Oral bisphosphonates: Adverse effects on the oral mucosa not related to the jaw bones. A scoping review

The effect of antiresorptive therapy on the prevalence and severity of oral lichen planus: a retrospective study

BACKGROUND

Antiresorptive therapy (AR) disrupts osseous homeostasis and can induce direct irritation over the gastrointestinal mucosa; however, its possible erosive effects on the oral epithelium have not been totally described. Among the most frequent oral erosive lesions, oral lichen planus (OLP) frequently presents as painful mucosal ulcerations, arising from basal membrane inflammatory damage. Thus, the aim of this retrospective study was to describe the association between AR and the incidence of OLP.

METHODS

This case-control study included data from 148 patients (17 patients undergoing AR therapy (AR group) / 131 without AR therapy (Control group)). Each patient record was systematically processed and the association between AR drugs and OLP clinical characteristics within both groups was assessed.

RESULTS

The erosive form of OLP was significantly more frequent in the AR group than in the Control group (p = 0.029). Indeed, the AR treatment using alendronic acid (41.2%) was the most frequently reported. Additionally, the erosive form of OLP showed the strongest association with pain and burning sensation among the OLP types (p < 0.050). However, disease worsening and AR consumption were not significantly associated (p = 0.150).

CONCLUSIONS

Patients under AR therapy show more clinical symptoms associated to the erosive type of OLP. Regardless of the AR therapy, the erosive type of OLP is associated with more severe symptoms.

Bisphosphonates and Their Connection to Dental Procedures: Exploring Bisphosphonate-Related Osteonecrosis of the Jaws

Bisphosphonates are widely used to treat osteoporosis and malignant tumors due to their effectiveness in increasing bone density and inhibiting bone resorption. However, their association with bisphosphonate-related osteonecrosis of the jaws (BRONJ) following invasive dental procedures poses a significant challenge. This review explores the functions, mechanisms, and side effects of bisphosphonates, emphasizing their impact on dental procedures. Dental patients receiving bisphosphonate treatment are at higher risk of BRONJ, necessitating dentists' awareness of these risks. Topical bisphosphonate applications enhance dental implant success, by promoting osseointegration and preventing osteoclast apoptosis, and is effective in periodontal treatment. Yet, systemic administration (intravenous or intraoral) significantly increases the risk of BRONJ following dental procedures, particularly in inflamed conditions. Prevention and management of BRONJ involve maintaining oral health, considering alternative treatments, and careful pre-operative and post-operative follow-ups. Future research could focus on finding bisphosphonate alternatives with fewer side effects or developing combinations that reduce BRONJ risk. This review underscores the need for further exploration of bisphosphonates and their implications in dental procedures.

Effects of Teriparatide Treatment on Bone Mineral Density in Patients With Osteoporosis: A Short-Term Dose-Response Study

INTRODUCTION

Osteoporosis is a chronic bone disease that develops with a decrease in bone mineral density (BMD) along with bone mass. An essential measure in the prevention of osteoporosis is the achievement of normal peak bone mass. Teriparatide (TPTD) functions as an osteoanabolic agent, exerting a dual influence on bone remodeling by modulating both osteogenesis and osteoclastogenesis. Bone mass is determined by dual-energy x-ray absorptiometry (DEXA) quantitative CT scan and has outstanding precision (within 1% to 2%) and has the ability to show the effectiveness of drug intervention.

OBJECTIVE

To assess the effectiveness of TPTD treatment on BMD in osteoporosis patients.

MATERIALS AND METHODS

The study is a retrospective, observational, multi-center study of 378 osteoporosis patients who were treated with 20 µg of subcutaneous TPTD every day for six months. DEXA scores of the hip joints of patients were measured both before and after TPTD treatment.

RESULTS

 The DEXA scores of the total population pre and post-treatment were -2.75+0.58 and -2.15+0.95 respectively, with a p-value of <0.001, which is statistically significant. In women the pre and post-treatment scores were -2.728+0.52 and -2.276+0.49, with a significant p-value of <0.001 whereas in males, the scores were -2.756+0.72 and -2.108+1.29 respectively, with a significant p-value of <0.05.

CONCLUSION

The six-month treatment with TPTD significantly improved DEXA scores in osteoporosis patients. DEXA score's precision and sensitivity in quantifying impact contribute to effective osteoporosis management, guiding treatment strategies for better outcomes in the Indian population. Further research is warranted to see the long-term effect of TPTD.

The Role of Geranylgeraniol in Managing Bisphosphonate-Related Osteonecrosis of the Jaw

Medication-related osteonecrosis of the jaw (ONJ) is a rare but significant adverse side effect of antiresorptive drugs. Bisphosphonate-related ONJ (BRONJ) is the most prevalent condition due to the extensive use of the drug in cancer and osteoporosis treatment. Nitrogen-containing bisphosphonates suppress osteoclastic resorption by inhibiting farnesyl pyrophosphate synthase in the mevalonate pathway, leading to deficiency of the substrate for GTPase prenylation. The bone remodelling process is uncoupled, subsequently impairing bone healing and causing ONJ. Targeted administration of geranylgeraniol (GGOH) represents a promising approach to mitigate BRONJ because GGOH is a substrate for GTPase prenylation. In the current review, the in vitro effects of GGOH on osteoclasts, osteoblasts and other related cells of the jaw are summarised. We also present and appraise the current in vivo evidence of GGOH in managing BRONJ in animal models. Lastly, several considerations of using GGOH in the clinical management of BRONJ are highlighted. As a conclusion, GGOH is a promising topical agent to manage BRONJ, pending more research on an effective delivery system and validation from a clinical trial.