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Boffano P, Agnone AM, Neirotti F, Bonfiglio R, Brucoli M, Ruslin M, Durković A, Milosavljević M, Konstantinovic V, Rodríguez JCDV, Santamarta TR, Meyer C, Louvrier A, Michel-Guillaneux A, Bertin E, Starch-Jensen T, Tadic AJ, Bajkin BV, Dugast S, Bertin H, Corre P, Szalma J, Dovsak T, Prodnik L, Mottl R, Dediol E, Kos B, Ontanon AV, Stathopoulos P, Tsekoura K, Polcyn A, Michcik A, Zaleckas L, Pavlov N, Sapundzhiev A, Uchikov P, Pechalova P. Epidemiology, etiopathogenesis, and management of MRONJ: A European multicenter study. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2024; 125:101931. [PMID: 38821192 DOI: 10.1016/j.jormas.2024.101931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Accepted: 05/28/2024] [Indexed: 06/02/2024]
Abstract
INTRODUCTION The purpose of this European multicenter study was to describe the general characteristics and risk factors of MRONJ lesions as well as their clinical diagnosis and management at different European Oral and Maxillofacial Surgery centers, in order to minimize selections biases and provide information about the epidemiology, etiopathogenesis, and the current trends in the treatment of MRONJ across Europe. MATERIALS AND METHODS The following data were registered for each patient: gender; age at MRONJ diagnosis; past medical history; indication for antiresorptive or antiangiogenic therapy; type of antiresorptive medication; local risk factor for MRONJ; MRONJ Stage; anatomic location and symptoms; treatment; surgical complications; recurrence. RESULTS A total of 537 patients (375 females, 162 males) with MRONJ were included. Statistically significant associations were found between patients with metastatic bone disease and recurrences (P < 0.0005) and between advanced MRONJ stages (stages 2 and 3) and recurrences (P < 0.005). Statistically significant associations were also found between male gender and recurrences (P < 0.05), and between MRONJ maxillary sites and recurrences (P < 0.0000005). CONCLUSIONS A longer mean duration of antiresorptive medications before MRONJ onset was observed in patients affected by osteoporosis, whereas a shorter mean duration was observed in all metastatic bone cancer patients, and in particular in those affected by prostate cancer with bone metastases or multiple myeloma. Surgery plays an important role for the management of MRONJ lesions.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Christophe Meyer
- Université de Franche-Comté, CHU Besançon, Chirurgie maxillo-faciale, stomatologie et odontologie hospitalière, F-25000 Besançon, France
| | - Aurelien Louvrier
- Université de Franche-Comté, CHU Besançon, Chirurgie maxillo-faciale, stomatologie et odontologie hospitalière, F-25000 Besançon, France
| | - Alexandre Michel-Guillaneux
- Université de Franche-Comté, CHU Besançon, Chirurgie maxillo-faciale, stomatologie et odontologie hospitalière, F-25000 Besançon, France
| | - Eugenie Bertin
- Université de Franche-Comté, CHU Besançon, Chirurgie maxillo-faciale, stomatologie et odontologie hospitalière, F-25000 Besançon, France
| | - Thomas Starch-Jensen
- Department of Oral and Maxillofacial Surgery, Aalborg University Hospital, Aalborg, Denmark
| | - Ana J Tadic
- Faculty of Medicine, University of Novi Sad, Dental Clinic of Vojvodina, Novi Sad, Serbia
| | - Branislav V Bajkin
- Faculty of Medicine, University of Novi Sad, Dental Clinic of Vojvodina, Novi Sad, Serbia
| | - Sophie Dugast
- Nantes Université, CHU Nantes, Service de chirurgie maxillo-faciale et stomatologie, F-4400 Nantes, France
| | - Helios Bertin
- Nantes Université, CHU Nantes, Service de chirurgie maxillo-faciale et stomatologie, F-4400 Nantes, France
| | - Pierre Corre
- Nantes Université, CHU Nantes, Service de chirurgie maxillo-faciale et stomatologie, F-4400 Nantes, France
| | - József Szalma
- University of Pécs, Medical School, Dept. Oral and Maxillofacial Surgery, 1. Tüzér st., 7623 Pécs, Hungary
| | - Tadej Dovsak
- University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Luka Prodnik
- University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Radovan Mottl
- Department of Dentistry, Faculty of Medicine in Hradec Kralove, Charles University and University Hospital Hradec Kralove, 50005 Hradec Kralove, Czech Republic
| | - Emil Dediol
- Department for Maxillofacial Surgery, University Hospital Dubrava, Zagreb, Croatia
| | - Boris Kos
- Department for Maxillofacial Surgery, University Hospital Dubrava, Zagreb, Croatia
| | | | | | | | - Adam Polcyn
- Medical University of Gdansk, Gdansk, Poland
| | | | - Linas Zaleckas
- Centre of Oral and Maxillofacial Surgery, Institute of Dentistry, Faculty of Medicine, Vilnius university, Vilnius, Lithuania
| | - Nikolai Pavlov
- Department of Oral surgery, Faculty of Dental medicine, Medical University of Plovdiv, Bulgaria
| | - Angel Sapundzhiev
- Department of Oral surgery, Faculty of Dental medicine, Medical University of Plovdiv, Bulgaria
| | - Petar Uchikov
- Department of Oral surgery, Faculty of Dental medicine, Medical University of Plovdiv, Bulgaria
| | - Petia Pechalova
- Department of Oral surgery, Faculty of Dental medicine, Medical University of Plovdiv, Bulgaria
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Byrne H, O'Reilly S, Weadick CS, Brady P, Ríordáin RN. How we manage medication-related osteonecrosis of the jaw. Eur J Med Res 2024; 29:402. [PMID: 39095845 PMCID: PMC11297747 DOI: 10.1186/s40001-024-01912-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 05/30/2024] [Indexed: 08/04/2024] Open
Abstract
Bone-modifying agents (BMAs) are integral to managing patients with advanced cancer. They improve quality of survival by reducing skeletal-related events, treating hypercalcaemia and chemotherapy-induced bone loss (Coleman in Clin Cancer Res 12: 6243s-6249s, 2006), (Coleman in Ann Oncol 31: 1650-1663, 2020). Two decades ago, medication-related osteonecrosis of the jaw (MRONJ) was first reported following BMA therapy (Marx in J Oral Maxillofac Surg 61: 1115-1117, 2003). The risk of MRONJ extends over a decade following BMA treatment with bisphosphonates, complicating dental care such as extractions. In addition, MRONJ has been reported following additional therapies such as antiangiogenic agents, cytotoxic agents, immunotherapy, and targeted agents. The use of BMAs in the curative and adjuvant cancer setting is increasing, consequently the implication of MRONJ is growing. Over the past 20 years, the literature has consolidated major risk factors for MRONJ, the pathophysiology and management strategies for MRONJ. Our review aims to document the development of MRONJ preventative and management strategies in cancer patients receiving a BMA. The authors advocate the incorporation of dental oncology strategies into contemporary cancer care, to optimise long-term quality of survival after cancer treatment.
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Affiliation(s)
- H Byrne
- Cork University Dental School and Hospital, University College Cork, Cork, Ireland.
| | - S O'Reilly
- Cancer Research @UCC, College of Medicine and Health, University College Cork, Cork, Ireland
- Department of Medical Oncology, Cork University Hospital, Wilton, Cork, Ireland
| | - C S Weadick
- Cancer Research @UCC, College of Medicine and Health, University College Cork, Cork, Ireland
- Department of Medical Oncology, Cork University Hospital, Wilton, Cork, Ireland
| | - P Brady
- Cork University Dental School and Hospital, University College Cork, Cork, Ireland
| | - R Ni Ríordáin
- Cork University Dental School and Hospital, University College Cork, Cork, Ireland
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Tan W, Rossi NA, Haroun KB, Conner GR, McKinnon B, Ranasinghe V, Shabani S, Coblens OM. Denosumab-Induced Maxillary Osteonecrosis: A Case Study on Long-Term Complications in Multiple Myeloma Treatment. EAR, NOSE & THROAT JOURNAL 2024:1455613241263181. [PMID: 38880987 DOI: 10.1177/01455613241263181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/18/2024] Open
Abstract
Background: Targeted therapies like denosumab have revolutionized multiple myeloma (MM) treatment, improved patient outcomes while introducing long-term complications. This study explores a rare instance of delayed maxillary osteonecrosis post-denosumab therapy, delving into its pathophysiology and management. Methods: A 40-year-old male MM patient who developed a painful palatal lesion post denosumab treatment and diagnosed of maxillary osteonecrosis by computed tomography scan and surgical biopsy is presented. Treatment history, symptom progression, and response to the PENTOCLO protocol were analyzed. Results: Post-denosumab discontinuation osteonecrosis highlights its prolonged impact on bone metabolism. PENTOCLO treatment protocol led to significant improvement. Genetic factors influencing osteonecrosis susceptibility have been discussed and considered. Conclusions: This case underscores the need for vigilance regarding long-term complications in MM survivors, preventive strategies, including regular dental evaluations and reducing invasive dental procedures, are crucial. We advocate for an interdisciplinary approach and further research into tailored prevention and management of osteonecrosis in cancer survivors.
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Affiliation(s)
- Wilhelmina Tan
- School of Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Nicholas A Rossi
- Department of Otolaryngology, University of Texas Medical Branch, Galveston, TX, USA
| | | | | | - Brian McKinnon
- Department of Otolaryngology, University of Texas Medical Branch, Galveston, TX, USA
| | - Viran Ranasinghe
- Department of Otolaryngology, University of Texas Medical Branch, Galveston, TX, USA
| | - Sepehr Shabani
- Department of Otolaryngology, University of Texas Medical Branch, Galveston, TX, USA
| | - Orly M Coblens
- Department of Otolaryngology, University of Texas Medical Branch, Galveston, TX, USA
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Qi G, Jiang Z, Lu W, Li D, Chen W, Yang X, Ding L, Yuan H. Berbamine inhibits RANKL- and M-CSF-mediated osteoclastogenesis and alleviates ovariectomy-induced bone loss. Front Pharmacol 2022; 13:1032866. [PMID: 36408260 PMCID: PMC9666778 DOI: 10.3389/fphar.2022.1032866] [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: 08/31/2022] [Accepted: 10/21/2022] [Indexed: 10/06/2023] Open
Abstract
Osteoporosis is a common public health problem characterized by decreased bone mass, increased bone brittleness and damage to the bone microstructure. Excessive bone resorption by osteoclasts is the main target of the currently used drugs or treatment for osteoporosis. Effective antiresorptive drugs without side effects following long-term administration have become a major focus of anti-osteoporotic drugs. In the present study, we investigated the effect of berbamine, a small molecule natural product from Berberis amurensis Rupr, a traditional Chinese medicine, on RANKL-induced osteoclast differentiation in vitro and ovariectomy-induced bone loss in vivo. The results demonstrated that berbamine at a safe and effective dose inhibited osteoclastogenesis and bone resorption function in vitro by suppressing the nuclear factor-κB signaling pathway. In addition, berbamine protected against osteoporosis by inhibiting osteoclastogenesis and bone resorption function without affecting osteogenesis in the ovariectomy mouse model. These findings revealed that berbamine has a protective role against osteoporosis and may represent a novel promising treatment strategy for osteoporosis.
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Affiliation(s)
- Guobin Qi
- Department of Orthopaedics, Shanghai Sixth People’s Hospital, Shanghai, China
- Department of Orthopedic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zengxin Jiang
- Department of Orthopaedics, Shanghai Sixth People’s Hospital, Shanghai, China
| | - Wei Lu
- Department of Orthopedic Surgery, Shanghai TCM-Integrated Hospital Shanghai University of TCM, Shanghai, China
| | - Defang Li
- Department of Orthopedic Surgery, Jinshan Hospital, Fudan University, Shanghai, China
| | - Weibing Chen
- Department of Orthopedic Surgery, Jinshan Hospital, Fudan University, Shanghai, China
| | - Xiuying Yang
- Department of Radiology, Jinshan Hospital, Fudan University, Shanghai, China
| | - Lei Ding
- Department of Orthopedic Surgery, Jinshan Hospital, Fudan University, Shanghai, China
| | - Hengfeng Yuan
- Department of Orthopaedics, Shanghai Sixth People’s Hospital, Shanghai, China
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Nashi M, Kishimoto H, Kobayashi M, Tachibana A, Suematsu M, Fujiwara S, Ota Y, Hashitani S, Shibatsuji T, Nishida T, Fujimura K, Furudoi S, Ishida Y, Ishii S, Fujita T, Iwai S, Shigeta T, Harada T, Miyai D, Takeda D, Akashi M, Noguchi K, Takenobu T. Incidence of antiresorptive agent-related osteonecrosis of the jaw: A multicenter retrospective epidemiological study in Hyogo Prefecture, Japan. J Dent Sci 2022. [DOI: 10.1016/j.jds.2022.10.030] [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] Open
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Konarski W, Poboży T, Hordowicz M, Śliwczyński A, Kotela I, Krakowiak J, Kotela A. Bone Infarcts and Tumorigenesis—Is There a Connection? A Mini-Mapping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159282. [PMID: 35954639 PMCID: PMC9367991 DOI: 10.3390/ijerph19159282] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 07/25/2022] [Accepted: 07/27/2022] [Indexed: 12/10/2022]
Abstract
(1) Background: Avascular necrosis (AVN) may affect every part of the bone. Epiphyseal infarcts are likely to be treated early because most are symptomatic. However, meta- and diaphyseal infarcts are silent and are diagnosed incidentally. Sarcomas developing in the necrotic bone are extremely rare, but they have been reported in the literature. (2) Methods: We conducted a mapping review of recent evidence regarding these malignancies. Methods: A mapping review using a systematic search strategy was conducted to answer research questions. We limited our research to the last ten years (2012–2022). (3) Results: A total of 11 papers were identified, including 9 case reports and 3 case series. The pathomechanism of carcinogenesis in AVN was not investigated to date. Histologically, most tumors were malignant fibrous histiocytoma. The prognosis is relatively poor, especially for patients with metastases, but adjuvant chemotherapy may increase short- and long-term survival. (4) Conclusions: Since AVN-related malignancies are sporadic, no prospective studies have been conducted. The majority of evidence comes from small case series. More research is needed to identify the risk factors that would justify follow-up of patients after bone infarcts at higher risk of developing a malignancy.
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Affiliation(s)
- Wojciech Konarski
- Department of Orthopaedic Surgery, Ciechanów Hospital, 06-400 Ciechanów, Poland;
- Correspondence: ; Tel.: +48-(50)-2110863
| | - Tomasz Poboży
- Department of Orthopaedic Surgery, Ciechanów Hospital, 06-400 Ciechanów, Poland;
| | - Martyna Hordowicz
- General Psychiatry Unit III, Dr Barbara Borzym’s Independent Public Regional Psychiatric Health Care Center, 26-600 Radom, Poland;
| | - Andrzej Śliwczyński
- Department of Social and Preventive Medicine, Social Medicine Institute, Medical University of Lodz, 90-647 Lodz, Poland; (A.Ś.); (J.K.)
| | - Ireneusz Kotela
- Department of Orthopedic Surgery and Traumatology, Central Research Hospital of Ministry of Interior, Wołoska 137, 02-507 Warsaw, Poland;
| | - Jan Krakowiak
- Department of Social and Preventive Medicine, Social Medicine Institute, Medical University of Lodz, 90-647 Lodz, Poland; (A.Ś.); (J.K.)
| | - Andrzej Kotela
- Faculty of Medicine, Collegium Medicum, Cardinal Stefan Wyszynski University in Warsaw, Woycickiego 1/3, 01-938 Warsaw, Poland;
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