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Khalfi L, Ndiaye A, Chabi W, Fiqhi MK, El Khatib K. Osteonecrosis Mandibular Extended to Bisphosphonates: A Very Rare Extensive Case. Cureus 2020; 12:e7428. [PMID: 32351808 PMCID: PMC7186105 DOI: 10.7759/cureus.7428] [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] [Indexed: 11/05/2022] Open
Abstract
After the first report of bisphosphonate-related osteonecrosis of the jaw (BRONJ) in 2003, it has increased significantly since then. We report a very rare extensive case never seen before in our experience of bone exposure with necrosis reaching the mandibular inferior border. Although the treatment modalities are not yet established, most researchers have recommended conservative approaches. The surgery was to be as conservative as possible, with a resection of the mandibular range followed by reconstruction using titanium plate with space maintainer. The authors would like to share their approach, management, and awareness.
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Affiliation(s)
- Lahcen Khalfi
- Plastic and Maxillo-Facial Surgery, Mohammed V Teaching Armed Forces Hospital, Rabat, MAR
| | - Abibou Ndiaye
- Surgery, Mohammed V Teaching Armed Forces Hospital, Rabat, MAR
| | - Wilfried Chabi
- Plastic and Maxillo-Facial Surgery, Mohammed V Teaching Armed Forces Hospital, Rabat, MAR
| | - Mohammed Kamal Fiqhi
- Plastic and Maxillo-Facial Surgery, Mohammed V Teaching Armed Forces Hospital, Rabat, MAR
| | - Karim El Khatib
- Plastic and Maxillo-Facial Surgery, Mohammed V Teaching Armed Forces Hospital, Rabat, MAR
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2
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Schmouchkovitch A, Remaud M, Simon H, Herry H, Le Toux G, Boisramé S. [Focus: Drug-related osteonecrosis of the jaw]. Presse Med 2017; 47:19-33. [PMID: 29275972 DOI: 10.1016/j.lpm.2017.10.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 10/02/2017] [Accepted: 10/04/2017] [Indexed: 11/25/2022] Open
Abstract
Antiresorptives and antiangiogenics are treatments that have proven effective in oncology and the treatment of osteoporosis and they are increasingly prescribed. The care of these patients requires collaboration between the prescriber and the oral health professional to establish an optimized treatment plan. Therapeutic education of the patient is essential for him to understand the issues of good oral health and the adverse effects that can be caused by these treatments. The management is essentially based on the individual benefit/risk balance resulting from the general, local and inherent of the molecule risk factors. Management of drug-related osteonecrosis of the jaw should be as early as possible.
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Affiliation(s)
| | - Matthieu Remaud
- CHRU de Brest, médecine bucco-dentaire, département d'odontologie, 29200 Brest, France
| | - Hélène Simon
- CHRU de Brest, département d'oncologie, 29200 Brest, France
| | - Héloïse Herry
- CHRU de Brest, hospitalo-universitaire, département de chirurgie orale, 29200 Brest, France
| | - Guy Le Toux
- CHRU de Brest, département de chirurgie orale, 29200 Brest, France
| | - Sylvie Boisramé
- CHRU de Brest, département de chirurgie orale, 29200 Brest, France
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Abstract
Bisphosphonates are effective therapy for osteoporosis, Paget's disease, and metastatic bone disease. Generally, the side effects of bisphosphonates are minimal. Recently, an uncommon adverse reaction affecting the maxilla or mandible, called osteonecrosis of the jaw, has been reported, especially in those patients receiving high doses of bisphosphonates in the oncology setting. Regarding doses used to treat osteoporosis, clinicians must keep the very small potential absolute risk of jaw osteonecrosis in perspective and consider it in relation to the demonstrated benefit of bisphosphonates. Still, in a very small number of patients taking bisphosphonates, intractable, painful, nonhealing exposed bone may occur following dental extractions or denture irritation.
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Cox TM, Aerts JMFG, Belmatoug N, Cappellini MD, vom Dahl S, Goldblatt J, Grabowski GA, Hollak CEM, Hwu P, Maas M, Martins AM, Mistry PK, Pastores GM, Tylki-Szymanska A, Yee J, Weinreb N. Management of non-neuronopathic Gaucher disease with special reference to pregnancy, splenectomy, bisphosphonate therapy, use of biomarkers and bone disease monitoring. J Inherit Metab Dis 2008; 31:319-36. [PMID: 18509745 DOI: 10.1007/s10545-008-0779-z] [Citation(s) in RCA: 100] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2007] [Revised: 01/28/2008] [Accepted: 02/19/2008] [Indexed: 12/21/2022]
Abstract
Enzyme replacement was introduced as treatment for non-neuronopathic Gaucher disease more than 15 years ago. To ensure the best use of this costly ultra-orphan agent, a systematic disease management approach has been proposed by an international panel; this includes the development, by consensus, of achievable treatment goals. Here we critically review these goals and monitoring guidelines and incorporate emerging experience of the disease in the therapeutic era, as well as contemporary clinical research. This review makes recommendations related specifically to the management of pregnancy; the appropriate use of splenectomy and bisphosphonate treatment; the relevance of biochemical markers to disease monitoring; and the use of semi-quantitative methods for assessing bone marrow infiltration. In addition, we identify key areas for development, including the requirement for a validated index of disease severity; the need to correlate widely used biomarkers with long-term disease outcomes, and the desirability of establishing agreed standards for monitoring of bone disease particularly in infants and children with Gaucher disease.
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Affiliation(s)
- T M Cox
- Department of Medicine, University of Cambridge, Addenbrooke's NHS Foundation Hospitals Trust, Cambridge, UK.
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Factors associated with osteonecrosis of the jaw among bisphosphonate users. Am J Med 2008; 121:475-483.e3. [PMID: 18501224 PMCID: PMC2601671 DOI: 10.1016/j.amjmed.2008.01.047] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2008] [Revised: 01/14/2008] [Accepted: 01/23/2008] [Indexed: 12/22/2022]
Abstract
BACKGROUND Bisphosphonates are medications that impact bone reformation by inhibiting osteoclast function. Osteonecrosis of the jaw has been reported among patients receiving these medications. It is unclear if the risk factors associated with osteonecrosis of the jaw among cancer patients taking bisphosphonates also are possible risk factors among patients receiving these medications for other indications. METHODS A systematic review search strategy was used to identify cases of osteonecrosis of the jaw among patients taking bisphosphonates for an indication other than cancer to identify potential contributing factors. Data were analyzed according to previous models to develop a more expanded model that may explain possible mechanisms for the development of osteonecrosis of the jaw among patients without cancer. RESULTS Ninety-nine cases of osteonecrosis of the jaw were identified among patients who were prescribed a bisphosphonate for an indication other than cancer. These cases included 85 osteoporosis patients, 10 patients with Paget's disease, 2 patients with rheumatoid arthritis, 1 patient with diabetes, and 1 patient with maxillary fibrous dysplasia. The mean age was 69.4 years, 87.3% were female, and 83.3% were receiving oral, but not intravenous, bisphosphonates. Of the 63 patients reporting dental care information, 88.9% had a dental procedure before the onset of osteonecrosis of the jaw. Of all cases providing medical information, 71% were taking at least one medication that affects bone turnover in addition to the bisphosphonate, and 81.3% reported additional underlying health conditions. CONCLUSIONS The case details suggest a multiplicity of factors associated with this condition and provide the foundation for a model outlining the potential mechanism for the development of osteonecrosis of the jaw among patients taking bisphosphonates for an indication other than cancer.
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Vance MA. Osteonecrosis of the jaw and bisphosphonates: a comparison with white phosphorus, radium, and osteopetrosis. Clin Toxicol (Phila) 2008; 45:753-62. [PMID: 17852160 DOI: 10.1080/15563650701232505] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Recent reports of bisphosphonate-associated jaw osteonecrosis are reminiscent of earlier incidents in which a comparable syndrome was caused by occupational exposure to white phosphorus or radium. Osteonecrosis of the jaw is also caused by an inherited disease: osteopetrosis. This review analyzes the biomedical and social aspects of these four situations associated with jaw osteonecrosis. RESULTS Clinical evidence is contradictory but suggests aminobisphosphonates cause rare cases of jaw necrosis. In addition to jaw problems, generalized skeletal defects characterize osteopetrosis and exposure to phosphorus or radium and there is evidence of decreased bone resorption in these conditions and with bisphosphonate therapy. CONCLUSION Bisphosphonate-induced jaw necrosis appears to be an on-target toxicity as the same mechanism, inhibition bone resorption, probably underlies both the therapeutic and adverse effects. Since bisphosphonates are retained for long periods by bone the theoretical potential for skeletal toxicity is increased by using higher doses of potent aminobisphosphonates administered less frequently.
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Affiliation(s)
- Michael A Vance
- Department of Pharmaceutical Sciences, Butler University, College of Pharmacy and Allied Health Sciences, Indianapolis, Indiana 46208, USA.
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Khosla S, Burr D, Cauley J, Dempster DW, Ebeling PR, Felsenberg D, Gagel RF, Gilsanz V, Guise T, Koka S, McCauley LK, McGowan J, McKee MD, Mohla S, Pendrys DG, Raisz LG, Ruggiero SL, Shafer DM, Shum L, Silverman SL, Van Poznak CH, Watts N, Woo SB, Shane E. Bisphosphonate-associated osteonecrosis of the jaw: report of a task force of the American Society for Bone and Mineral Research. J Bone Miner Res 2007; 22:1479-91. [PMID: 17663640 DOI: 10.1359/jbmr.0707onj] [Citation(s) in RCA: 1057] [Impact Index Per Article: 62.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
UNLABELLED ONJ has been increasingly suspected to be a potential complication of bisphosphonate therapy in recent years. Thus, the ASBMR leadership appointed a multidisciplinary task force to address key questions related to case definition, epidemiology, risk factors, diagnostic imaging, clinical management, and future areas for research related to the disorder. This report summarizes the findings and recommendations of the task force. INTRODUCTION The increasing recognition that use of bisphosphonates may be associated with osteonecrosis of the jaw (ONJ) led the leadership of the American Society for Bone and Mineral Research (ASBMR) to appoint a task force to address a number of key questions related to this disorder. MATERIALS AND METHODS A multidisciplinary expert group reviewed all pertinent published data on bisphosphonate-associated ONJ. Food and Drug Administration drug adverse event reports were also reviewed. RESULTS AND CONCLUSIONS A case definition was developed so that subsequent studies could report on the same condition. The task force defined ONJ as the presence of exposed bone in the maxillofacial region that did not heal within 8 wk after identification by a health care provider. Based on review of both published and unpublished data, the risk of ONJ associated with oral bisphosphonate therapy for osteoporosis seems to be low, estimated between 1 in 10,000 and <1 in 100,000 patient-treatment years. However, the task force recognized that information on incidence of ONJ is rapidly evolving and that the true incidence may be higher. The risk of ONJ in patients with cancer treated with high doses of intravenous bisphosphonates is clearly higher, in the range of 1-10 per 100 patients (depending on duration of therapy). In the future, improved diagnostic imaging modalities, such as optical coherence tomography or MRI combined with contrast agents and the manipulation of image planes, may identify patients at preclinical or early stages of the disease. Management is largely supportive. A research agenda aimed at filling the considerable gaps in knowledge regarding this disorder was also outlined.
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Gering A, Grange L, Villier C, Woeller A, Mallaret M. [Bisphosphonates-associated osteonecrosis of the jaw: review on reported cases]. Therapie 2007; 62:49-54. [PMID: 17374348 DOI: 10.2515/therapie:2007003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Osteonecrosis of the jaws associated with the use of bisphosphonates (alendronate, pamidronate, risedronate et zoledronate) are described as an avascular necrosis. We have listed 184 cases of bisphosphonates-associated osteonecrosis of the maxillary in the literature. Many mechanisms are discussed in bisphosphonates-associated osteonecrosis: a disturbing bone turnover, an accumulation of bone's microdamage or an antiangiogenic effect. Other risk factors seem however to be involved: cancer, chemotherapy, glucocorticoids, infection and renal insufficiency.
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Affiliation(s)
- Audrey Gering
- Centre Hospitalo Universitaire de Grenoble, Centre de pharmacovigilance, Grenoble, France
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Dunstan CR, Felsenberg D, Seibel MJ. Therapy insight: the risks and benefits of bisphosphonates for the treatment of tumor-induced bone disease. ACTA ACUST UNITED AC 2007; 4:42-55. [PMID: 17183355 DOI: 10.1038/ncponc0688] [Citation(s) in RCA: 98] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2006] [Accepted: 08/02/2006] [Indexed: 11/09/2022]
Abstract
Bisphosphonates are a valuable class of drugs with potent anti-resorptive actions that make them ideal for skeletal protection in osteoporosis, cancer bone metastasis, multiple myeloma, and Paget's disease of bone. It has become apparent, however, that these drugs also have the potential to cause a number of adverse effects. While these do not limit bisphosphonate use, the incidence of these adverse events can be minimized if appropriate care is taken with their administration, and by maintaining appropriate surveillance and patient care. We review the range of adverse reactions to bisphosphonate therapy with a particular emphasis on the recently identified association between long-term bisphosphonate treatment and osteonecrosis of the jaw. This is a potentially serious side effect seen mostly in patients with multiple myeloma or breast cancer bone metastases who receive intravenous bisphosphonate treatment. While the etiology is uncertain, a strong association with dental pathology and interventions highlights the need for close attention to dental health in this patient group.
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Affiliation(s)
- Colin R Dunstan
- Bone Research Program, ANZAC Research Institute, The University of Sydney at Concord, Concord, NSW 2139, Australia.
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Shane E, Goldring S, Christakos S, Drezner M, Eisman J, Silverman S, Pendrys D. Osteonecrosis of the jaw: more research needed. J Bone Miner Res 2006; 21:1503-5. [PMID: 16995804 DOI: 10.1359/jbmr.060712] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Current awareness: Pharmacoepidemiology and drug safety. Pharmacoepidemiol Drug Saf 2006. [DOI: 10.1002/pds.1177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Naveau A, Naveau B. Osteonecrosis of the jaw in patients taking bisphosphonates. Joint Bone Spine 2006; 73:7-9. [PMID: 16386936 DOI: 10.1016/j.jbspin.2005.11.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2005] [Accepted: 11/22/2005] [Indexed: 11/27/2022]
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