds; Helen C. Marshall, Michelle Collinson, Victoria Liversedge, and Geraldine A. Murden, University of Leeds, Leeds; David Cameron, Western General Hospital, University of
| | - Janet E. Brown
- Emma J. Rathbone, Janet E. Brown, and Robert E. Coleman, Weston Park Hospital, Academic Unit of Clinical Oncology, Cancer Research UK (CRUK)/Yorkshire Cancer Research Sheffield Cancer Research Centre, Sheffield; Emma J. Rathbone and Janet E. Brown, St James' Institute of Oncology, CRUK Leeds Cancer Research Centre, University of Leeds; Helen C. Marshall, Michelle Collinson, Victoria Liversedge, and Geraldine A. Murden, University of Leeds, Leeds; David Cameron, Western General Hospital, University of
| | - Helen C. Marshall
- Emma J. Rathbone, Janet E. Brown, and Robert E. Coleman, Weston Park Hospital, Academic Unit of Clinical Oncology, Cancer Research UK (CRUK)/Yorkshire Cancer Research Sheffield Cancer Research Centre, Sheffield; Emma J. Rathbone and Janet E. Brown, St James' Institute of Oncology, CRUK Leeds Cancer Research Centre, University of Leeds; Helen C. Marshall, Michelle Collinson, Victoria Liversedge, and Geraldine A. Murden, University of Leeds, Leeds; David Cameron, Western General Hospital, University of
| | - Michelle Collinson
- Emma J. Rathbone, Janet E. Brown, and Robert E. Coleman, Weston Park Hospital, Academic Unit of Clinical Oncology, Cancer Research UK (CRUK)/Yorkshire Cancer Research Sheffield Cancer Research Centre, Sheffield; Emma J. Rathbone and Janet E. Brown, St James' Institute of Oncology, CRUK Leeds Cancer Research Centre, University of Leeds; Helen C. Marshall, Michelle Collinson, Victoria Liversedge, and Geraldine A. Murden, University of Leeds, Leeds; David Cameron, Western General Hospital, University of
| | - Victoria Liversedge
- Emma J. Rathbone, Janet E. Brown, and Robert E. Coleman, Weston Park Hospital, Academic Unit of Clinical Oncology, Cancer Research UK (CRUK)/Yorkshire Cancer Research Sheffield Cancer Research Centre, Sheffield; Emma J. Rathbone and Janet E. Brown, St James' Institute of Oncology, CRUK Leeds Cancer Research Centre, University of Leeds; Helen C. Marshall, Michelle Collinson, Victoria Liversedge, and Geraldine A. Murden, University of Leeds, Leeds; David Cameron, Western General Hospital, University of
| | - Geraldine A. Murden
- Emma J. Rathbone, Janet E. Brown, and Robert E. Coleman, Weston Park Hospital, Academic Unit of Clinical Oncology, Cancer Research UK (CRUK)/Yorkshire Cancer Research Sheffield Cancer Research Centre, Sheffield; Emma J. Rathbone and Janet E. Brown, St James' Institute of Oncology, CRUK Leeds Cancer Research Centre, University of Leeds; Helen C. Marshall, Michelle Collinson, Victoria Liversedge, and Geraldine A. Murden, University of Leeds, Leeds; David Cameron, Western General Hospital, University of
| | - David Cameron
- Emma J. Rathbone, Janet E. Brown, and Robert E. Coleman, Weston Park Hospital, Academic Unit of Clinical Oncology, Cancer Research UK (CRUK)/Yorkshire Cancer Research Sheffield Cancer Research Centre, Sheffield; Emma J. Rathbone and Janet E. Brown, St James' Institute of Oncology, CRUK Leeds Cancer Research Centre, University of Leeds; Helen C. Marshall, Michelle Collinson, Victoria Liversedge, and Geraldine A. Murden, University of Leeds, Leeds; David Cameron, Western General Hospital, University of
| | - Richard Bell
- Emma J. Rathbone, Janet E. Brown, and Robert E. Coleman, Weston Park Hospital, Academic Unit of Clinical Oncology, Cancer Research UK (CRUK)/Yorkshire Cancer Research Sheffield Cancer Research Centre, Sheffield; Emma J. Rathbone and Janet E. Brown, St James' Institute of Oncology, CRUK Leeds Cancer Research Centre, University of Leeds; Helen C. Marshall, Michelle Collinson, Victoria Liversedge, and Geraldine A. Murden, University of Leeds, Leeds; David Cameron, Western General Hospital, University of
| | - Saiqa Spensley
- Emma J. Rathbone, Janet E. Brown, and Robert E. Coleman, Weston Park Hospital, Academic Unit of Clinical Oncology, Cancer Research UK (CRUK)/Yorkshire Cancer Research Sheffield Cancer Research Centre, Sheffield; Emma J. Rathbone and Janet E. Brown, St James' Institute of Oncology, CRUK Leeds Cancer Research Centre, University of Leeds; Helen C. Marshall, Michelle Collinson, Victoria Liversedge, and Geraldine A. Murden, University of Leeds, Leeds; David Cameron, Western General Hospital, University of
| | - Rajiv Agrawal
- Emma J. Rathbone, Janet E. Brown, and Robert E. Coleman, Weston Park Hospital, Academic Unit of Clinical Oncology, Cancer Research UK (CRUK)/Yorkshire Cancer Research Sheffield Cancer Research Centre, Sheffield; Emma J. Rathbone and Janet E. Brown, St James' Institute of Oncology, CRUK Leeds Cancer Research Centre, University of Leeds; Helen C. Marshall, Michelle Collinson, Victoria Liversedge, and Geraldine A. Murden, University of Leeds, Leeds; David Cameron, Western General Hospital, University of
| | - Rema Jyothirmayi
- Emma J. Rathbone, Janet E. Brown, and Robert E. Coleman, Weston Park Hospital, Academic Unit of Clinical Oncology, Cancer Research UK (CRUK)/Yorkshire Cancer Research Sheffield Cancer Research Centre, Sheffield; Emma J. Rathbone and Janet E. Brown, St James' Institute of Oncology, CRUK Leeds Cancer Research Centre, University of Leeds; Helen C. Marshall, Michelle Collinson, Victoria Liversedge, and Geraldine A. Murden, University of Leeds, Leeds; David Cameron, Western General Hospital, University of
| | - Prabir Chakraborti
- Emma J. Rathbone, Janet E. Brown, and Robert E. Coleman, Weston Park Hospital, Academic Unit of Clinical Oncology, Cancer Research UK (CRUK)/Yorkshire Cancer Research Sheffield Cancer Research Centre, Sheffield; Emma J. Rathbone and Janet E. Brown, St James' Institute of Oncology, CRUK Leeds Cancer Research Centre, University of Leeds; Helen C. Marshall, Michelle Collinson, Victoria Liversedge, and Geraldine A. Murden, University of Leeds, Leeds; David Cameron, Western General Hospital, University of
| | - Frances Yuille
- Emma J. Rathbone, Janet E. Brown, and Robert E. Coleman, Weston Park Hospital, Academic Unit of Clinical Oncology, Cancer Research UK (CRUK)/Yorkshire Cancer Research Sheffield Cancer Research Centre, Sheffield; Emma J. Rathbone and Janet E. Brown, St James' Institute of Oncology, CRUK Leeds Cancer Research Centre, University of Leeds; Helen C. Marshall, Michelle Collinson, Victoria Liversedge, and Geraldine A. Murden, University of Leeds, Leeds; David Cameron, Western General Hospital, University of
| | - Robert E. Coleman
- Emma J. Rathbone, Janet E. Brown, and Robert E. Coleman, Weston Park Hospital, Academic Unit of Clinical Oncology, Cancer Research UK (CRUK)/Yorkshire Cancer Research Sheffield Cancer Research Centre, Sheffield; Emma J. Rathbone and Janet E. Brown, St James' Institute of Oncology, CRUK Leeds Cancer Research Centre, University of Leeds; Helen C. Marshall, Michelle Collinson, Victoria Liversedge, and Geraldine A. Murden, University of Leeds, Leeds; David Cameron, Western General Hospital, University of
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Shapiro CL. Bisphosphonate-Related Osteonecrosis of Jaw in the Adjuvant Breast Cancer Setting: Risks and Perspective. J Clin Oncol 2013; 31:2648-50. [DOI: 10.1200/jco.2013.48.6837] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Affiliation(s)
- Charles L. Shapiro
- Wexner Medical Center and Comprehensive Cancer Center, Ohio State University, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, OH
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Donetti E, Gualerzi A, Sardella A, Lodi G, Carrassi A, Sforza C. Alendronate impairs epithelial adhesion, differentiation and proliferation in human oral mucosa. Oral Dis 2013; 20:466-72. [PMID: 23837876 DOI: 10.1111/odi.12154] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Revised: 05/24/2013] [Accepted: 06/09/2013] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study aimed at evaluating from a morphological point of view the effects of alendronate (ALN), a widely used nitrogen-containing bisphosphonate for the chronic treatment of osteoporosis, on the oral epithelium of healthy keratinized human oral mucosa. Bisphosphonate-related osteonecrosis of the jaw is a well-known severe consequence, but the effects during chronic therapy on the oral soft tissues are still matter of debate. MATERIALS AND METHODS Six women over 60 year-old undergoing treatment of osteoporosis with 70 mg per week of oral ALN (lasting at least 2 years) were recruited and compared with a gender and age-matched group (n = 6). Proliferation, apoptosis, intercellular adhesion and terminal differentiation (TD) were investigated by immunofluorescence. In parallel, ultrastructural analysis was carried out. RESULTS By immunofluorescence, a statistically significant decrease in keratinocyte proliferation was detected in the oral epithelium of the ALN group without any sign of apoptosis, but accompanied by a reduction in desmoglein 1 and keratin 10 expressions. In the uppermost layers of the oral epithelium of the ALN group, thin desmosomes were visible by transmission electron microscopy. CONCLUSION Our results show that epithelial adhesion, TD and proliferation are affected by ALN therapeutic doses in clinically healthy human oral mucosa.
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Affiliation(s)
- E Donetti
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy
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Sedghizadeh PP, Yooseph S, Fadrosh DW, Zeigler-Allen L, Thiagarajan M, Salek H, Farahnik F, Williamson SJ. Metagenomic investigation of microbes and viruses in patients with jaw osteonecrosis associated with bisphosphonate therapy. Oral Surg Oral Med Oral Pathol Oral Radiol 2013; 114:764-70. [PMID: 23159114 DOI: 10.1016/j.oooo.2012.08.444] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2012] [Revised: 07/26/2012] [Accepted: 08/10/2012] [Indexed: 01/10/2023]
Abstract
OBJECTIVE The goal of this preliminary study was to use metagenomic approaches to investigate the taxonomic diversity of microorganisms in patients with bisphosphonate-related osteonecrosis of the jaw (BRONJ). STUDY DESIGN Samples of saliva for planktonic microbial analysis and biofilm cultivation were collected from 10 patients (5 with BRONJ and 5 non-BRONJ control subjects) who met all ascertainment criteria. Prophage induction experiments-16S rRNA polymerase chain reaction and 454 pyrosequencing-and epifluorescent microscopy were performed for characterization and enumeration of microbes and viruses. RESULTS Three phyla of microbes-Proteobacteria (70%), Firmicutes (26.9%), and Actinobacteria (1.95%)-dominated all BRONJ samples and accounted for almost 99% of the total data. Viral abundance was ∼1 order of magnitude greater than microbial cell abundance and comprised mainly phage viruses. CONCLUSIONS Individuals with jaw osteonecrosis harbored different microbial assemblages than nonaffected patients, and in general viral abundance and prophage induction increased with biofilm formation, suggesting that biofilm formation encouraged lysogenic interactions between viruses and microbial hosts and may contribute to pathogenicity.
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Affiliation(s)
- Parish P Sedghizadeh
- USC Center for Biofilms, Ostrow School of Dentistry, University of Southern California, Los Angeles, California 90089, USA.
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Electrically conductive bacterial nanowires in bisphosphonate-related osteonecrosis of the jaw biofilms. Oral Surg Oral Med Oral Pathol Oral Radiol 2013; 115:71-8. [PMID: 23217537 DOI: 10.1016/j.oooo.2012.08.446] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2012] [Revised: 08/14/2012] [Accepted: 08/20/2012] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Bacterial biofilms play a role in the pathogenesis of bisphosphonate-related osteonecrosis of the jaw (BRONJ). The purpose of this preliminary study was to test the hypothesis that the extracellular filaments observed in biofilms associated with BRONJ contain electrically conductive nanowires. STUDY DESIGN Bone samples of patients affected by BRONJ were evaluated for conductive nanowires by scanning electron microscopy (SEM) and conductive probe atomic force microscopy (CP-AFM). We created nanofabricated electrodes to measure electrical transport along putative nanowires. RESULTS SEM revealed large-scale multispecies biofilms containing numerous filamentous structures throughout necrotic bone. CP-AFM analysis revealed that these structures were electrically conductive nanowires with resistivities on the order of 20 Ω·cm. Nanofabricated electrodes spaced along the nanowires confirmed their ability to transfer electrons over micron-scale lengths. CONCLUSIONS Electrically conductive bacterial nanowires to date have been described only in environmental isolates. This study shows for the first time that these nanowires can also be found in clinically relevant biofilm-mediated diseases, such as BRONJ, and may represent an important target for therapy.
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Schaudinn C, Gorur A, Webster P, Jones AC, Neely M, Jelliffe RW, Le AD, Sedghizadeh PP. Quantification by energy dispersive x-ray spectroscopy of alendronate in the diseased jaw bone of patients with bisphosphonate-related jaw osteonecrosis. Oral Surg Oral Med Oral Pathol Oral Radiol 2013; 114:480-6. [PMID: 22986243 DOI: 10.1016/j.oooo.2012.06.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2012] [Revised: 05/24/2012] [Accepted: 06/10/2012] [Indexed: 01/17/2023]
Abstract
OBJECTIVE Recently, specific in vitro bisphosphonate concentrations have been established for reaching a toxic threshold that could result in the induction of bisphosphonate-related osteonecrosis of the jaw (BRONJ), but these data have not been validated in vivo. The purpose of this study was to quantify the concentration of bisphosphonates (BPs) in the diseased jaw bone of patients experiencing BRONJ. STUDY DESIGN We hypothesized that if the average natural nitrogen content of mammalian bone is known, the excess of nitrogen in the jaw bone of BRONJ patients is likely to reflect the concentration of amino-BP. To test our hypothesis, jaw bone specimens from patients with BRONJ were acquired after sequestrectomy and analyzed by energy-dispersive X-ray spectroscopy (EDS). RESULTS The EDS analysis of the bone demonstrated a highly linear correlation between increasing concentrations of BP and the increasing percentage of nitrogen measured at the bone surfaces (R(2) = .9851, P = .0149). CONCLUSIONS SEM/EDS can be a valuable tool for assessing BP concentration in jaw bone and provides important insight into BP pharmacokinetics and BRONJ.
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Affiliation(s)
- Christoph Schaudinn
- Robert Koch Institute, Centre for Biological Security, Berlin, Germany, European Union
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64
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Wong PK, Borromeo GL, Wark JD. Bisphosphonate-related osteonecrosis of the jaw in non-malignant bone disease. Rheumatol Int 2013; 33:2189-98. [PMID: 23652790 DOI: 10.1007/s00296-013-2771-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2012] [Accepted: 04/26/2013] [Indexed: 10/26/2022]
Abstract
Bisphosphonates such as alendronate, risedronate and zoledronate have revolutionised the treatment for osteoporosis and Paget's disease. These drugs reduce fracture risk and probably mortality in patients with osteoporosis. However, they have a long in vivo half-life following cessation and may be associated with delayed dental healing and even the devastating complication of osteonecrosis of the jaw (ONJ). Extensive media attention highlighting this issue has caused much concern among patients and healthcare professionals. This paper seeks to provide treating clinicians with a balanced multi-disciplinary review of the available evidence pertaining to this issue and practical advice regarding prevention and management of ONJ.
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Affiliation(s)
- Peter K Wong
- Mid-North Coast Arthritis Clinic, PO Box 6307, Coffs Harbour, NSW 2450, Australia.
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Qi WX, Tang LN, He AN, Yao Y, Shen Z. Risk of osteonecrosis of the jaw in cancer patients receiving denosumab: a meta-analysis of seven randomized controlled trials. Int J Clin Oncol 2013; 19:403-10. [PMID: 23605142 DOI: 10.1007/s10147-013-0561-6] [Citation(s) in RCA: 129] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Accepted: 04/09/2013] [Indexed: 01/18/2023]
Abstract
AIMS The aim of this study is to gain a better understanding of the overall incidence and risk of osteonecrosis of the jaw (ONJ) in cancer patients receiving denosumab. METHODS We performed a meta-analysis of relevant randomized controlled trials identified in Pubmed, Embase, and Cochrane databases. Abstracts presented at the conferences were also searched. Overall incidence rates, relative risk (RR), and 95 % confidence intervals (CI) were calculated employing fixed- or random-effects models depending on the heterogeneity of the included trials. RESULTS A total of 8963 patients with a variety of solid tumors from 7 randomized controlled trials (RCTs) were included for the meta-analysis. The overall incidence of ONJ in cancer patients receiving denosumab was 1.7 % [95 % CI: 0.9-3.1 %]. Also, the use of denosumab was associated with significantly increased risk of ONJ in comparison with bisphosphonates (BPs)/placebo treatment (RR 1.61, 95 % CI: 1.05-2.48, P = 0.029). Subgroup analysis based on controlled therapies demonstrated an increased risk of ONJ in denosumab therapy, when compared with BPs (RR 1.48, 95 % CI: 0.96-2.29, P = 0.078) or placebo (RR 16.28, 95 % CI: 1.68-158.05, P = 0.017). Similar results were observed in prostate cancer (RR 3.358, 95 % CI: 1.573-7.166, P = 0.002) while there was a non-significantly increased risk of denosumab-related osteonecrosis of the jaw (DONJ) in non-prostate cancers (RR 1.142, 95 % CI: 0.678-1.921, P = 0.618). CONCLUSIONS The use of denosumab is associated with an increased risk of developing ONJ when compared with BP treatment or placebo, although the increased risk was not statistically significant between denosumab and BP treatment. Further studies are still needed to establish guidelines for the prevention and effective treatment of ONJ.
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Affiliation(s)
- Wei-Xiang Qi
- Department of Oncology, The Sixth People's Hospital, Shanghai Jiao Tong University, No. 600, Yishan Road, Shanghai, 200233, China
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Li Y, Xu J, Mao L, Liu Y, Gao R, Zheng Z, Chen W, Le A, Shi S, Wang S. Allogeneic mesenchymal stem cell therapy for bisphosphonate-related jaw osteonecrosis in Swine. Stem Cells Dev 2013; 22:2047-56. [PMID: 23461552 DOI: 10.1089/scd.2012.0615] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Bisphosphonates (BPs), which are used to treat a variety of clinical disorders, have the side effect of jawbone necrosis. Currently, there is no reliable treatment for BP-related osteonecrosis of the jaw (BRONJ) due to a lack of understanding of its pathogenesis. To investigate the pathogenesis of BRONJ and observe the treatment effect of bone marrow mesenchymal stem cell (BMMSC) transplantation, we established a preclinical animal model of BRONJ in miniature pigs (minipigs). After treatment with zoledronic acid, the clinical and radiographic manifestations of BRONJ could be observed in minipigs after first premolar extraction. The biological and immunological properties of BMMSCs were impaired in the BP-treated minipigs. Moreover, the ratio of Foxp3-positive regulatory T-cells (Tregs) in peripheral blood decreased, and interleukin (IL)-17 increased in the serum of BP-treated minipigs. After allogeneic BMMSC transplantation via intravenous infusion, mucosal healing and bone reconstruction were observed; IL-17 levels were reduced; and Tregs were elevated. In summary, we established a clinically relevant BRONJ model in minipigs and tested a promising allogeneic BMMSC-based therapy, which may have potential clinical applications for treating BRONJ.
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Affiliation(s)
- Yunsheng Li
- Molecular Laboratory for Gene Therapy & Tooth Regeneration, Beijing Key Laboratory of Tooth Regeneration and Function Reconstruction, Capital Medical University School of Stomatology, Beijing, China
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Margaix-Muñoz M, Bagan J, Poveda-Roda R. Intravenous bisphosphonate-related osteonecrosis of the jaws: influence of coadjuvant antineoplastic treatment and study of buccodental condition. Med Oral Patol Oral Cir Bucal 2013; 18:e194-200. [PMID: 23229272 PMCID: PMC3613869 DOI: 10.4317/medoral.18604] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Accepted: 07/27/2012] [Indexed: 12/17/2022] Open
Abstract
Objectives: To determine whether coadjuvant antineoplastic treatment can influence the number and size of bone exposures among patients with intravenous bisphosphonate-related osteonecrosis of the jaws (iBRONJ), and to analyze the buccodental condition of these patients.
Material and methods: The study sample comprised 67 patients with iBRONJ, 53 patients without iBRONJ receiving treatment with intravenous bisphosphonates, and 36 healthy subjects. In all three groups, measurements were made of the CAO index and of resting whole saliva and stimulated whole saliva. In the patients with iBRONJ, the size (cm) and number of bone exposures were recorded. The data obtained were subjected to analysis of variance (ANOVA), the Mann-Whitney U-test, and multivariate logistic regression analysis.
Results: A total of 57.6% of the patients presented single bone exposure, 25.4% presented two, and 17% more than two exposures. The mean exposure size was 2.3±1.9 cm. Neither the bivariate analysis nor the multivariate multiple regression analysis found coadjuvant antineoplastic treatment to exert a statistically significant effect upon the number and size of bone exposures. On the other hand, there were statistically significant differences among the three study groups in relation to the CAO index (p=0.02) and the number of missing teeth (p=0.00). The resting whole saliva and stimulated whole saliva levels were similar in the three groups, though the patients with osteonecrosis of the jaws showed comparatively lower SWS levels.
Conclusions: Coadjuvant antineoplastic treatment alone appears to exert no influence upon the size and number of bone exposures in iBRONJ. The patients with this disease show a higher CAO index and a larger number of missing teeth.
Key words:Osteonecrosis of the jaws, bisphosphonates, bone exposure, CAO index, resting whole saliva, stimulated whole saliva.
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Affiliation(s)
- Maria Margaix-Muñoz
- Oral Medicine Unit, Department of Stomatology, University of Valencia,Valencia, Spain.
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68
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Decreasing frequency of osteonecrosis of the jaw in cancer and myeloma patients treated with bisphosphonates: the experience of the oncology network of piedmont and aosta valley (north-Western Italy). ISRN ONCOLOGY 2013; 2013:672027. [PMID: 23533811 PMCID: PMC3600177 DOI: 10.1155/2013/672027] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2012] [Accepted: 01/18/2013] [Indexed: 11/21/2022]
Abstract
Background. Data concerning frequency of Osteonecrosis of Jaws (ONJ) are mostly based on single center experiences.
Patients and Methods. Since 2005 a multidisciplinary study group collected data of cases of ONJ in patients treated with Bisphosphonates (BP) and observed in oncology and hematology centers of a regional network. Results. By December 2008, 221 cases were registered. We report details of 200 cases, identified after cross-checking reports from centres of medical oncology, haematology, and oral care. Primary neoplasm was breast cancer (39%), myeloma (32%), prostate cancer (16%), and other types of cancer (8%). In about 50% of the cases a history of dental extraction was present. Zoledronic acid was administered (alone or with other BP) to 178 patients (89%). Median time from first infusion to ONJ diagnosis was 21.0 (zoledronic acid only) and 39.0 months (pamidronate only). The number of ONJ cases per year was 3 in 2003, 21 in 2004, 58 in 2005, 60 in 2006, 37 in 2007, and 21 in 2008. Conclusion. The number of new ONJ cases in cancer and myeloma patients increased until 2006 and then reduced. The possible reasons of this trend (introduction of zoledronic acid; increase of ONJ awareness; diffusion of preventive dental measures; late modifications of BP prescription) are herein discussed.
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Population pharmacokinetic and pharmacodynamic modeling for assessing risk of bisphosphonate-related osteonecrosis of the jaw. Oral Surg Oral Med Oral Pathol Oral Radiol 2012; 115:224-32. [PMID: 23246224 DOI: 10.1016/j.oooo.2012.08.455] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2012] [Revised: 08/20/2012] [Accepted: 08/27/2012] [Indexed: 11/21/2022]
Abstract
OBJECTIVE We hypothesized that patients with bisphosphonate (BP)-related osteonecrosis of the jaw (BRONJ) accumulate higher levels of BP in bone than those without BRONJ. STUDY DESIGN Using the Pmetrics package and published data, we designed a population pharmacokinetic model of pamidronate concentration in plasma and bone and derived a toxic bone BP threshold of 0.2 mmol/L. With the model, and using patient individual BP duration and bone mineral content estimated from lean body weight, we calculated bone BP levels in 153 subjects. RESULTS Mean bone BP in 69 BRONJ cases was higher than in 84 controls (0.20 vs 0.10 mmol/L, P < 0.001), consistent with the toxic bone threshold of 0.2 mmol/L. BRONJ was also associated with longer duration BP therapy (5.3 vs 2.7 years, P < 0.001), older age (76 vs 70 years, P < 0.001), and Asian race (49% vs 14%, P < 0.001). CONCLUSIONS Our model accurately discriminated BRONJ cases from controls among patients on BP therapy.
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Epstein JB, Thariat J, Bensadoun RJ, Barasch A, Murphy BA, Kolnick L, Popplewell L, Maghami E. Oral complications of cancer and cancer therapy: from cancer treatment to survivorship. CA Cancer J Clin 2012; 62:400-22. [PMID: 22972543 DOI: 10.3322/caac.21157] [Citation(s) in RCA: 283] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Answer questions and earn CME/CNE Oral complications resulting from cancer and cancer therapies cause acute and late toxicities that may be underreported, underrecognized, and undertreated. Recent advances in cancer treatment have led to changes in the incidence, nature, and severity of oral complications. As the number of survivors increases, it is becoming increasingly recognized that the aggressive management of oral toxicities is needed to ensure optimal long-term oral health and general well-being. Advances in care have had an impact on previously recognized oral complications and are leading to newly recognized adverse effects. Here, the authors briefly review advances in cancer therapy, including recent advances in surgery, oral care, radiation therapy, hematopoietic cell transplantation, and medical oncology; describe how these advances affect oral health; and discuss the frequent and/or severe oral health complications associated with cancer and cancer treatment and their effect upon long-term health. Although some of the acute oral toxicities of cancer therapies may be reduced, they remain essentially unavoidable. The significant impact of long-term complications requires increased awareness and recognition to promote prevention and appropriate intervention. It is therefore important for the primary oncologist to be aware of these complications so that appropriate measures can be implemented in a timely manner. Prevention and management is best provided via multidisciplinary health care teams, which must be integrated and communicate effectively in order to provide the best patient care in a coordinated manner at the appropriate time.
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Affiliation(s)
- Joel B Epstein
- Division of Otolaryngology and Head and Neck Surgery, City of Hope, Duarte, CA, USA.
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71
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Aguirre JI, Akhter MP, Kimmel DB, Pingel JE, Williams A, Jorgensen M, Kesavalu L, Wronski TJ. Oncologic doses of zoledronic acid induce osteonecrosis of the jaw-like lesions in rice rats (Oryzomys palustris) with periodontitis. J Bone Miner Res 2012; 27:2130-43. [PMID: 22623376 PMCID: PMC3436957 DOI: 10.1002/jbmr.1669] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Though osteonecrosis of the jaw (ONJ) is temporally-associated with the use of nitrogen-containing bisphosphonates (N-BPs), a cause-and-effect relationship has not yet been established. We hypothesize that ONJ is a two-stage process in which: (1) risk factors initiate pathologic processes in the oral cavity that lead to a supranormal rate of hard tissue necrosis; and (2) powerful antiresorptives reduce the rate of removal of necrotic bone sufficiently to allow its net accumulation in the jaw. To test this hypothesis, we used the rice rat model of periodontitis. At age 28 days, rats (n = 15/group) were placed on a high-sucrose and casein diet to exacerbate the development of periodontitis. Animals were injected subcutaneously (SC) biweekly with vehicle or alendronate (ALN, 15 µg/kg), or IV once monthly with vehicle, a low dose (LD) of zoledronic acid (ZOL), or a high dose (HD) of ZOL and sacrificed after 6, 12, 18, and 24 weeks. Mandibles and maxillae were analyzed to determine the effects on the: (1) progression of periodontitis; (2) integrity of alveolar bone; (3) status of bone resorption and formation; (4) vascularity; and (5) osteocyte viability. We found that only HD-ZOL induced ONJ-like lesions in mandibles of rice rats after 18 and 24 weeks of treatment. These lesions were characterized by areas of exposed necrotic alveolar bone, osteolysis, a honeycomb-like appearance of the alveolar bone, presence of bacterial colonies, and periodontal tissue destruction. In addition, inhibition of bone formation, a paradoxical abolition of the antiresorptive effect of only HD-ZOL, increased osteocyte necrosis/apoptosis, and decreased blood vessel number were found after 18 and/or 24 weeks. Our study suggests that only HD-ZOL exacerbates the inflammatory response and periodontal tissue damage in rice rats, inducing bone lesions that resemble ONJ.
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Affiliation(s)
- J Ignacio Aguirre
- Department of Physiological Sciences, University of Florida, Gainesville, FL, USA.
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72
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Ding X, Fan Y, Ma F, Li Q, Wang J, Zhang P, Yuan P, Xu B. Prolonged administration of bisphosphonates is well-tolerated and effective for skeletal-related events in Chinese breast cancer patients with bone metastasis. Breast 2012; 21:544-9. [DOI: 10.1016/j.breast.2012.04.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2012] [Revised: 03/19/2012] [Accepted: 04/23/2012] [Indexed: 10/28/2022] Open
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Bedogni A, Saia G, Bettini G, Tronchet A, Totola A, Bedogni G, Tregnago P, Valenti MT, Bertoldo F, Ferronato G, Nocini PF, Blandamura S, Dalle Carbonare L. Osteomalacia: the missing link in the pathogenesis of bisphosphonate-related osteonecrosis of the jaws? Oncologist 2012; 17:1114-9. [PMID: 22723507 DOI: 10.1634/theoncologist.2012-0141] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a well-documented adverse event from treatment with nitrogen-containing bisphosphonates (NBPs). During a preliminary histomorphometric study aimed at assessing the rate of bone remodeling in the jaws of patients with surgically resected BRONJ, we found a defect of bone mineralization (unpublished data). We hypothesized that osteomalacia could be a risk factor for BRONJ in patients taking NBPs. Therefore, we looked for static and dynamic histomorphometric evidence of osteomalacia in biopsies from subjects with and without BRONJ. METHODS This case-control study used histomorphometric analysis of bone specimens of patients using NBPs (22 patients with BRONJ and 21 patients without BRONJ) who required oral surgical interventions for the treatment/prevention of osteonecrosis. Patients were given tetracycline hydrochloride according to a standardized protocol before taking bone biopsies from their jaws. Biopsies with evidence of osteomyelitis or necrosis at histology were excluded from the study. Osteomalacia was defined as a mineralization lag time >100 days, a corrected mean osteoid thickness >12.5 mm, and an osteoid volume >10%. RESULTS In all, 77% of patients with BRONJ were osteomalacic compared with 5% of patients without BRONJ, according to histomorphometry. Because osteomalacia was found almost exclusively in NBP users with BRONJ, this is likely to be a generalized process in which the use of NBPs further deteriorates mechanisms of bone repair. CONCLUSIONS Osteomalacia represents a new and previously unreported risk factor for disease development. This finding may contribute to a better understanding of the pathogenesis of this disease and help with the development of strategies to increase the safety of NBP administration.
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Affiliation(s)
- Alberto Bedogni
- Section of Oral and Maxillofacial Surgery, Department of Surgery, Azienda Ospedaliera Universitaria Integrata, Square L.A. Scuro 10, 37134 Verona, Italy.
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Katsenos S, Christophylakis C, Psathakis K. Osteonecrosis mandibular en un paciente con cáncer de pulmón no microcítico avanzado tratado con bevacizumab. Arch Bronconeumol 2012; 48:218-9. [DOI: 10.1016/j.arbres.2012.01.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2011] [Revised: 01/17/2012] [Accepted: 01/21/2012] [Indexed: 11/16/2022]
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Anti-RANKL therapy for bone tumours: Basic, pre-clinical and clinical evidences. J Bone Oncol 2012; 1:2-11. [PMID: 26909248 PMCID: PMC4723324 DOI: 10.1016/j.jbo.2012.03.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2012] [Accepted: 03/28/2012] [Indexed: 01/24/2023] Open
Abstract
Bone remodelling is related to coordinated phases of bone resorption and bone apposition allowing the maintenance of bone integrity, the phosphocalcic homoeostasis all along the life and consequently the bone adaptation to mechanical constraints or/and to endocrine fluctuations. Unfortunately, bone is a frequent site of tumour development originated from bone cell lineages (primary bone tumours: bone sarcomas) or from nonosseous origins (bone metastases: carcinomas). These tumour cells disrupt the balance between osteoblast and osteoclast activities resulting in a disturbed bone remodelling weakening the bone tissue, in a strongly altered bone microenvironment and consequently facilitating the tumour growth. At the early stage of tumour development, osteoclast differentiation and recruitment of mature osteoclasts are strongly activated resulting in a strong bone matrix degradation and release of numerous growth factors initially stored into this organic/calcified matrix. In turn these soluble factors stimulate the proliferation of tumour cells and exacerbate their migration and their ability to initiate metastases. Because Receptor Activator of NFκB Ligand (RANKL) is absolutely required for in vivo osteoclastogenesis, its role in the bone tumour growth has been immediately pointed out and has consequently allowed the development of new targeted therapies of these malignant diseases. The present review summarises the role of RANKL in the bone tumour microenvironment, the most recent pre-clinical and clinical evidences of its targeting in bone metastases and bone sarcomas. The following sections position RANKL targeted therapy among the other anti-resorptive therapies available and underline the future directions which are currently under investigations.
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Longo V, Brunetti O, D'Oronzo S, Dammacco F, Silvestris F. Therapeutic approaches to myeloma bone disease: an evolving story. Cancer Treat Rev 2012; 38:787-97. [PMID: 22494965 DOI: 10.1016/j.ctrv.2012.03.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2012] [Revised: 03/12/2012] [Accepted: 03/13/2012] [Indexed: 02/06/2023]
Abstract
Bone disease is a major morbidity factor in patients with multiple myeloma and significantly affects their overall survival. A complex interplay between malignant plasma cells and other marrow cells results in the generation of a microenvironment capable of enhancing both tumor growth and bone destruction. Bisphosphonates have consistently reduced the incidence of skeletal-related events in patients with multiple myeloma and other osteotropic tumors as well. However, their use is burdened with side-effects, including the risks of osteonecrosis of the jaw and kidney failure, suggesting that they should be discontinued after prolonged administration. New molecular targets of cell cross-talk in myeloma bone marrow are therefore under intensive investigation and new drugs are being explored in preclinical and clinical studies of myeloma bone disease. Compounds targeting osteoclast activation pathways, such as receptor activator of nuclear factor-κB/receptor activator of nuclear factor-κB ligand/osteoprotegerin, B-cell activating factor, mitogen-activated protein kinase and macrophage inflammatory protein-1α/chemokine receptor for macrophage inflammatory protein-1α axes, or soluble agents that improve osteoblast differentiation by modulating specific inhibitors such as Dickkopf-1 and transforming growth factor-β, as well as novel approaches of cytotherapy represent a new generation of promising drugs for the treatment of myeloma bone disease.
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Affiliation(s)
- Vito Longo
- DIMO, Department of Internal Medicine and Clinical Oncology, University of Bari 'Aldo Moro', Piazza Giulio Cesare, 11 - 70124 Bari, Italy.
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Bedogni A, Fusco V, Agrillo A, Campisi G. Learning from experience. Proposal of a refined definition and staging system for bisphosphonate-related osteonecrosis of the jaw (BRONJ). Oral Dis 2012; 18:621-3. [PMID: 22353421 PMCID: PMC3443365 DOI: 10.1111/j.1601-0825.2012.01903.x] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Prevalence of bisphosphonate-related osteonecrosis in patients with cancer could be as high as 13.3 percent. J Am Dent Assoc 2012; 143:170-1. [DOI: 10.14219/jada.archive.2012.0128] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Martins MAT, Martins MD, Lascala CA, Curi MM, Migliorati CA, Tenis CA, Marques MM. Association of laser phototherapy with PRP improves healing of bisphosphonate-related osteonecrosis of the jaws in cancer patients: A preliminary study. Oral Oncol 2012; 48:79-84. [DOI: 10.1016/j.oraloncology.2011.08.010] [Citation(s) in RCA: 77] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2011] [Revised: 08/16/2011] [Accepted: 08/16/2011] [Indexed: 01/09/2023]
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Surgical Approach and Laser Applications in BRONJ Osteoporotic and Cancer Patients. J Osteoporos 2012; 2012:585434. [PMID: 22645701 PMCID: PMC3356936 DOI: 10.1155/2012/585434] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2011] [Revised: 01/28/2012] [Accepted: 02/20/2012] [Indexed: 11/28/2022] Open
Abstract
Bisphosphonates-related Osteonecrosis of the Jaw (BRONJ) has been reported with increasing frequency in literature over last years, but its therapy is still a dilemma. One hundred ninety patients affected by BRONJ were observed between January 2004 and November 2011 and 166 treated sites were subdivided in five groups on the basis of the therapeutical approach (medical or surgical, traditional or laser-assisted approach, with or without Low Level Laser Therapy (LLLT)). Clinical success has been defined for each treatment performed as clinical improvement or complete mucosal healing. Combination of antibiotic therapy, conservative surgery performed with Er:YAG laser and LLLT applications showed best results for cancer and noncancer patients. Nonsurgical approach performed on 69 sites induced an improvement in 35 sites (50.7%) and the complete healing in 19 sites (27.5%), while surgical approach on 97 sites induced an improvement in 84 sites (86.6%) and the complete healing in 78 sites (80.41%). Improvement and healing were recorded in 31 (81.5%) and 27 (71.5%) out of the 38 BRONJ sites treated in noncancer patients and in 88 (68.75%) and in 69 (53.9%) out of the 128 in cancer patients.
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Vescovi P, Manfredi M, Merigo E, Guidotti R, Meleti M, Pedrazzi G, Fornaini C, Bonanini M, Ferri T, Nammour S. Early surgical laser-assisted management of bisphosphonate-related osteonecrosis of the jaws (BRONJ): a retrospective analysis of 101 treated sites with long-term follow-up. Photomed Laser Surg 2011; 30:5-13. [PMID: 22054203 DOI: 10.1089/pho.2010.2955] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND DATA The management of bisphosphonate-related osteonecrosis of the jaws (BRONJ) is still controversial. OBJECTIVE The purpose of this study was to compare surgical and nonsurgical approaches to the treatment of BRONJ and the possible usefulness of Nd:YAG and Er:YAG lasers. METHODS One hundred and twenty-eight patients (33 males, 95 females; 52 with diagnosis of multiple myeloma, 53 with diagnosis of bone metastasis, and 23 with diagnosis of osteoporosis) affected by BRONJ were evaluated at the Unit of Oral Pathology and Medicine and Laser-Assisted Surgery of the University of Parma, Italy, between January 2004 and July 2009. Overall number of BRONJ sites was 151, and number of treated sites was 101. In order to assess the efficacy of different treatments, sites were subclassified as follows: Group 1 (G1): 12 sites treated with medical therapy; Group 2 (G2): 27 sites treated with medical therapy associated with low level laser therapy (LLLT); Group 3 (G3): 17 sites treated with a combination of medical and surgical therapy; Group 4 (G4): 45 sites treated with a combination of medical therapy, surgical (including laser-assisted) therapy, and LLLT. Outcome of treatment was assessed using the staging system proposed by Ruggiero et al. Transition from a higher stage to a lower one for at least 6 months was considered as clinical improvement and suggestive of a successful treatment. RESULTS Clinical improvement was achieved in 3 out of 12 (25%) BRONJ sites in G1. Sites if G2 with an improvement were 18 out of 27 (66%). Nine out 17 BRONJ sites (53%) in G3 had a transition to a lower stage after treatment. For sites in G4, a clinical improvement was recorded in 40 out of 45 cases (89%). CONCLUSIONS In our experience, the percentage of success obtained with a combined approach based on medical therapy, surgical (including laser-assisted) therapy, and LLLT (G4) is significantly higher than the percentage of improvement obtained in G1, G2, and G3.
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Affiliation(s)
- Paolo Vescovi
- Oral Medicine, Pathology and Laser-Assisted Surgery Unit, University of Parma, Parma, Italy
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Waimann CA, Lu H, Suarez Almazor ME. Rheumatic manifestations of primary and metastatic bone tumors and paraneoplastic bone disease. Rheum Dis Clin North Am 2011; 37:527-49. [PMID: 22075196 DOI: 10.1016/j.rdc.2011.09.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Bone tumors can show a wide range of nonspecific rheumatic manifestations. The presence of unexplained or atypical chronic bone pain, an enlarging bone mass, neurovascular compression syndromes, or pathologic fractures should alert us to the possibility of a bone tumor causing these symptoms. These patients must undergo a complete physical examination; adequate imaging; and, if needed, a biopsy to confirm their diagnosis and offer them an opportune treatment. In addition, bone tumors and other malignancies can present remote clinical manifestations and unusual laboratory findings (eg, HOA, hypophosphatemia, hyperphosphaturia, and hypercalcemia) that may be the first and early manifestation of an occult cancer. These findings should motivate a cancer screening according to age, sex, and personal history. Cancer therapies also have a big impact on bone health, increasing the risk of osteoporosis, osteomalacia, and/or osteonecrosis. Rheumatologists should be aware of possible long-term adverse events of cancer treatment to avoid future complications.
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Affiliation(s)
- Christian A Waimann
- Section of Rheumatology, Department of General Internal Medicine, The University of Texas at MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1465, Houston, TX 77030, USA.
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Vescovi P, Merigo E, Meleti M, Manfredi M, Guidotti R, Nammour S. Bisphosphonates-related osteonecrosis of the jaws: a concise review of the literature and a report of a single-centre experience with 151 patients. J Oral Pathol Med 2011; 41:214-21. [DOI: 10.1111/j.1600-0714.2011.01091.x] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Sardella A, Carrassi A, Tarozzi M, Lodi G. Bisphosphonate-related osteonecrosis of the jaws associated with photodynamic therapy. J Oral Maxillofac Surg 2011; 69:e314-6. [PMID: 21939806 DOI: 10.1016/j.joms.2011.06.219] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2011] [Revised: 06/21/2011] [Accepted: 06/21/2011] [Indexed: 10/17/2022]
Affiliation(s)
- Andrea Sardella
- Department of Medicine, Surgery and Dentistry, Unit of Oral Medicine, Oral Pathology and Gerodontology, University of Milan, Milan, Italy.
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Fusco V, Galassi C, Berruti A, Ciuffreda L, Ortega C, Ciccone G, Angeli A, Bertetto O. Osteonecrosis of the jaw after zoledronic acid and denosumab treatment. J Clin Oncol 2011; 29:e521-2; author reply e523-4. [PMID: 21537047 DOI: 10.1200/jco.2011.35.1551] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Abstract
Hedgehog is a ligand-activated signaling pathway that regulates Gli-mediated transcription. Although most noted for its role as an embryonic morphogen, hyperactive hedgehog also causes human skin and brain malignancies. The hedgehog-related gene anomalies found in these tumors are rarely found in prostate cancer. Yet surveys of human prostate tumors show concordance of high expression of hedgehog ligands and Gli2 that correlate with the potential for metastasis and therapy-resistant behavior. Likewise, prostate cancer cell lines express hedgehog target genes, and their growth and survival is affected by hedgehog/Gli inhibitors. To date, the preponderance of data supports the idea that prostate tumors benefit from a paracrine hedgehog microenvironment similar to the developing prostate. Uncertainty remains as to whether hedgehog's influence in prostate cancer also includes aspects of tumor cell autocrine-like signaling. The recent findings that Gli proteins interact with the androgen receptor and affect its transcriptional output have helped to identify a novel pathway through which hedgehog/Gli might affect prostate tumor behavior and raises questions as to whether hedgehog signaling in prostate cancer cells is suitably measured by the expression of Gli target genes alone.
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Affiliation(s)
- Mengqian Chen
- Ordway Research Institute, 150 New Scotland Avenue, Albany, NY 12208, USA
| | - Richard Carkner
- Ordway Research Institute, 150 New Scotland Avenue, Albany, NY 12208, USA
| | - Ralph Buttyan
- Ordway Research Institute, 150 New Scotland Avenue, Albany, NY 12208, USA
- Division of Urology, Albany Medical College, New York, NY, USA
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