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Aboalela AA, Farook FF, Alqahtani AS, Almousa MA, Alanazi RT, Almohammadi DS. The Effect of Antiresorptive Drug Holidays on Medication-Related Osteonecrosis of the Jaw: A Systematic Review and Meta-Analysis. Cureus 2022; 14:e30485. [DOI: 10.7759/cureus.30485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2022] [Indexed: 11/05/2022] Open
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Feng Z, An J, Zhang Y. Factors Influencing Severity of Medication-Related Osteonecrosis of the Jaw: A Retrospective Study. J Oral Maxillofac Surg 2021; 79:1683-1688. [PMID: 33529608 DOI: 10.1016/j.joms.2020.12.045] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 12/28/2020] [Accepted: 12/29/2020] [Indexed: 12/15/2022]
Abstract
PURPOSE The progression of medication-related osteonecrosis of the jaw (MRONJ) is influenced by many factors. This study aimed to identify the clinical risk factors associated with severe MRONJ (stage 3). PATIENTS AND METHODS The data of patients with MRONJ who were hospitalized between July 2013 and December 2019 were retrospectively analyzed. Demographic and clinical factors were the independent variables, and the clinical stage of MRONJ lesions was the dependent variable. Multivariate logistic regression analysis was performed to identify the risk factors for advanced stage disease (MRONJ stage 3). RESULTS A total of 79 patients (with 93 MRONJ lesions) were included. In multivariate regression analysis, the risk factors associated with stage 3 MRONJ were age ≤65 years (odds ratio [OR] = 3.968, 95% confidence interval [CI]: 1.280-12.301; P = .017); chemotherapy (OR = 3.687, 95% CI: 1.048-12.972; P = .042); preoperative MRONJ duration ≥12 months (OR = 7.616, 95% CI: 1.865-31.110; P = .005); lesion location in maxilla (OR = 1.150, 95% CI: 1.006-1.315; P = .041); lesion location in posterior jaw, that is, in molar area (OR = 1.384, 95% CI; 1.118-1.715; P = .003); and serum albumin <40 g/L (OR = 6.257, 95% CI: 1.313-29.815; P = .021). CONCLUSIONS Age ≤65 years, chemotherapy, preoperative MRONJ duration ≥12 months, lesion location in maxilla, lesion location in the molar area, and serum albumin <40 g/L may increase the risk for severe MRONJ.
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Affiliation(s)
- Zhiqiang Feng
- Attending Doctor, Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China and Attending Doctor, Department of Oral and Maxillofacial Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Jingang An
- Associate Professor, Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China.
| | - Yi Zhang
- Professor, Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
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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 cancer patients using antiresorptive agent zoledronic acid. J Formos Med Assoc 2020; 120:1572-1580. [PMID: 33309430 DOI: 10.1016/j.jfma.2020.11.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 11/19/2020] [Accepted: 11/24/2020] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND/PURPOSE Anti-resorptive agents are commonly used in cancer patients with bone metastasis or multiple myeloma (MM). An adverse event termed medication-related osteonecrosis of the jaws (MRONJ) was discovered in patients using these agents but relatively little attention has been paid to its prognosis. Our aims were to find out the treatment outcomes and prognostic indicators of MRONJ in cancer patients who received zoledronic acid as antiresorptive therapy. METHODS We retrospectively surveyed a cohort of 133 cancer patients who received zoledronic acid. A total of 150 MRONJ lesions were included for investigation. Cumulative complete response rate after treatment was calculated with the Kaplan-Meier method, and significance was examined with the log-rank tests. Cox regression was used for univariate and multivariate analyses of prognostic factors. RESULTS The cumulative complete response rate of all patients at 24 months was 53.2%, and those of patients with MM, breast cancer and prostate cancer were 27.8%, 60.7% and 68.0%, respectively. Having MM was identified as an independent prognostic factor in a multivariate analysis with adjusted hazard ratios of 0.28 (95% confidence interval, 0.09-0.83). CONCLUSION For cancer patients with ONJ related to zoledronic acid, patients with MM endure a worse treatment outcome.
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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, National Taiwan University Hospital, Bei-hu Branch, 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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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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Park SY, Ahn SH, Yoo JI, Chung YJ, Jeon YK, Yoon BH, Kim HY, Lee SH, Lee J, Hong S. Position Statement on the Use of Bone Turnover Markers for Osteoporosis Treatment. J Bone Metab 2019; 26:213-224. [PMID: 31832387 PMCID: PMC6901690 DOI: 10.11005/jbm.2019.26.4.213] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 11/22/2019] [Accepted: 11/23/2019] [Indexed: 01/18/2023] Open
Abstract
Current evidences continue to support the clinical application of bone turnover markers (BTMs) in the management of postmenopausal osteoporosis. The limitations of bone mineral density measured by dual energy X-ray absorptiomet especially emphasize the beneficial roles of BTMs, such as serum C-terminal telopeptide of type I collagen and serum procollagen type I N-propeptide, as monitoring tools to assess the responses to treatment. Therefore, the proper application and assessment of BTM in clinical practice is very important. However, their use in Korea is still insufficient. Therefore, the BTM committee has set up by the Korean Society for Bone and Mineral Research have been constituted and provided a position statement which will suggest on the clinical application of BTM for the management of postmenopausal osteoporosis in Korea.
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Affiliation(s)
- So Young Park
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kyung Hee University Hospital, Seoul, Korea
| | - Seong Hee Ahn
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Inha University Hospital, Inha University School of Medicine, Incheon, Korea
| | - Jun-Il Yoo
- Department of Orthopaedic Surgery, Gyeongsang National University Hospital, Jinju, Korea
| | - Youn-Jee Chung
- Department of Obstetrics and Gynecology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yun Kyung Jeon
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Pusan National University Hospital, Busan, Korea
| | - Byung-Ho Yoon
- Department of Orthopaedic Surgery, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Ha Young Kim
- Division of Endocrinology, Department of Internal Medicine, Wonkwang University Sanbon Hospital, Wonkwang University School of Medicine, Gunpo, Korea
| | - Seung Hun Lee
- Division of Endocrinology and Metabolism, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jehoon Lee
- Department of Laboratory Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seongbin Hong
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Inha University Hospital, Inha University School of Medicine, Incheon, Korea
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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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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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Lorenzo-Pouso AI, Pérez-Sayáns M, García A, Carballo J. Vitamin D supplementation: Hypothetical effect on medication-related osteonecrosis of the jaw. Med Hypotheses 2018; 116:79-83. [PMID: 29857915 DOI: 10.1016/j.mehy.2018.04.023] [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: 02/27/2018] [Revised: 04/10/2018] [Accepted: 04/27/2018] [Indexed: 10/17/2022]
Abstract
Vitamin D is an important nutrient for bone health and skeleton growth. Few foods are natural sources of this secosteroid; this is the reason why the consumption of vitamin D as a dietary supplement is becoming common in developed countries. For many years vitamin D has been considered crucial in the treatment and prevention of the Global Burden of Disease and in a reduction in mortality among elder people. Many health care providers prescribe these supplements in the management of osteoporosis and metabolic bone diseases; specifically in the primary prevention of fractures. Recently medication-related osteonecrosis of the jaw (MRONJ) has been reported as severe late sequelae of antiresorptive therapies (i.e., bisphosphonates and some monoclonal antibodies). Although MRONJ-related pathophysiology is not fully understood, there are three fundamental theories to explain it: (1) the inhibition of osteoclasts, (2) the inhibition of angiogenesis and (3) the processes of inflammation-infection. Recent advances in Vitamin D research have shown that this secosteroid can play a potential pivotal role in many of the different etiological pathways of MRONJ. Furthermore, there are a large number of co-morbidities between the deficit of this vitamin and other MRONJ concomitant outcomes. Our hypothesis argues that the low-risk and low-cost vitamin D dietary supplementation may prove to be suitable for use as a practical MRONJ prevention strategy. The described framework gives more insight into the study of disease mechanisms, search of potential biomarkers, and therapeutic targets in MRONJ.
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Affiliation(s)
- Alejandro I Lorenzo-Pouso
- Oral Medicine, Oral Surgery and Implantology Unit, School of Dentistry, Faculty of Medicine and Odontology, University of Santiago de Compostela, Santiago de Compostela, Spain; GI-1319 Research Group, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain.
| | - Mario Pérez-Sayáns
- Oral Medicine, Oral Surgery and Implantology Unit, School of Dentistry, Faculty of Medicine and Odontology, University of Santiago de Compostela, Santiago de Compostela, Spain; GI-1319 Research Group, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Abel García
- Oral Medicine, Oral Surgery and Implantology Unit, School of Dentistry, Faculty of Medicine and Odontology, University of Santiago de Compostela, Santiago de Compostela, Spain; GI-1319 Research Group, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Javier Carballo
- Department of Food Technology, Faculty of Sciences, University of Vigo - Ourense Campus, Ourense, Spain
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The influence of alendronate and tooth extraction on the incidence of osteonecrosis of the jaw among osteoporotic subjects. PLoS One 2018; 13:e0196419. [PMID: 29694412 PMCID: PMC5918995 DOI: 10.1371/journal.pone.0196419] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 04/12/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Although bisphosphonate-related osteonecrosis of the jaw (ONJ) develops mainly after tooth extractions (TEs), the strength of the association between them and how the existence of the disease among bisphosphonate (BP)-treated osteoporotic patients exposed to TE remain uncertain. METHODS A nationwide retrospective cohort study investigated the influence of alendronate and TE on the development of ONJ. RESULTS Incidence of ONJ following long-term alendronate therapy was 262/100,000 person-years, while no event developed in the control group on raloxifene. Overall prevalence of ONJ in osteoporotic subjects receiving alendronate was estimated at 0.34% which rose to 2.16% after TE. Multiple logistic regression analysis, adjusted for the potential confounders, showed TE (adjusted odds ratio, 9.60 [4.33-21.29]), drug duration exceeding 3 years (3.00 [1.33-6.76]), and concomitant rheumatoid arthritis (4.94 [1.64-14.90]) were independent predictors of ONJ. CONCLUSIONS This article strengthens the relationship between ONJ and BPs. Among osteoporotic patients exposed to alendronate, TE confers a 9.6-fold increased risk for ONJ and it should be performed with caution irrespective of drug duration.
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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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Kwon YD, Kim DY. Role of Teriparatide in Medication-Related Osteonecrosis of the Jaws (MRONJ). Dent J (Basel) 2016; 4:dj4040041. [PMID: 29563483 PMCID: PMC5806950 DOI: 10.3390/dj4040041] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 10/18/2016] [Accepted: 10/18/2016] [Indexed: 01/10/2023] Open
Abstract
While the optimal treatment concept of medication-related osteonecrosis of the jaws (MRONJ) is still in debate, several adjunct therapies have been introduced. Among these adjunctive measures, recombinant human parathyroid hormone (rhPTH, teriparatide) seems to be the most promising treatment modality. Several studies have presented the beneficial effect of short-term teriparatide; they have shown an improved level of bone markers and radiographic evidence of bone healing. Although clinical validation by a controlled trial with prospective design would be essential, short-term teripratide therapy would be a good treatment option for MRONJ patients with impaired bone remodeling.
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Affiliation(s)
- Yong-Dae Kwon
- Center for Refractory Jawbone Diseases, Department of Oral & Maxillofacial Surgery, Kyung Hee University Dental Hospital, Seoul 02447, Korea.
| | - Deog-Yoon Kim
- Department of Nuclear Medicine, Kyung Hee University Hospital, Seoul 02447, Korea.
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Enciso R, Keaton J, Saleh N, Ahmadieh A, Clark GT, Sedghizadeh PP. Assessing the utility of serum C-telopeptide cross-link of type 1 collagen as a predictor of bisphosphonate-related osteonecrosis of the jaw: A systematic review and meta-analysis. J Am Dent Assoc 2016; 147:551-560.e11. [PMID: 27040417 DOI: 10.1016/j.adaj.2016.02.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 01/21/2016] [Accepted: 02/09/2016] [Indexed: 12/01/2022]
Abstract
BACKGROUND The authors of this systematic review and meta-analysis assessed the utility of serum C-telopeptide cross-link of type 1 collagen (sCTX), a biomarker of bone resorption, as a predictor of the development of bisphosphonate-related osteonecrosis of the jaw (BRONJ). TYPES OF STUDIES REVIEWED The authors searched for studies involving adult participants, written in English, and published through January 20, 2016, using the following electronic databases: the Cochrane Library, MEDLINE via PubMed, and Web of Science. They also searched Google Scholar and the reference lists of all eligible trials and reviews. They identified 16 articles that met their inclusion criteria (9 controlled studies and 7 case series). They applied the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for systematic reviews and meta-analyses. They independently extracted data in duplicate, including the characteristics of study participants, risk factors, control groups, and outcomes. They assessed risk of bias, and they resolved any disagreements between review authors through discussion. RESULTS A meta-analysis with 9 controlled studies revealed no significant difference in mean sCTX values between patients with BRONJ and control participants (difference in means, -31.417; 95% confidence interval [CI], -91.560 to 28.726; P = .306). A second meta-analysis with 4 studies showed no significant difference in risk of having an sCTX value below 150 picograms per milliliter for patients with BRONJ compared with control participants (risk ratio, 1.892; 95% CI, 0.636-5.626; P = .251). CONCLUSIONS AND PRACTICAL IMPLICATIONS A systematic review of the literature with meta-analysis does not support the use of sCTX levels as a predictor of the development of BRONJ. Further prospective large sample studies are needed to understand the role of sCTX as a predictor for BRONJ.
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Bedogni A, Fedele S, Bedogni G, Scoletta M, Favia G, Colella G, Agrillo A, Bettini G, Di Fede O, Oteri G, Fusco V, Gabriele M, Ottolenghi L, Valsecchi S, Porter S, Petruzzi M, Arduino P, D’Amato S, Ungari C, Fung Polly PL, Saia G, Campisi G. Staging of osteonecrosis of the jaw requires computed tomography for accurate definition of the extent of bony disease. Br J Oral Maxillofac Surg 2014; 52:603-8. [PMID: 24856927 DOI: 10.1016/j.bjoms.2014.04.009] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Accepted: 04/21/2014] [Indexed: 10/25/2022]
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Rivera MF, Chukkapalli SS, Velsko IM, Lee JY, Bhattacharyya I, Dolce C, Toro EJ, Holliday LS, Kesavalu L. Bis-enoxacin blocks rat alveolar bone resorption from experimental periodontitis. PLoS One 2014; 9:e92119. [PMID: 24638087 PMCID: PMC3956892 DOI: 10.1371/journal.pone.0092119] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Accepted: 02/17/2014] [Indexed: 12/30/2022] Open
Abstract
Periodontal diseases are multifactorial, caused by polymicrobial subgingival pathogens, including Porphyromonas gingivalis, Treponema denticola, and Tannerella forsythia. Chronic periodontal infection results in inflammation, destruction of connective tissues, periodontal ligament, and alveolar bone resorption, and ultimately tooth loss. Enoxacin and a bisphosphonate derivative of enoxacin (bis-enoxacin) inhibit osteoclast formation and bone resorption and also contain antibiotic properties. Our study proposes that enoxacin and/or bis-enoxacin may be useful in reducing alveolar bone resorption and possibly bacterial colonization. Rats were infected with 10(9) cells of polymicrobial inoculum consisting of P. gingivalis, T. denticola, and T. forsythia, as an oral lavage every other week for twelve weeks. Daily subcutaneous injections of enoxacin (5 mg/kg/day), bis-enoxacin (5, 25 mg/kg/day), alendronate (1, 10 mg/kg/day), or doxycycline (5 mg/day) were administered after 6 weeks of polymicrobial infection. Periodontal disease parameters, including bacterial colonization/infection, immune response, inflammation, alveolar bone resorption, and systemic spread, were assessed post-euthanasia. All three periodontal pathogens colonized the rat oral cavity during polymicrobial infection. Polymicrobial infection induced an increase in total alveolar bone resorption, intrabony defects, and gingival inflammation. Treatment with bis-enoxacin significantly decreased alveolar bone resorption more effectively than either alendronate or doxycycline. Histologic examination revealed that treatment with bis-enoxacin and enoxacin reduced gingival inflammation and decreased apical migration of junctional epithelium. These data support the hypothesis that bis-enoxacin and enoxacin may be useful for the treatment of periodontal disease.
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Affiliation(s)
- Mercedes F. Rivera
- Department of Periodontology, College of Dentistry, University of Florida, Gainesville, Florida, United States of America
| | - Sasanka S. Chukkapalli
- Department of Periodontology, College of Dentistry, University of Florida, Gainesville, Florida, United States of America
| | - Irina M. Velsko
- Department of Periodontology, College of Dentistry, University of Florida, Gainesville, Florida, United States of America
| | - Ju-Youn Lee
- Department of Periodontology, College of Dentistry, University of Florida, Gainesville, Florida, United States of America
| | - Indraneel Bhattacharyya
- Department of Oral Diagnostic Sciences, College of Dentistry, University of Florida, Gainesville, Florida, United States of America
| | - Calogero Dolce
- Department of Orthodontics, College of Dentistry, University of Florida, Gainesville, Florida, United States of America
| | - Edgardo J. Toro
- Department of Orthodontics, College of Dentistry, University of Florida, Gainesville, Florida, United States of America
| | - L. Shannon Holliday
- Department of Orthodontics, College of Dentistry, University of Florida, Gainesville, Florida, United States of America
- Department of Anatomy and Cell Biology, College of Medicine, University of Florida, Gainesville, Florida, United States of America
| | - Lakshmyya Kesavalu
- Department of Periodontology, College of Dentistry, University of Florida, Gainesville, Florida, United States of America
- Department of Oral Biology, College of Dentistry, University of Florida, Gainesville, Florida, United States of America
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