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Borgen TT, Lee-Ødegård S, Eriksen BF, Eriksen EF. Intermittent dosing of zoledronic acid based on bone turnover marker assessment reduces vertebral and non-vertebral fractures. JBMR Plus 2024; 8:ziae072. [PMID: 38939827 PMCID: PMC11208720 DOI: 10.1093/jbmrpl/ziae072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 05/15/2024] [Accepted: 05/30/2024] [Indexed: 06/29/2024] Open
Abstract
Previous studies have demonstrated that the administration of zoledronic acid (ZOL) once yearly for 3 years or once over 3 years, yields similar antifracture efficacy. Bone turnover markers can predict the antifracture efficacy of antiresorptive agents, with procollagen type 1 N-terminal propeptide (P1NP) being the most useful marker. In this retrospective cohort study, we explored the effects of intravenous dosing of ZOL guided by serum (S)-P1NP assessment on bone mineral density (BMD) and fractures. Consenting patients (N = 202, mean age 68.2 years) with osteoporosis were treated with ZOL for an average of 4.4 (range 2-8) years. S-P1NP and BMD were measured at baseline and every 1-2 years. We assessed the number of subsequent vertebral and nonvertebral fractures in the 2-year time periods. The number of patients assessed was 202, 147, 69, and 29 at years 1-2, 3-4, 5-6, and 7-8, respectively. A new ZOL infusion was given if S-P1NP exhibited values above 35 μg/L. BMD increased by 6.2% (SD 4.0) over the first 2 years and stabilized in years 2-8 (P <.05). Median S-P1NP exhibited an initial reduction from 58.0 to 31.3 μg/L at year 2 and then increased to 39.0 μg/L at years 7-8. Compared with fractures observed in the last 2 years before baseline, fracture rates exhibited consistent reductions, for vertebral fractures odds ratio (OR) [95% confidence interval] = 0.61 [0.47, 0.80], P <.001 and for nonvertebral fractures OR = 0.23 [0.18, 0.31], P <.001. In conclusion, intermittent dosing of intravenous ZOL based on the assessment of S-P1NP with cut-off at 35 μg/L resulted in an initial increase followed by a stable BMD, suppression of S-P1NP, and stable reduction of fractures for 8 years. Only 39% of patients needed more than one infusion. This approach reduces healthcare costs and might also reduce the risk of rare side effects such as osteonecrosis of the jaw and atypical femoral fracture.
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Affiliation(s)
| | - Sindre Lee-Ødegård
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, 0424 Oslo, Norway
| | - Barbara Fink Eriksen
- Faculty of Medicine, University of Aarhus, 8000 Aarhus, Denmark
- Spesialistsenteret Pilestredet Park, 0176 Oslo, Norway
| | - Erik Fink Eriksen
- Spesialistsenteret Pilestredet Park, 0176 Oslo, Norway
- Faculty of Dentistry, University of Oslo, 1142 Blindern, Oslo, Norway
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Medication-Related Osteonecrosis of the Jaw in Dental Practice: A Retrospective Analysis of Data from the Milan Cohort. Dent J (Basel) 2022; 10:dj10050089. [PMID: 35621542 PMCID: PMC9139814 DOI: 10.3390/dj10050089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 05/11/2022] [Accepted: 05/13/2022] [Indexed: 02/01/2023] Open
Abstract
A retrospective analysis was performed with the aim of understanding whether the risk factors showed in the literature for medication-related osteonecrosis of the jaws (MRONJ) in cancer patients are also relevant in osteoporotic patients taking antiresorptive drugs (ARDs). Data were retrospectively pooled from health records of patients on ARDs who requested a dental visit between January 2006 and April 2020 in the Dental Unit at Fondazione Ca’ Granda IRCCS Ospedale Maggiore Policlinico, University of Milan. A total of 434 patients were included. The following variables were collected: sex, age, smoking habit, type of ARD, duration of treatment, route of administration, therapeutic indication, concurrent systemic therapies and pathologies. Statistical analysis confirmed the relevance of chemotherapy, smoking, and immunosuppressive drugs as risk factors. In addition, a higher frequency of MRONJ in osteoporotic patients was reported in our cohort in association with an immunodeficiency disorder of variable origin. In conclusion, the identification of individual risk-profile before dental treatments is crucial for prevention. Anamnesis should include main risk factors, such as immunosuppression, dental extractions, smoking, trauma, and poor dental health. Nevertheless, our suggestion for dental professionals is to conduct a complete medical history of patients who mention long-term per oral therapies with ARDs for osteoporosis. Osteoporotic, as well as cancer patients, may also benefit from periodic monitoring of the ARDs therapy in order to prevent MRONJ.
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Huang YF, Lin KC, Liu SP, Chang CT, Muo CH, Chang PJ, Tsai CH, Wu CZ. The association between the severity of periodontitis and osteonecrosis of the jaw in patients with different cancer locations: a nationwide population-based study. Clin Oral Investig 2022; 26:3843-3852. [PMID: 35482084 DOI: 10.1007/s00784-021-04175-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 08/31/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To determine the relation between the severity of periodontitis and osteonecrosis of the jaw (ONJ) occurrence among different cancer locations and estimate the effect of dental care on ONJ prevention in cancer patients. MATERIALS AND METHODS This population-based cross-sectional study was conducted through the Longitudinal Health Insurance Database, Taiwan. Patients with malignancies were collected and subdivided into groups according to their different cancer locations, the severity of periodontitis, and dental care. Multivariable logistic regression analysis was performed to assess the associations between ONJ and ONJ-related factors. RESULTS A total of 8,234 ONJ patients and 32,912 control patients were investigated. Lip, oral cavity, and pharynx malignancies had the highest ONJ risk among all cancer locations (OR from 3.07 to 9.56, P < 0.01). There is a linear relationship between different severities of periodontitis and ONJ. Patients with radiotherapy and severe periodontitis had the highest ONJ risk (adjusted OR, 9.56; 95% CI, 5.34-17.1). Patients with good dental care had a lower ONJ risk. CONCLUSIONS The periodontal condition and cancer location showed a significant impact on the risk of developing ONJ after adjusting for bisphosphonate use. Good dental care could decrease the risk of ONJ in cancer patients. The severity of periodontitis might be a target to predict the potency of ONJ. CLINICAL RELEVANCE Dentists must be vigilant about the increased risk of ONJ in cancer patients with periodontitis, especially in the head and neck cancer population. Good dental care is advised for cancer patients with severe periodontitis.
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Affiliation(s)
- Yi-Fang Huang
- Department of General Dentistry, Chang Gung Memorial Hospital, Linkou, 33305, Taiwan
- School of Dentistry, College of Oral Medicine, Taipei Medical University, No. 250, Wu-Hsing St., Xinyi Dist, Taipei, 11031, Taiwan
- Graduate Institute of Dental and Craniofacial Science, College of Medicine, Chang Gung University, Taoyuan, 33302, Taiwan
| | - Kuan-Chou Lin
- School of Dentistry, College of Oral Medicine, Taipei Medical University, No. 250, Wu-Hsing St., Xinyi Dist, Taipei, 11031, Taiwan
- Department of Oral and Maxillofacial Surgery, Wan Fang Hospital, Taipei Medical University, Taipei, 11696, Taiwan
| | - Shih-Ping Liu
- Graduate Institute of Basic Medical Science, China Medical University, Taichung, 40402, Taiwan
- Center for Neuropsychiatry, China Medical University Hospital, Taichung, 40402, Taiwan
- Department of Social Work, Asia University, Taichung, 41354, Taiwan
| | - Chung-Ta Chang
- School of Dentistry, College of Oral Medicine, Taipei Medical University, No. 250, Wu-Hsing St., Xinyi Dist, Taipei, 11031, Taiwan
- Department of Emergency Medicine, Far Eastern Memorial Hospital, Taipei, 22056, Taiwan
- Graduate Institute of Medicine, Yuan Ze University, Taoyuan, 32003, Taiwan
| | - Chih-Hsin Muo
- Management Office for Health Data, China Medical University Hospital, Taichung, 40402, Taiwan
| | - Po-Jen Chang
- School of Dentistry, College of Oral Medicine, Taipei Medical University, No. 250, Wu-Hsing St., Xinyi Dist, Taipei, 11031, Taiwan
| | - Chun-Hao Tsai
- Graduate Institute of Clinical Medicine, China Medical University, Taichung, 40402, Taiwan
- Department of Orthopedics, China Medical University Hospital, Taichung, 40402, Taiwan
| | - Ching-Zong Wu
- School of Dentistry, College of Oral Medicine, Taipei Medical University, No. 250, Wu-Hsing St., Xinyi Dist, Taipei, 11031, Taiwan.
- Department of Dentistry, Taipei Medical University Hospital, Taipei, 11031, Taiwan.
- Department of Dentistry, Lotung Poh-Ai Hospital, Yilan, 26546, Taiwan.
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Targeted histological evaluation shows high incidence of actinomyces infection in medication-related osteonecrosis of the jaws. Sci Rep 2022; 12:3406. [PMID: 35233034 PMCID: PMC8888741 DOI: 10.1038/s41598-022-07375-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 01/28/2022] [Indexed: 11/08/2022] Open
Abstract
Medication-Related Osteonecrosis of the Jaws (MRONJ) is a difficult-to-treat complication of the therapy of osteoporosis and some malignancies cured with bisphosphonates and antiresorptive drugs. The pathomechanism is unclear, but there is increasing observation that Actinomyces infection may play a role in its development and progression. The aim of our study was to demonstrate that histological examination using a validated triple staining procedure for Actinomyces bacteria strains can detect a high rate of Actinomyces infection in patient's samples with MRONJ. 112 previously hematoxylin-eosin (HE) stained samples submitted with the clinical diagnosis of MRONJ were re-evaluated histologically using an appropriate triple special staining validated for the identification of Actinomyces infection. During the first evaluation, when pathologists did not specifically look for Actinomyces, only 8.93% of the samples were reported as positive. In contrast, re-evaluation with triple staining provided a yield of 93.7% positive samples, therefore, we suggest the triple special staining to be standard in MRONJ histology evaluation. These results show that if the clinician suspects Actinomyces infection and brings this to the attention of the pathologist, it could significantly increase the number of correct diagnoses. It serves as an aid for clinicians in therapeutic success of MRONJ by selecting a long-term adequate antibiotic medication which is suitable for the elimination of actinomyces infection.
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Prognosis by cancer type and incidence of zoledronic acid-related osteonecrosis of the jaw: a single-center retrospective study. Support Care Cancer 2022; 30:4505-4514. [PMID: 35113225 DOI: 10.1007/s00520-022-06839-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 01/13/2022] [Indexed: 10/19/2022]
Abstract
PURPOSE Survival time after bisphosphonate use has been increasingly recognized to be associated with the incidence of medication-related osteonecrosis of the jaw (MRONJ); however, this has not been elucidated sufficiently in the literature. This study aimed to clarify the incidence of MRONJ and the corresponding survival rate of patients treated with zoledronic acid (ZA) for each type of cancer and obtain useful information for the oral/dental supportive care of cancer patients. METHODS We evaluated 988 patients who were administered ZA at our hospital; among them, 862 patients with metastatic bone tumors or myeloma were included. RESULTS The median survival time (MST) after ZA initiation was 35, 34, 8, 41, 12, and 6 months for patients with breast, prostrate, lung, myeloma, renal, and other cancers, respectively. Patients with cancers that had a short survival time (lung and other cancers [MST = 8 and 6 months, respectively] and cancers with MST < 10 months) did not develop MRONJ; this could be attributed to the shorter duration of ZA administration. The cumulative incidence of MRONJ in breast cancer, prostate cancer, and multiple myeloma was related to the frequency of anti-resorptive drug use and the increased risk over time. In renal cancer, the cumulative incidence of MRONJ increased early, although the MST was 12 months. CONCLUSION For the dentists in charge of dental management, it is essential to be aware of prognosis-related factors, predict MRONJ risk for each cancer treatment, and use risk prediction in dental management planning, particularly for cancers with non-poor prognosis.
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Sacco R, Woolley J, Patel G, Calasans-Maia MD, Yates J. Systematic review of medication related osteonecrosis of the jaw (MRONJ) in patients undergoing only antiangiogenic drug therapy: surgery or conservative therapy? Br J Oral Maxillofac Surg 2022; 60:e216-e230. [PMID: 35115201 DOI: 10.1016/j.bjoms.2021.03.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 03/16/2021] [Indexed: 10/21/2022]
Abstract
Osteonecrosis of the jaw is a severe adverse condition affecting patients exposed to specific types of medications. Previous studies have highlighted that osteonecrosis of the jaw is triggered by invasive dental procedures and can be very challenging to manage, especially in patients with cancer. The primary aim of this review was to analyse all available evidence on the management (surgical and/or conservative) of medication related osteonecrosis of the jaws (MRONJ) in patients with a history of antiangiogenic drugs therapy and who had not been previously exposed to any antiresorptive drug treatments. A multi-database search (PubMed, MEDLINE, EMBASE and CINAHL) was performed to identify related multi-language papers published from January 2003 until November 2020. Data were extracted from relevant papers and analysed according to the outcomes selected in this review. The search generated 28 studies eligible for the analysis. The total number of patients included in the analysis was 36. Sixteen patients were treated with anti-vascular endothelial growth factor drugs (anti-VEGF) while the remaining patients were administered a combination of antiangiogenic drugs. The most common MRONJ site was the mandible in 29 patients. MRONJ recurrence after treatment was only reported in six patients, the majority of which were treated conservatively. The data reviewed confirmed that an invasive procedure was the most common trigger of MRONJ with relatively high frequency of postoperative recurrence following treatment. However, due to the low quality of available research in the literature, it is difficult to draw a definitive conclusion on the validity of the presented treatment to manage patients affected by MRONJ associated with angiogenic therapy.
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Affiliation(s)
- R Sacco
- Clinical Lecturer, University of Manchester Division of Dentistry, School of Medical Sciences, Oral Surgery Department, Manchester, UK; Clinical Teacher, King's College Hospital, Oral Surgery Department, London, UK.
| | - J Woolley
- Dental Core Trainee, Northwick Park Hospital - London North West University Healthcare NHS Trust, Oral and Maxillofacial Surgery Department, London, UK
| | - G Patel
- Dental Core Trainee, Eastman Dental Hospital, Paediatric Dentistry Department, London, UK
| | - M D Calasans-Maia
- Professor of Oral and Maxillofacial Surgery, Fluminense Federal University, Dental School, Oral Surgery Department, Rio de Janeiro, Brazil
| | - J Yates
- Professor of Oral and Maxillofacial Surgery and Implantology, University of Manchester Division of Dentistry, School of Medical Sciences, Oral Surgery Department, Manchester, UK
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Lentzen MP, Buller J, Riekert M, Grandoch A, Kreppel M, Zöller JE, Zirk M. Bisphosphonate application and volumetric effects on MRONJ lesions. J Craniomaxillofac Surg 2021; 49:501-507. [PMID: 33853745 DOI: 10.1016/j.jcms.2021.01.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 10/27/2020] [Accepted: 01/31/2021] [Indexed: 01/22/2023] Open
Abstract
The purpose of this investigation was to analyze the volume of medication-related osteonecrosis of the jaw (MRONJ) lesions by semi-automatic segmentation of cone-beam computed tomography images, and correlate the results with the underlying diseases and applied medication. MRONJ lesions detected in cone-beam computed tomography images were assessed. The open-source software ITK-Snap enabled volumetric measurements of MRONJ lesions based on semi-automatic segmentation. Results were analyzed according to necrosis volume, localization, and gender. In addition, the underlying disease and the type of application of antiresorptive medication were investigated. Cone-beam computed tomography images of 66 patients were studied. 34 male and 32 female patients were included, with ages ranging from 50 to 93 years at the time of diagnosis. The mean volume was 993.24 ± 620.94 mm3: 484.73 ± 230.97 mm3 for the upper jaw and 1084.04 ± 625.74 mm3 for the lower jaw. The results indicated statistically significant differences between lesions of the upper and lower jaw, regardless of gender (p = 0.003). The analysis of differences between males and females did not show any significant results (p = 0.464), although males presented slightly larger lesions than females. With regard to the underlying disease, patients with osteoporosis presented larger volumes, whereas patients with malignant tumors presented smaller volumes. Nevertheless, no statistically significant differences according to the underlying disease (p = 0.313) were detected. However, patients with intravenous (iv) application showed statistically significantly larger lesions than patients who underwent oral or subcutaneous (s.c.) applications (p = 0.004). It seems that the osteonecrosis volume correlates with the applied antiresorptive agents. Larger MRONJ lesions should be expected in patients who receive intravenous antiresorptive therapy.
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Affiliation(s)
- Max-Philipp Lentzen
- Department for Oral and Craniomaxillofacial and Plastic Surgery, University Hospital Cologne and Faculty of Medicine, University of Cologne, Germany.
| | - Johannes Buller
- Department for Oral and Craniomaxillofacial and Plastic Surgery, University Hospital Cologne and Faculty of Medicine, University of Cologne, Germany
| | - Maximilian Riekert
- Department for Oral and Craniomaxillofacial and Plastic Surgery, University Hospital Cologne and Faculty of Medicine, University of Cologne, Germany
| | - Andrea Grandoch
- Department for Oral and Craniomaxillofacial and Plastic Surgery, University Hospital Cologne and Faculty of Medicine, University of Cologne, Germany
| | - Matthias Kreppel
- Department for Oral and Craniomaxillofacial and Plastic Surgery, University Hospital Cologne and Faculty of Medicine, University of Cologne, Germany
| | - Joachim E Zöller
- Department for Oral and Craniomaxillofacial and Plastic Surgery, University Hospital Cologne and Faculty of Medicine, University of Cologne, Germany
| | - Matthias Zirk
- Department for Oral and Craniomaxillofacial and Plastic Surgery, University Hospital Cologne and Faculty of Medicine, University of Cologne, Germany
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Minabe M, Suzuki T, Komatsu M, Hashimoto K, Nomura T. Intraoral localized methotrexate-associated lymphoproliferative disorders concurrent with antiresorptive agent-related osteonecrosis of the jaw: A case report and literature review. Clin Case Rep 2020; 8:2926-2935. [PMID: 33363853 PMCID: PMC7752373 DOI: 10.1002/ccr3.3192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 06/18/2020] [Accepted: 07/05/2020] [Indexed: 11/30/2022] Open
Abstract
Intraoral localized methotrexate-associated lymphoproliferative disorders can cause antiresorptive agent-related osteonecrosis of the jaw associated with infection due to its immunological abnormalities and ulcer formation.
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Affiliation(s)
- Masaki Minabe
- Department of Oral Medicine, Oral and Maxillofacial SurgeryTokyo Dental CollegeIchikawaJapan
| | - Taiki Suzuki
- Department of Oral Medicine, Oral and Maxillofacial SurgeryTokyo Dental CollegeIchikawaJapan
- Division of Oral and Maxillofacial SurgerySUBARU Health Insurance Society Ota Memorial HospitalOtaJapan
| | - Masumi Komatsu
- Department of Oral Medicine, Oral and Maxillofacial SurgeryTokyo Dental CollegeIchikawaJapan
| | - Kazuhiko Hashimoto
- Department of Pathology and Laboratory MedicineTokyo Dental CollegeIchikawa General HospitalIchikawaJapan
| | - Takeshi Nomura
- Department of Oral Medicine, Oral and Maxillofacial SurgeryTokyo Dental CollegeIchikawaJapan
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Vereb T, Boda K, Czakó L, Vaszilkó M, Fülöp G, Klenk G, Janovszky Á, Oberna F, Piffkó J, Seres L. Cloud-Based Multicenter Data Collection and Epidemiologic Analysis of Bisphosphonate-Related Osteonecrosis of the Jaws in a Central European Population. J Clin Med 2020. [DOI: https://doi.org/10.3390/jcm9020426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objective: Bisphosphonate-related osteonecrosis of the jaws is considered to be a rare but severe complication of bisphosphonate therapy. To understand this condition better, data collection is essential. Although the number of scientific papers about this subject is large, to date only a few multicenter reports have been published. Study design: We present a novel cloud-based data collection system for the evaluation of the risk factors of bisphosphonate-related osteonecrosis of the jaws. Web-based questionnaire and database have been set up and made available to voluntary researchers and clinicians in oral and maxillofacial surgery in Hungary and Slovakia. Results: To date, fifteen colleagues from eight maxillofacial units have joined the study. Data of 180 patients have been recorded. Collected data were statistically analysed and evaluated from an epidemiological point of view. Conclusions: Authors consider cloud-based multicenter data collection a useful tool that allows for real-time collaboration between users, facilitates fast data entry and analysis, and thus considerably contributes to widening our knowledge of bisphosphonate-related osteonecrosis of the jaws.
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Cloud-Based Multicenter Data Collection and Epidemiologic Analysis of Bisphosphonate-Related Osteonecrosis of the Jaws in a Central European Population. J Clin Med 2020; 9:jcm9020426. [PMID: 32033299 PMCID: PMC7073980 DOI: 10.3390/jcm9020426] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 01/29/2020] [Accepted: 01/31/2020] [Indexed: 12/01/2022] Open
Abstract
Objective: Bisphosphonate-related osteonecrosis of the jaws is considered to be a rare but severe complication of bisphosphonate therapy. To understand this condition better, data collection is essential. Although the number of scientific papers about this subject is large, to date only a few multicenter reports have been published. Study design: We present a novel cloud-based data collection system for the evaluation of the risk factors of bisphosphonate-related osteonecrosis of the jaws. Web-based questionnaire and database have been set up and made available to voluntary researchers and clinicians in oral and maxillofacial surgery in Hungary and Slovakia. Results: To date, fifteen colleagues from eight maxillofacial units have joined the study. Data of 180 patients have been recorded. Collected data were statistically analysed and evaluated from an epidemiological point of view. Conclusions: Authors consider cloud-based multicenter data collection a useful tool that allows for real-time collaboration between users, facilitates fast data entry and analysis, and thus considerably contributes to widening our knowledge of bisphosphonate-related osteonecrosis of the jaws.
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Shapiro CL, Yarom N, Peterson DE, Bohlke K, Saunders DP. Medication-Related Osteonecrosis of the Jaw: MASCC/ISOO/ASCO Clinical Practice Guideline Summary. J Oncol Pract 2019. [DOI: 10.1200/jop.19.00384] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Noam Yarom
- Tel Hashomer and Tel Aviv University, Tel Aviv, Israel
| | | | - Kari Bohlke
- American Society of Clinical Oncology, Alexandria, VA
| | - Deborah P. Saunders
- Health Sciences North, Northern Ontario School of Medicine, Sudbury, Ontario, Canada
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12
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Zirk M, Buller J, Zöller JE, Heneweer C, Kübler N, Lentzen MP. Volumetric analysis of MRONJ lesions by semiautomatic segmentation of CBCT images. Oral Maxillofac Surg 2019; 23:465-472. [PMID: 31673817 DOI: 10.1007/s10006-019-00805-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 09/11/2019] [Indexed: 12/21/2022]
Abstract
PURPOSE The purpose of this study was to evaluate potential differences in volumes of areas of osteolysis caused by medication-related osteonecrosis of the jaw (MRONJ) between the upper and lower jaw. We aim to analyze the clinical relevance of volumetric measurement of osteolytic lesions for surgical planning of MRONJ patients. METHODS Sixty-seven patients who were clinically and histopathologically diagnosed with MRONJ were retrospectively included in this study. Cone beam computed tomography (CBCT) images were evaluated according to localization, affected anatomical structures, and volumetric measurement of osteolytic lesions caused by MRONJ in appliance of CBCT datasets by using ITK-SNAP. RESULTS The most frequently affected localization is the mandible, whereas female patients show significantly more often lesions of the maxilla. The cortical bone was predominantly affected. Furthermore, the affection of teeth, sinus floor, inferior alveolar nerve canal, or even a pathological fracture of the mandible are infrequently existing. The volumetric measurements revealed a statistically significant greater absolute osteolysis volume in males. CONCLUSIONS Image analysis and volumetric measurements of osteolytic lesions of MRONJ patients is a helpful tool to further understand the clinical appearance and identify compromised anatomic landmarks. Volumetric analysis aids in pre-surgical planning and visualizes the individual extent of the disease for each patient.
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Affiliation(s)
- Matthias Zirk
- Department for Oral and Craniomaxillofacial and Plastic Surgery, University Hospital of Cologne, Kerpener Strasse 62, 50931, Cologne, Germany.
| | - Johannes Buller
- Department for Oral and Craniomaxillofacial and Plastic Surgery, University Hospital of Cologne, Kerpener Strasse 62, 50931, Cologne, Germany
| | - Joachim E Zöller
- Department for Oral and Craniomaxillofacial and Plastic Surgery, University Hospital of Cologne, Kerpener Strasse 62, 50931, Cologne, Germany
| | - Carola Heneweer
- Institute of Diagnostic and Interventional Radiology, University Hospital of Cologne, Cologne, Germany
| | - Norbert Kübler
- Department for Oral and Maxillofacial Surgery, University Hospital Duesseldorf, Duesseldorf, Germany
| | - Max-Philipp Lentzen
- Department for Oral and Maxillofacial Surgery, University Hospital Duesseldorf, Duesseldorf, Germany
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13
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Yarom N, Shapiro CL, Peterson DE, Van Poznak CH, Bohlke K, Ruggiero SL, Migliorati CA, Khan A, Morrison A, Anderson H, Murphy BA, Alston-Johnson D, Mendes RA, Beadle BM, Jensen SB, Saunders DP. Medication-Related Osteonecrosis of the Jaw: MASCC/ISOO/ASCO Clinical Practice Guideline. J Clin Oncol 2019; 37:2270-2290. [PMID: 31329513 DOI: 10.1200/jco.19.01186] [Citation(s) in RCA: 179] [Impact Index Per Article: 35.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To provide guidance regarding best practices in the prevention and management of medication-related osteonecrosis of the jaw (MRONJ) in patients with cancer. METHODS Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology (MASCC/ISOO) and ASCO convened a multidisciplinary Expert Panel to evaluate the evidence and formulate recommendations. Guideline development involved a systematic review of the literature and a formal consensus process. PubMed and EMBASE were searched for studies of the prevention and management of MRONJ related to bone-modifying agents (BMAs) for oncologic indications published between January 2009 and December 2017. Results from an earlier systematic review (2003 to 2008) were also included. RESULTS The systematic review identified 132 publications, only 10 of which were randomized controlled trials. Recommendations underwent two rounds of consensus voting. RECOMMENDATIONS Currently, MRONJ is defined by (1) current or previous treatment with a BMA or angiogenic inhibitor, (2) exposed bone or bone that can be probed through an intraoral or extraoral fistula in the maxillofacial region and that has persisted for longer than 8 weeks, and (3) no history of radiation therapy to the jaws or metastatic disease to the jaws. In patients who initiate a BMA, preventive care includes comprehensive dental assessments, discussion of modifiable risk factors, and avoidance of elective dentoalveolar surgery (ie, surgery that involves the teeth or contiguous alveolar bone) during BMA treatment. It remains uncertain whether BMAs should be discontinued before dentoalveolar surgery. Staging of MRONJ should be performed by a clinician with experience in the management of MRONJ. Conservative measures comprise the initial approach to MRONJ treatment. Ongoing collaboration among the dentist, dental specialist, and oncologist is essential to optimal patient care.
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Affiliation(s)
- Noam Yarom
- Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.,Tel Aviv University, Tel Aviv, Israel
| | | | | | | | - Kari Bohlke
- American Society of Clinical Oncology, Alexandria, VA
| | - Salvatore L Ruggiero
- Hofstra North Shore-LIJ School of Medicine, Hempstead, NY.,Stony Brook School of Dental Medicine, Stony Brook, NY.,New York Center for Orthognathic and Maxillofacial Surgery, New York, NY
| | | | - Aliya Khan
- McMaster University, Hamilton, Ontario, Canada
| | - Archie Morrison
- Dalhousie University, Halifax, Nova Scotia, Canada.,Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
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Anderson K, Ismaila N, Flynn PJ, Halabi S, Jagannath S, Ogaily MS, Omel J, Raje N, Roodman GD, Yee GC, Kyle RA. Role of Bone-Modifying Agents in Multiple Myeloma: American Society of Clinical Oncology Clinical Practice Guideline Update. J Clin Oncol 2018; 36:812-818. [PMID: 29341831 DOI: 10.1200/jco.2017.76.6402] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Purpose To update guideline recommendations on the role of bone-modifying agents in multiple myeloma. Methods An update panel conducted a targeted systematic literature review by searching PubMed and the Cochrane Library for randomized controlled trials, systematic reviews, meta-analyses, clinical practice guidelines, and observational studies. Results Thirty-five relevant studies were identified, and updated evidence supports the current recommendations. Recommendations For patients with active symptomatic multiple myeloma that requires systemic therapy with or without evidence of lytic destruction of bone or compression fracture of the spine from osteopenia on plain radiograph(s) or other imaging studies, intravenous administration of pamidronate 90 mg over at least 2 hours or zoledronic acid 4 mg over at least 15 minutes every 3 to 4 weeks is recommended. Denosumab has shown to be noninferior to zoledronic acid for the prevention of skeletal-related events and provides an alternative. Fewer adverse events related to renal toxicity have been noted with denosumab compared with zoledronic acid and may be preferred in this setting. The update panel recommends that clinicians consider reducing the initial pamidronate dose in patients with preexisting renal impairment. Zoledronic acid has not been studied in patients with severe renal impairment and is not recommended in this setting. The update panel suggests that bone-modifying treatment continue for up to 2 years. Less frequent dosing has been evaluated and should be considered in patients with responsive or stable disease. Continuous use is at the discretion of the treating physician and the risk of ongoing skeletal morbidity. Retreatment should be initiated at the time of disease relapse. The update panel discusses measures regarding osteonecrosis of the jaw. Additional information is available at www.asco.org/hematologic-malignancies-guidelines and www.asco.org/guidelineswiki .
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Affiliation(s)
- Kenneth Anderson
- Kenneth Anderson, Dana-Farber Cancer Institute; Noopur Raje, Massachusetts General Hospital, Boston, MA; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria, VA; Patrick J. Flynn, Minnesota Oncology, Woodbury; Robert A. Kyle, Mayo Clinic, Rochester, MN; Susan Halabi, Duke University Medical Center, Durham, NC; Sundar Jagannath, Mount Sinai Medical Center, New York, NY; Mohammed S. Ogaily, Beuamont Center for Hematology and Oncology-Downriver, Brownstown, MI; Jim Omel, Education and Advocacy, Grand Island; Gary C. Yee, University of Nebraska Medical Center, Omaha, NE; and G. David Roodman, Indiana University School of Medicine, Indianapolis, IN
| | - Nofisat Ismaila
- Kenneth Anderson, Dana-Farber Cancer Institute; Noopur Raje, Massachusetts General Hospital, Boston, MA; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria, VA; Patrick J. Flynn, Minnesota Oncology, Woodbury; Robert A. Kyle, Mayo Clinic, Rochester, MN; Susan Halabi, Duke University Medical Center, Durham, NC; Sundar Jagannath, Mount Sinai Medical Center, New York, NY; Mohammed S. Ogaily, Beuamont Center for Hematology and Oncology-Downriver, Brownstown, MI; Jim Omel, Education and Advocacy, Grand Island; Gary C. Yee, University of Nebraska Medical Center, Omaha, NE; and G. David Roodman, Indiana University School of Medicine, Indianapolis, IN
| | - Patrick J Flynn
- Kenneth Anderson, Dana-Farber Cancer Institute; Noopur Raje, Massachusetts General Hospital, Boston, MA; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria, VA; Patrick J. Flynn, Minnesota Oncology, Woodbury; Robert A. Kyle, Mayo Clinic, Rochester, MN; Susan Halabi, Duke University Medical Center, Durham, NC; Sundar Jagannath, Mount Sinai Medical Center, New York, NY; Mohammed S. Ogaily, Beuamont Center for Hematology and Oncology-Downriver, Brownstown, MI; Jim Omel, Education and Advocacy, Grand Island; Gary C. Yee, University of Nebraska Medical Center, Omaha, NE; and G. David Roodman, Indiana University School of Medicine, Indianapolis, IN
| | - Susan Halabi
- Kenneth Anderson, Dana-Farber Cancer Institute; Noopur Raje, Massachusetts General Hospital, Boston, MA; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria, VA; Patrick J. Flynn, Minnesota Oncology, Woodbury; Robert A. Kyle, Mayo Clinic, Rochester, MN; Susan Halabi, Duke University Medical Center, Durham, NC; Sundar Jagannath, Mount Sinai Medical Center, New York, NY; Mohammed S. Ogaily, Beuamont Center for Hematology and Oncology-Downriver, Brownstown, MI; Jim Omel, Education and Advocacy, Grand Island; Gary C. Yee, University of Nebraska Medical Center, Omaha, NE; and G. David Roodman, Indiana University School of Medicine, Indianapolis, IN
| | - Sundar Jagannath
- Kenneth Anderson, Dana-Farber Cancer Institute; Noopur Raje, Massachusetts General Hospital, Boston, MA; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria, VA; Patrick J. Flynn, Minnesota Oncology, Woodbury; Robert A. Kyle, Mayo Clinic, Rochester, MN; Susan Halabi, Duke University Medical Center, Durham, NC; Sundar Jagannath, Mount Sinai Medical Center, New York, NY; Mohammed S. Ogaily, Beuamont Center for Hematology and Oncology-Downriver, Brownstown, MI; Jim Omel, Education and Advocacy, Grand Island; Gary C. Yee, University of Nebraska Medical Center, Omaha, NE; and G. David Roodman, Indiana University School of Medicine, Indianapolis, IN
| | - Mohammed S Ogaily
- Kenneth Anderson, Dana-Farber Cancer Institute; Noopur Raje, Massachusetts General Hospital, Boston, MA; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria, VA; Patrick J. Flynn, Minnesota Oncology, Woodbury; Robert A. Kyle, Mayo Clinic, Rochester, MN; Susan Halabi, Duke University Medical Center, Durham, NC; Sundar Jagannath, Mount Sinai Medical Center, New York, NY; Mohammed S. Ogaily, Beuamont Center for Hematology and Oncology-Downriver, Brownstown, MI; Jim Omel, Education and Advocacy, Grand Island; Gary C. Yee, University of Nebraska Medical Center, Omaha, NE; and G. David Roodman, Indiana University School of Medicine, Indianapolis, IN
| | - Jim Omel
- Kenneth Anderson, Dana-Farber Cancer Institute; Noopur Raje, Massachusetts General Hospital, Boston, MA; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria, VA; Patrick J. Flynn, Minnesota Oncology, Woodbury; Robert A. Kyle, Mayo Clinic, Rochester, MN; Susan Halabi, Duke University Medical Center, Durham, NC; Sundar Jagannath, Mount Sinai Medical Center, New York, NY; Mohammed S. Ogaily, Beuamont Center for Hematology and Oncology-Downriver, Brownstown, MI; Jim Omel, Education and Advocacy, Grand Island; Gary C. Yee, University of Nebraska Medical Center, Omaha, NE; and G. David Roodman, Indiana University School of Medicine, Indianapolis, IN
| | - Noopur Raje
- Kenneth Anderson, Dana-Farber Cancer Institute; Noopur Raje, Massachusetts General Hospital, Boston, MA; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria, VA; Patrick J. Flynn, Minnesota Oncology, Woodbury; Robert A. Kyle, Mayo Clinic, Rochester, MN; Susan Halabi, Duke University Medical Center, Durham, NC; Sundar Jagannath, Mount Sinai Medical Center, New York, NY; Mohammed S. Ogaily, Beuamont Center for Hematology and Oncology-Downriver, Brownstown, MI; Jim Omel, Education and Advocacy, Grand Island; Gary C. Yee, University of Nebraska Medical Center, Omaha, NE; and G. David Roodman, Indiana University School of Medicine, Indianapolis, IN
| | - G David Roodman
- Kenneth Anderson, Dana-Farber Cancer Institute; Noopur Raje, Massachusetts General Hospital, Boston, MA; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria, VA; Patrick J. Flynn, Minnesota Oncology, Woodbury; Robert A. Kyle, Mayo Clinic, Rochester, MN; Susan Halabi, Duke University Medical Center, Durham, NC; Sundar Jagannath, Mount Sinai Medical Center, New York, NY; Mohammed S. Ogaily, Beuamont Center for Hematology and Oncology-Downriver, Brownstown, MI; Jim Omel, Education and Advocacy, Grand Island; Gary C. Yee, University of Nebraska Medical Center, Omaha, NE; and G. David Roodman, Indiana University School of Medicine, Indianapolis, IN
| | - Gary C Yee
- Kenneth Anderson, Dana-Farber Cancer Institute; Noopur Raje, Massachusetts General Hospital, Boston, MA; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria, VA; Patrick J. Flynn, Minnesota Oncology, Woodbury; Robert A. Kyle, Mayo Clinic, Rochester, MN; Susan Halabi, Duke University Medical Center, Durham, NC; Sundar Jagannath, Mount Sinai Medical Center, New York, NY; Mohammed S. Ogaily, Beuamont Center for Hematology and Oncology-Downriver, Brownstown, MI; Jim Omel, Education and Advocacy, Grand Island; Gary C. Yee, University of Nebraska Medical Center, Omaha, NE; and G. David Roodman, Indiana University School of Medicine, Indianapolis, IN
| | - Robert A Kyle
- Kenneth Anderson, Dana-Farber Cancer Institute; Noopur Raje, Massachusetts General Hospital, Boston, MA; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria, VA; Patrick J. Flynn, Minnesota Oncology, Woodbury; Robert A. Kyle, Mayo Clinic, Rochester, MN; Susan Halabi, Duke University Medical Center, Durham, NC; Sundar Jagannath, Mount Sinai Medical Center, New York, NY; Mohammed S. Ogaily, Beuamont Center for Hematology and Oncology-Downriver, Brownstown, MI; Jim Omel, Education and Advocacy, Grand Island; Gary C. Yee, University of Nebraska Medical Center, Omaha, NE; and G. David Roodman, Indiana University School of Medicine, Indianapolis, IN
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Furukawa S, Oobu K, Moriyama M, Kawano S, Sako S, Hayashida JN, Matsubara R, Ogata KI, Kiyoshima T, Nakamura S. Oral Methotrexate-related Lymphoproliferative Disease Presenting with Severe Osteonecrosis of the Jaw: A Case Report and Literature Review. Intern Med 2018; 57:575-581. [PMID: 29225245 PMCID: PMC5849556 DOI: 10.2169/internalmedicine.8946-17] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Long-term methotrexate (MTX) treatment can cause MTX-related lymphoproliferative disorder (MTX-LPD). We experienced a case of MTX-LPD that was associated with severe osteonecrosis of the jaw mimicking medication-related osteonecrosis of the jaw. The patient was an 81-year-old woman with rheumatoid arthritis (RA) who was treated with MTX and bisphosphonate. After 7 years, she was referred to our department for the assessment of giant ulcer and exposure of the alveolar bone of the left maxilla. Histopathological and immunological analyses confirmed a diagnosis of MTX-LPD. At seven months after the cessation of MTX treatment, the ulcerative and necrotic lesions had markedly decreased in size. A 1-year follow-up examination showed no evidence of recurrence and good RA control.
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Affiliation(s)
- Sachiko Furukawa
- Section of Oral and Maxillofacial Oncology, Division of Maxillofacial Diagnostic and Surgical Sciences, Faculty of Dental Science, Kyushu University, Japan
| | - Kazunari Oobu
- Section of Oral and Maxillofacial Oncology, Division of Maxillofacial Diagnostic and Surgical Sciences, Faculty of Dental Science, Kyushu University, Japan
| | - Masafumi Moriyama
- Section of Oral and Maxillofacial Oncology, Division of Maxillofacial Diagnostic and Surgical Sciences, Faculty of Dental Science, Kyushu University, Japan
- OBT Research Center, Faculty of Dental Science, Kyushu University, Japan
| | - Shintaro Kawano
- Section of Oral and Maxillofacial Oncology, Division of Maxillofacial Diagnostic and Surgical Sciences, Faculty of Dental Science, Kyushu University, Japan
| | - Saori Sako
- Section of Oral and Maxillofacial Oncology, Division of Maxillofacial Diagnostic and Surgical Sciences, Faculty of Dental Science, Kyushu University, Japan
| | - Jun-Nosuke Hayashida
- Section of Oral and Maxillofacial Oncology, Division of Maxillofacial Diagnostic and Surgical Sciences, Faculty of Dental Science, Kyushu University, Japan
| | - Ryota Matsubara
- Section of Oral and Maxillofacial Oncology, Division of Maxillofacial Diagnostic and Surgical Sciences, Faculty of Dental Science, Kyushu University, Japan
| | - Ken-Ichi Ogata
- Section of Oral and Maxillofacial Oncology, Division of Maxillofacial Diagnostic and Surgical Sciences, Faculty of Dental Science, Kyushu University, Japan
| | - Tamotsu Kiyoshima
- Laboratory of Oral Pathology, Division of Maxillofacial Diagnostic and Surgical Sciences, Faculty of Dental Science, Kyushu University, Japan
| | - Seiji Nakamura
- Section of Oral and Maxillofacial Oncology, Division of Maxillofacial Diagnostic and Surgical Sciences, Faculty of Dental Science, Kyushu University, Japan
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Mhaskar R, Kumar A, Miladinovic B, Djulbegovic B. Bisphosphonates in multiple myeloma: an updated network meta-analysis. Cochrane Database Syst Rev 2017; 12:CD003188. [PMID: 29253322 PMCID: PMC6486151 DOI: 10.1002/14651858.cd003188.pub4] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Bisphosphonates are specific inhibitors of osteoclastic activity and are used in the treatment of patients with multiple myeloma (MM). While bisphosphonates are shown to be effective in reducing vertebral fractures and pain, their role in improving overall survival (OS) remains unclear. This is an update of a Cochrane review first published in 2002 and previously updated in 2010 and 2012. OBJECTIVES To assess the evidence related to benefits and harms associated with use of various types of bisphosphonates (aminobisphosphonates versus non-aminobisphosphonates) in the management of patients with MM. Our primary objective was to determine whether adding bisphosphonates to standard therapy in MM improves OS and progression-free survival (PFS), and decreases skeletal-related morbidity. Our secondary objectives were to determine the effects of bisphosphonates on pain, quality of life, incidence of hypercalcemia, incidence of bisphosphonate-related gastrointestinal toxicities, osteonecrosis of jaw (ONJ) and hypocalcemia. SEARCH METHODS We searched MEDLINE, Embase (September 2011 to July 2017) and the CENTRAL (2017, Issue 7) to identify all randomized controlled trial (RCT) in MM up to July 2017 using a combination of text and MeSH terms. SELECTION CRITERIA Any randomized controlled trial (RCT) comparing bisphosphonates versus placebo/no treatment/bisphosphonates and observational studies or case reports examining bisphosphonate-related ONJ in patients with MM were eligible for inclusion. DATA COLLECTION AND ANALYSIS Two review authors extracted the data. Data were pooled and reported as hazard ratio (HR) or risk ratio (RR) using a random-effects model. We used meta-regression to explore statistical heterogeneity. Network meta-analysis using Bayesian approach was conducted. MAIN RESULTS In this update, we included four new studies (601 participants), resulting in a total of 24 included studies.Twenty RCTs compared bisphosphonates with either placebo or no treatment and four RCTs involved another bisphosphonate as a comparator. The 24 included RCTs enrolled 7293 participants. Pooled results showed that there was moderate-quality evidence of a reduction in mortality with on OS from 41% to 31%, but the confidence interval is consistent with a larger reduction and small increase in mortality compared with placebo or no treatment (HR 0.90, 95% CI 0.76 to 1.07; 14 studies; 2706 participants). There was substantial heterogeneity among the included RCTs (I2 = 65%) for OS. To explain this heterogeneity we performed a meta-regression assessing the relationship between bisphosphonate potency and improvement in OS, which found an OS benefit with zoledronate but limited evidence of an effect on PFS. This provided a further rationale for performing a network meta-analyses of the various types of bisphosphonates that were not compared head-to-head in RCTs. Results from network meta-analyses showed evidence of a benefit for OS with zoledronate compared with etidronate (HR 0.56, 95% CI 0.29 to 0.87) and placebo (HR 0.67, 95% CI 0.46 to 0.91). However, there was no evidence for a difference between zoledronate and other bisphosphonates.The effect of bisphosphonates on disease progression (PFS) is uncertain. Based on the HR of 0.75 (95% CI 0.57 to 1.00; seven studies; 908 participants), 47% participants would experience disease progression without treatment compared with between 30% and 47% with bisphosphonates (low-quality evidence). There is probably a similar risk of non-vertebral fractures between treatment groups (RR 1.03, 95% CI 0.68 to 1.56; six studies; 1389 participants; moderate-quality evidence). Pooled analysis demonstrated evidence for a difference favoring bisphosphonates compared with placebo or no treatment on prevention of pathological vertebral fractures (RR 0.74, 95% CI 0.62 to 0.89; seven studies; 1116 participants; moderate-quality evidence) and skeletal-related events (SREs) (RR 0.74, 95% CI 0.63 to 0.88; 10 studies; 2141 participants; moderate-quality evidence). The evidence for less pain with bisphosphonates was of very low quality (RR 0.75, 95% CI 0.60 to 0.95; eight studies; 1281 participants).Bisphosphonates may increase ONJ compared with placebo but the confidence interval is very wide (RR 4.61, 95% CI 0.99 to 21.35; P = 0.05; six studies; 1284 participants; low-quality evidence). The results from the network meta-analysis did not show any evidence for a difference in the incidence of ONJ (eight RCTs, 3746 participants) between bisphosphonates. Data from nine observational studies (1400 participants) reported an incidence of 5% to 51% with combination of pamidronate and zoledronate, 3% to 11% with zoledronate alone, and 0% to 18% with pamidronate alone.The pooled results showed no evidence for a difference in increase in frequency of gastrointestinal symptoms with the use of bisphosphonates compared with placebo or no treatment (RR 1.23, 95% CI 0.95 to 1.59; seven studies; 1829 participants; low-quality evidence).The pooled results showed no evidence for a difference in increase in frequency of hypocalcemia with the use of bisphosphonates compared with placebo or no treatment (RR 2.19, 95% CI 0.49 to 9.74; three studies; 1090 participants; low-quality evidence). The results from network meta-analysis did not show any evidence for differences in the incidence of hypocalcemia, renal dysfunction and gastrointestinal toxicity between the bisphosphonates used. AUTHORS' CONCLUSIONS Use of bisphosphonates in participants with MM reduces pathological vertebral fractures, SREs and pain. Bisphosphonates were associated with an increased risk of developing ONJ. For every 1000 participants treated with bisphosphonates, about one patient will suffer from the ONJ. We found no evidence of superiority of any specific aminobisphosphonate (zoledronate, pamidronate or ibandronate) or non-aminobisphosphonate (etidronate or clodronate) for any outcome. However, zoledronate was found to be better than placebo and first-generation bisposphonate (etidronate) in pooled direct and indirect analyses for improving OS and other outcomes such as vertebral fractures. Direct head-to-head trials of the second-generation bisphosphonates are needed to settle the issue if zoledronate is truly the most efficacious bisphosphonate currently used in practice.
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Affiliation(s)
- Rahul Mhaskar
- University of South FloridaCenter for Evidence Based Medicine and Health Outcomes ResearchTampaFloridaUSA
| | - Ambuj Kumar
- University of South FloridaCenter for Evidence Based Medicine and Health Outcomes ResearchTampaFloridaUSA
| | - Branko Miladinovic
- University of South FloridaCenter for Evidence‐based MedicineTampaFloridaUSA
| | - Benjamin Djulbegovic
- University of South Florida & Mofftt Cancer CenterUSF Program for Comparative Effectiveness Research & Dpt of Hematology, Moffitt Cancer CtrTampaFloridaUSA
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Zirk M, Kreppel M, Buller J, Pristup J, Peters F, Dreiseidler T, Zinser M, Zöller JE. The impact of surgical intervention and antibiotics on MRONJ stage II and III – Retrospective study. J Craniomaxillofac Surg 2017; 45:1183-1189. [DOI: 10.1016/j.jcms.2017.05.027] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 05/22/2017] [Accepted: 05/29/2017] [Indexed: 01/23/2023] Open
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Avilès A, Nambo MJ, Huerta-Guzmàn J, Cleto S, Neri N. Prolonged Use of Zoledronic Acid (4 Years) Did Not Improve Outcome in Multiple Myeloma Patients. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2017; 17:207-210. [PMID: 28284745 DOI: 10.1016/j.clml.2017.02.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 01/09/2017] [Accepted: 02/07/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND Bisphosphonates, especially zoledronic acid (ZA), show antitumor effects in multiple myeloma (MM) and other neoplasms. The standard time for ZA administration has been 2 years. However, with improvement in overall survival (OS) in MM with new agents, it unclear whether ZA could be administered for a prolonged time to improve OS. PATIENTS AND METHODS A total of 170 patients with untreated, symptomatic MM were randomly divided into a group to receive ZA for 4 years, with a control group to receive ZA for 2 years. All patients were treated with the same induction therapy and stem-cell transplantation. RESULTS Actuarial curves at 5 years, showed that progression-free survival was 75% (95% confidence interval [CI], 64%-82%) and OS was 68% (95% CI, 60%-76%) in the 4-year group, which was not statistically significantly different compared with the control group: 72% (95% CI, 62%-78%) and 68% (95% CI, 60%-75%; P = .67). However, the 4-year group showed reduced skeletal events (21% occurrence rate); this was statistically significant compared with the control group: 43% (P < .001). CONCLUSION Although ZA did not improve OS in patients with MM; it continued to be useful to reduce skeletal events, and thus improve better quality of life for patients.
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Affiliation(s)
- Agustin Avilès
- Oncology Research Unit, Oncology Hospítal, National Medical Center, IMSS, México, Federal District, Mexico.
| | - Maria-Jesùs Nambo
- Department of Hematology, Oncology Hospítal, National Medical Center, IMSS, México, Federal District, Mexico
| | - Judith Huerta-Guzmàn
- Department of Hematology, Oncology Hospítal, National Medical Center, IMSS, México, Federal District, Mexico
| | - Sergio Cleto
- Department of Hematology, Oncology Hospítal, National Medical Center, IMSS, México, Federal District, Mexico
| | - Natividad Neri
- Department of Hematology, Oncology Hospítal, National Medical Center, IMSS, México, Federal District, Mexico
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Abstract
Younger patients are affected more often by osteonecrosis than by osteoarthritis, and osteonecrosis has significantly greater long-term morbidity. Corticosteroids are the most common cause of nontraumatic osteonecrosis. The femoral head is the most common site of osteonecrosis. In rare instances, osteonecrosis of the jaw has been associated with bisphosphonate exposure. This phenomenon is more common with repeated intravenous infusions of bisphosphonates. Case reports of osteonecrosis of the jaw in association with other medications, such as denosumab, have been reported. The final common pathway in the pathogenesis of osteonecrosis is disruption of blood supply to a segment of bone. Abnormalities in lipid metabolism, bone homeostasis, regulation of apoptosis, coagulopathies, innate immunity, and oxidative stress may play a role in the pathogenesis of osteonecrosis. Epigenetics may alter the predisposition to develop osteonecrosis. MRI is currently the optimal test for early diagnosis and identification of the extent of osteonecrosis. Nonsurgical treatment of osteonecrosis does not change the natural history of the disease. Although surgical treatment of femoral head osteonecrosis has many variations, most symptomatic patients eventually require total hip arthroplasty. Knowledge of risk factors and early detection are crucial to the successful management of osteonecrosis. Because of the lack of successful treatment options, new modes of management focus on the prevention of osteonecrosis.
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Ohbayashi Y, Nakai F, Iwasaki A, Ogawa T, Yamamoto Y, Nishiyama Y, Miyake M. The utility of bone scintigraphy in the assessment of mandibular metabolism during long-term bisphosphonate administration. Odontology 2016; 105:382-390. [DOI: 10.1007/s10266-016-0279-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 09/23/2016] [Indexed: 10/20/2022]
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Prevention and management of osteonecrosis of the jaw secondary to bone-targeted therapy in patients with kidney cancer. Curr Opin Support Palliat Care 2016; 10:273-80. [PMID: 27380219 DOI: 10.1097/spc.0000000000000219] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The aim of this revision is prevention and management of osteonecrosis of the jaw (ONJ) secondary to bone-targeted therapy in patients with kidney cancer. RECENT FINDINGS Patients with kidney cancer treated with zoledronate suffered from ONJ earlier compared with patients with breast cancer or multiple myeloma; among men, ONJ occurred at 24 months of zoledronic acid treatment in more than 80% of the patients and much earlier, in respect to patients with prostate cancer or multiple myeloma. Protective factors against an ONJ can be sequential prescription of different bisphosphonates and female sex. Less data are available on ONJ secondary to denosumab administration in patients with kidney cancer. SUMMARY Bone metastases, developing in about 30% of the patients with metastatic renal cell carcinoma, are typically osteolytic on imaging and cause significant morbidity and poor quality of life. Incidence of skeletal-related events has been reported to reach 3.38 per year in such patients. To decrease the incidence of ONJ, a maxillofacial examination must be performed in all patients before treatment with bisphosphonates, in particular in patients with metastatic renal cell carcinoma treated with sunitinib alone or in association with zoledronate. The management of ONJ consider a conservative approach.
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Taguchi A, Shiraki M, Sugimoto T, Ohta H, Soen S. Lack of cooperation between physicians and dentists during osteoporosis treatment may increase fractures and osteonecrosis of the jaw. Curr Med Res Opin 2016; 32:1261-8. [PMID: 27007294 DOI: 10.1185/03007995.2016.1170005] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Our previous questionnaire-based survey suggested that discontinuation of antiresorptive agents before tooth extraction may increase adverse events and disturb osteoporosis treatment without completely preventing osteonecrosis of the jaw (O.N.J.). We also found little cooperation between physicians and dentists in Japan. However, limitations of our previous study included a survey of doctors belonging to small clinics and a small sample size. Our current study aimed to confirm the results of our previous survey in doctors mainly belonging to academia. METHODS A structured questionnaire including 14 key clinical queries was sent to 1812 physicians of the Japan Osteoporosis Society, and 629 responses were received. RESULTS Dentists requested discontinuation of many medications that were not associated with the incidence of O.N.J. A total of 523 respondents had received discontinuation requests from dentists. Of these, 97 respondents experienced 119 adverse events including 25 fractures and seven incidences of O.N.J. The ratios of valid responses for fractures were 3.6% and 5.3% in patients with a discontinuation of <3 and ≥3 months, respectively. Those for O.N.J. were 0.7% and 1.6%, respectively. Respondents who refused discontinuation requests reported no cases of O.N.J. Approximately 17% of respondents had patients who discontinued osteoporosis treatment following a requested drug discontinuation after tooth extraction. Approximately 62% of respondents did not request oral health care by a dentist before antiresorptive therapy, and 72% reported no cooperation between physicians and dentists in their region. CONCLUSIONS This study reconfirms the results of our previous survey. Discontinuation of antiresorptive treatment may increase both fractures and O.N.J. Immediate development of a strategy for sharing information about O.N.J. among physicians, dentists, and patients is required to reduce the incidence of both O.N.J. and skeletal events in osteoporosis treatment. Study limitations were selection bias due to low response rate and possible inaccurate responses to the questionnaire.
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Affiliation(s)
- Akira Taguchi
- a Department of Oral and Maxillofacial Radiology , School of Dentistry, Matsumoto Dental University , Nagano , Japan
| | - Masataka Shiraki
- b Research Institute and Practice for Involutional Diseases , Nagano , Japan
| | - Toshitsugu Sugimoto
- c Internal Medicine 1, Shimane University Faculty of Medicine , Shimane , Japan
| | - Hiroaki Ohta
- d Department of Clinical Medical Research Center , International University of Health and Welfare, Women's Medical Center of Sanno Medical Center , Tokyo , Japan
| | - Satoshi Soen
- e Department of Orthopaedic Surgery and Rheumatology, Nara Hospital , Kinki University Faculty of Medicine , Nara , Japan
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Fusco V, Santini D, Armento G, Tonini G, Campisi G. Osteonecrosis of jaw beyond antiresorptive (bone-targeted) agents: new horizons in oncology. Expert Opin Drug Saf 2016; 15:925-35. [DOI: 10.1080/14740338.2016.1177021] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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