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Evaluation of therapeutic effects of teriparatide in a rat model of zoledronic acid-induced bisphosphonate-related osteonecrosis. JOURNAL OF ORAL AND MAXILLOFACIAL SURGERY, MEDICINE, AND PATHOLOGY 2019. [DOI: 10.1016/j.ajoms.2019.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Jain V, Seith A, Manchanda S, Pillai R, Sharma DN, Mathur VP. Effect of intravenous administration of zoledronic acid on jaw bone density in cases having skeletal metastasis: A prospective clinical study. J Indian Prosthodont Soc 2019; 19:203-209. [PMID: 31462858 PMCID: PMC6685335 DOI: 10.4103/jips.jips_368_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 06/28/2019] [Indexed: 11/17/2022] Open
Abstract
Aim: The objective is to evaluate the effect of intravenous (i.v.) administration of bisphosphonate (zoledronic acid) therapy on the jaw bone density and incidence of any other bony patholog. Settings and Design: Observational – prospective study. Materials and Methods: A total of 57 patients having a history of bony metastasis (excluding the jaw bone) were enrolled following the inclusion/exclusion criteria. Each patient received six doses of 4 mg i.v. bisphosphonate once a month. Multidetector computed tomography (MDCT) of jawbones for each patient was performed before the start of therapy (baseline) and subsequently at 6 and 12 months. Bone density was assessed at 24 predetermined sites (8 sites in maxilla and 16 sites in mandible) and any pathological change in either of the jaw bones was noted. Statistical Analysis Used: Shapiro–Wilk test ,Pearson's Chisquare test and repeated measures analysis of variance. Results: The result showed no statistically significant increase in mean bone density over a period of 1 year in maxilla and mandible. However, a significant increase in bone density was observed from 6 months to 1 year in mandibular anterior cancellous bone. The detailed observation of each MDCT scan showed no pathological change in either of the jaw bones during the study period. Conclusion: The administration (i.v.) of six doses of 4 mg bisphosphonate did not lead to a significant change in bone density over a period of 1 year.
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Affiliation(s)
- Veena Jain
- Department of Prosthodontics, Center for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Ashu Seith
- Department of Radio-Diagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Smita Manchanda
- Department of Radio-Diagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Rajath Pillai
- Department of Prosthodontics, Center for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
| | - D N Sharma
- Department of Radiation Oncology, B. R. Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Vijay Prakash Mathur
- Department of Prosthodontics, Center for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
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Voss P, Ludwig U, Poxleitner P, Bergmaier V, El-Shafi N, von Elverfeldt D, Stadelmann V, Hövener JB, Flügge T. Evaluation of BP-ONJ in osteopenic and healthy sheep: comparing ZTE-MRI with µCT. Dentomaxillofac Radiol 2016; 45:20150250. [PMID: 26846710 DOI: 10.1259/dmfr.20150250] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES Bisphosphonate-associated osteonecrosis of the jaw (BP-ONJ) is a side effect of antiresorptive treatment that is increasingly prescribed for patients with osteoporosis or malignant diseases with bone metastases. Surgical treatment of BP-ONJ requires adequate pre-operative imaging. To date, CT is the imaging standard in clinical routine; however, defining the extent of the pathological area is difficult and soft tissues are poorly displayed. MRI with zero echo time (ZTE-MRI) to display hard tissues enables a precise display of calcified structures and soft tissues for the delineation of bone necrosis and soft-tissue reactions. METHODS BP-ONJ was induced in eight sheep by extraction of two premolars in the left mandible and zoledronate (ZOL) administration. Eight sheep without ZOL administration served as the control group. Four sheep of each main group underwent osteopenia induction via ovariectomy, glucocorticoid administration and a calcium-free diet. After sacrifice, the area of tooth extraction was harvested and scanned with micro-CT (µCT) and ZTE-MRI. Two trained dentists analyzed digital imaging and communications in medicine data sets using three-dimensional imaging software. The periosteal reaction and the remaining extraction sockets were measured. RESULTS BP-ONJ was evident, and the remaining extraction sockets were observed in all animals treated with ZOL. Periosteal reactions were more pronounced in animals treated with ZOL, and they appeared broader in ZTE-MRI. CONCLUSIONS BP-ONJ lesions in the sheep mandible can be detected using µCT and ZTE-MRI. Although illustration of sequester was more consistent using the µCT, ZTE-MRI was advantageous in evaluation of periosteal reaction.
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Affiliation(s)
- Pit Voss
- 1 Department of Oral and Maxillofacial Surgery, University Medical Center Freiburg, Freiburg, Germany
| | - Ute Ludwig
- 2 Medical Physics, Department of Radiology, University Medical Center Freiburg, Freiburg, Germany
| | - Philipp Poxleitner
- 1 Department of Oral and Maxillofacial Surgery, University Medical Center Freiburg, Freiburg, Germany.,3 AO Research Institute, Davos, Switzerland
| | - Veronika Bergmaier
- 1 Department of Oral and Maxillofacial Surgery, University Medical Center Freiburg, Freiburg, Germany
| | - Nora El-Shafi
- 1 Department of Oral and Maxillofacial Surgery, University Medical Center Freiburg, Freiburg, Germany
| | - Dominik von Elverfeldt
- 2 Medical Physics, Department of Radiology, University Medical Center Freiburg, Freiburg, Germany
| | | | - Jan-Bernd Hövener
- 2 Medical Physics, Department of Radiology, University Medical Center Freiburg, Freiburg, Germany
| | - Tabea Flügge
- 1 Department of Oral and Maxillofacial Surgery, University Medical Center Freiburg, Freiburg, Germany
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Ristow O, Gerngroß C, Schwaiger M, Hohlweg-Majert B, Kehl V, Jansen H, Hahnefeld L, Otto S, Pautke C. Is Bone Turnover of Jawbone and Its Possible Over Suppression by Bisphosphonates of Etiologic Importance in Pathogenesis of Bisphosphonate-Related Osteonecrosis? J Oral Maxillofac Surg 2014; 72:903-10. [DOI: 10.1016/j.joms.2013.11.005] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Revised: 10/17/2013] [Accepted: 11/04/2013] [Indexed: 11/29/2022]
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Effect of antiresorptive drugs on bony turnover in the jaw: denosumab compared with bisphosphonates. Br J Oral Maxillofac Surg 2014; 52:308-13. [DOI: 10.1016/j.bjoms.2014.01.021] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Accepted: 01/31/2014] [Indexed: 11/22/2022]
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Ristow O, Gerngroß C, Schwaiger M, Hohlweg-Majert B, Ristow M, Koerdt S, Schuster R, Otto S, Pautke C. Does regular zoledronic acid change the bone turnover of the jaw in men with metastatic prostate cancer: A possible clue to the pathogenesis of bisphosphonate related osteonecrosis of the jaw? J Cancer Res Clin Oncol 2014; 140:487-93. [DOI: 10.1007/s00432-014-1588-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Accepted: 01/17/2014] [Indexed: 01/23/2023]
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Carlson ER, Gerard DA. Commentary--Is the bone turnover of the jawbone and its possible over suppression by bisphosphonates of etiological importance for the pathogenesis of the bisphosphonate-related osteonecrosis? J Oral Maxillofac Surg 2013; 72:911-3. [PMID: 24480759 DOI: 10.1016/j.joms.2013.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Revised: 12/03/2013] [Accepted: 12/04/2013] [Indexed: 10/25/2022]
Affiliation(s)
- Eric R Carlson
- Professor and Kelly L. Krahwinkel Chairman, Department of Oral and Maxillofacial Surgery, University of Tennessee Medical Center, Knoxville, TN.
| | - David A Gerard
- Professor and Director of Research, Department of Oral and Maxillofacial Surgery, University of Tennessee Medical Center, Knoxville, TN
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Sciannameo V, Matteini C, Perugini M, Di Curzio P, Saponaro G, Taglia C. Bisphosphonate-Related Osteonecrosis of the Jaw: A Retrospective Study on the Role of Dental Prophylaxis. EUR J INFLAMM 2013. [DOI: 10.1177/1721727x1301100335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Clinicians use bisphosphonates in neoplastic and metabolic bone diseases. Osteonecrosis is the main complication of the maxillary bones, along with late mucosal healing with necrotic bone exposure, pain, burning sensation, paresthesia, and is commonly associated with osteonecrosis. In the dental unit of our department, we checked 181 patients, and divided them into three groups: patients who had not undergone therapy, patients who were currently undergoing bisphosphonate therapy, and those who had completed bisphosphonate therapy (but who had not been followed-up). For clinical management, patients were treated with a dental prophylaxis protocol or drug therapy, involving topical and/or systemic administration, and then underwent surgical resections when the osteonecrosis did not improve with any treatment. Variability with the percent of complications was statistically significant in the three groups. Despite the limited number of patients in this study, which will require further investigation, our experience demonstrated that preventive strategies in relation to complications are crucial. At this point, a satisfactory treatment for this pathology does not exist.
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Affiliation(s)
- V. Sciannameo
- U.O.C. Maxillofacial Surgery, Belcolle Hospital, AUSL, Viterbo, Italy
| | - C. Matteini
- U.O.C. Maxillofacial Surgery, Belcolle Hospital, AUSL, Viterbo, Italy
| | - M. Perugini
- U.O.C. Maxillofacial Surgery, Belcolle Hospital, AUSL, Viterbo, Italy
| | - P. Di Curzio
- U.O.C. Maxillofacial Surgery, Policlinico “Umberto I”, “Sapienza” University, Rome, Italy
| | - G. Saponaro
- U.O.C. Maxillofacial Surgery, Policlinico “Umberto I”, “Sapienza” University, Rome, Italy
| | - C. Taglia
- U.O.C. Maxillofacial Surgery, Belcolle Hospital, AUSL, Viterbo, Italy
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Hayama K, Tsuchimochi M, Yamaguchi H, Oda T, Sue M, Kameta A, Sasaki Y. Dynamic analysis of technetium-99m HMDP accumulation and its effect on regional bone metabolism and bone blood flow in bisphosphonate-related osteonecrosis of the jaw. Oral Radiol 2013. [DOI: 10.1007/s11282-013-0146-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Migliorati CA, Epstein JB, Abt E, Berenson JR. Osteonecrosis of the jaw and bisphosphonates in cancer: a narrative review. Nat Rev Endocrinol 2011; 7:34-42. [PMID: 21079615 DOI: 10.1038/nrendo.2010.195] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Bisphosphonate-associated osteonecrosis (BON) is a complication that almost exclusively affects the jaw bones. The clinical presentation of BON often mimics that of other conditions, such as routine dental disease, osteoradionecrosis or avascular necrosis; therefore, diagnosis can be difficult. As this complication has only been recognized within the past 10 years, management strategies for patients with BON are poorly defined. Physicians must choose between continuing the bisphosphonate therapy (to reduce the risk of skeletal complications in patients with metastatic bone disease or osteoporosis) and discontinuing the drug (to possibly improve the odds for tissue healing). A conservative or aggressive management strategy must be chosen with limited evidence that the outcome of either strategy will be successful. BON is most prevalent in patients with cancer using intravenous nitrogen-containing bisphosphonates. The pathobiology of this complication is not fully understood and the diagnosis relies on the clinical manifestations of the condition. Future research should focus on the pathobiological mechanisms involved in the development of BON, which could help explain why this complication affects only a small number of those who use bisphosphonates, and also suggest strategies for prevention and management.
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Affiliation(s)
- Cesar A Migliorati
- University of Tennessee Health Science Center, College of Dentistry, 875 Union Avenue, Memphis, TN 38163, USA.
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Morris PG, Hudis C, Carrasquillo J, Larson S, Grewal RK, Van Poznak C. Bone scans, bisphosphonates, and a lack of acute changes within the mandible. J Oral Maxillofac Surg 2010; 69:114-9. [PMID: 21056922 DOI: 10.1016/j.joms.2010.06.210] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2010] [Accepted: 06/25/2010] [Indexed: 01/22/2023]
Abstract
PURPOSE The etiology of osteonecrosis of the jaw is poorly understood, but preferential mandibular uptake of intravenous bisphosphonates (IVBPs) has been implicated. We examined this association within a prospective study assessing the effect of IVBPs on radionuclide bone scanning. PATIENTS AND METHODS Women with at least 3 osseous breast metastases on bone scanning and previous IVBP use within 8 weeks were eligible for the present study. After the first clinically indicated bone scan, the patients received zoledronic acid within 72 hours and underwent a second bone scan within another 72 hours. The regions of interest on the bone scan were read in triplicate, and the mean count per pixel was calculated for the mandible (C(M)), left femur (C(FL)), right femur (C(FR)), and thigh (C(B)). The mandibular bone turnover (MBT) was quantified as the ratio of (C(M) - C(B))/(C(F) - C(B)), where C(F) = (C(FL) + C(FR)/2). The MBT was compared before and after IVBP use. RESULTS A total of 10 patients were enrolled (median age 51 years, range 40 to 71); none had known osteonecrosis of the jaw. Of the 10 patients, 8 had paired bone scans available for analysis. The previous zoledronic acid exposure was 48.6 mg (range 24 to 148) for a median of 13 months (range 6 to 35). The baseline mean MBT ratio was 2.33 (range 0.88 to 4.22). After IVBP administration, the mean MBT ratio was statistically unchanged at 2.23 (range 1.05 to 3.09). The MBT had declined in 4 patients and increased in 4. Only 1 patient had had an MBT of less than 1.0 before IVBP use, and no patient had an MBT ratio of less than 1.0 after IVBP use. CONCLUSIONS The mandibular region appears to be a site of increased uptake of technetium-99m bound to methylene diphosphonate-technetium. Acute changes in bisphosphonate binding in the mandible were not observed in our patients receiving chronic IVBP therapy.
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