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Innes-Taylor D, Adams V. Medication-related osteonecrosis of the jaw in a paediatric patient taking denosumab: a case report. Br Dent J 2024; 236:453-456. [PMID: 38519674 DOI: 10.1038/s41415-024-7139-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 10/06/2023] [Accepted: 10/13/2023] [Indexed: 03/25/2024]
Abstract
Medication-related osteonecrosis of the jaw (MRONJ) is a known complication of antiresorptive and anti-angiogenic therapies in adults. Increasingly, these drugs are being prescribed for children with a variety of conditions, such as osteogenesis imperfecta and cancers of the bone. Review of the literature, however, reveals no reported paediatric MRONJ cases to date. We present such a case in a nine-year-old female patient with a vertebral aneurysmal bone cyst, who received dental extractions subsequent to denosumab therapy.
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Affiliation(s)
- Dominic Innes-Taylor
- Dental Core Trainee 2, Oral Surgery and Oral Medicine, School of Dentistry, Belfast, UK.
| | - Vicky Adams
- Consultant Oral Surgeon, School of Dentistry, Belfast, UK
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2
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Mitsuhata C, Kozai K. Management of bisphosphonate preparation-treated children in the field of pediatric dentistry. JAPANESE DENTAL SCIENCE REVIEW 2022; 58:155-161. [PMID: 35516908 PMCID: PMC9065718 DOI: 10.1016/j.jdsr.2022.03.001] [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: 07/02/2021] [Revised: 02/24/2022] [Accepted: 03/08/2022] [Indexed: 11/27/2022] Open
Abstract
Since most of the reports of BRONJ onset are adults, in order to clarify the current situation of BRONJ onset in children, it is necessary to search for articles and report on the current status and actual conditions of surgical treatment of children with BP preparations who are being followed up in our clinic. In previous reports both inside and outside Japan, there was no mention of jaw bone necrosis during tooth extraction or surgery in children who were receiving or had a history of BP administration. There were 15 children with a history of BP administration who manage the oral cavity in our clinic. No unpleasant events in the extraction of deciduous teeth were confirmed in medical records. It is necessary to intervene early on oral management of pediatric BP-administered children, especially BP-and steroid-administered children, obtain plaque control to keep the oral cavity cleaner, respond early to infectious diseases, and manage to prevent inflammation from spreading to the jawbone. When surgical treatment is unavoidable, it is important to consider reducing the invasion as much as possible and to cooperate with the medical department such as administration of antibiotics to prevent infection.
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Affiliation(s)
- Chieko Mitsuhata
- Department of Pediatric Dentistry, Graduate School of Biomedical & Health Sciences, Hiroshima University, Japan
| | - Katsuyuki Kozai
- Department of Pediatric Dentistry, Graduate School of Biomedical & Health Sciences, Hiroshima University, Japan
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Contaldo M, Luzzi V, Ierardo G, Raimondo E, Boccellino M, Ferati K, Bexheti-Ferati A, Inchingolo F, Di Domenico M, Serpico R, Polimeni A, Bossù M. Bisphosphonate-related osteonecrosis of the jaws and dental surgery procedures in children and young people with osteogenesis imperfecta: A systematic review. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2020; 121:556-562. [PMID: 32156673 DOI: 10.1016/j.jormas.2020.03.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 03/02/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Bisphosphonates (BPs) contrast the bone fragility and improve bone density in some metastatic cancers and bone diseases, such as Osteogenesis Imperfecta (OI). BPs use has been associated with osteonecrosis of the jaws (BRONJs) in adults needing for invasive dental procedures. AIM To conduct a systematic review on BRONJ occurrence after dental surgery in paediatric population under BPs therapy for OI, so as to identify the pre-surgical protocols adopted. DESIGN According to PRISMA guidelines, Pubmed, Web of Science (WoS) and Cochrane were investigated on September 2018, and re-checked on July 2019. Inclusion criteria were English-language papers on children/young adults (until 24 years old) reporting dental/oral surgery procedures. RESULTS Totally, 60 articles were found. After title/abstract reviews and duplicates exclusion, 22 eligible titles underwent full-text evaluation. Finally, 10 studies were included. CONCLUSIONS The lack of BRONJ occurrence in paediatric population suffering OI and treated with BPs, was confirmed, but the reasons are still debated, being the BPs therapies and the surgical strategies various and not standardized. Longitudinal studies should evaluate what happens to those former children once adult, to evaluate the delayed BRONJs onset associated with the occurrence of comorbidities during the adulthood.
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Affiliation(s)
- M Contaldo
- Multidisciplinary Department of Medical-Surgical and Odontostomatological Specialties, University of Campania "Luigi Vanvitelli", Via L. de Crecchio, 6, 80138 Naples, Italy.
| | - V Luzzi
- Department of Oral and Maxillo-facial Sciences, Sapienza University of Rome, Rome, Italy.
| | - G Ierardo
- Department of Oral and Maxillo-facial Sciences, Sapienza University of Rome, Rome, Italy.
| | - E Raimondo
- Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", Bari, Italy.
| | - M Boccellino
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy.
| | - K Ferati
- Faculty of Medicine, University of Tetovo, Tetovo, Macedonia.
| | | | - F Inchingolo
- Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", Bari, Italy.
| | - M Di Domenico
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy.
| | - R Serpico
- Multidisciplinary Department of Medical-Surgical and Odontostomatological Specialties, University of Campania "Luigi Vanvitelli", Via L. de Crecchio, 6, 80138 Naples, Italy.
| | - A Polimeni
- Department of Oral and Maxillo-facial Sciences, Sapienza University of Rome, Rome, Italy.
| | - M Bossù
- Department of Oral and Maxillo-facial Sciences, Sapienza University of Rome, Rome, Italy.
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Duarte NT, Rech BDO, Martins IG, Franco JB, Ortega KL. Can children be affected by bisphosphonate-related osteonecrosis of the jaw? A systematic review. Int J Oral Maxillofac Surg 2019; 49:183-191. [PMID: 31447218 DOI: 10.1016/j.ijom.2019.08.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Revised: 07/29/2019] [Accepted: 08/06/2019] [Indexed: 10/26/2022]
Abstract
Knowledge of bisphosphonate-related osteonecrosis of the jaw (BRONJ) is mostly based on adult cases, however bisphosphonates are also currently recommended for different paediatric diseases resulting in osteoporosis. The aim of this study was to review the literature on the risk of developing BRONJ in children and adolescents. The PubMed, LILACS, Web of Science, Scopus, and Cochrane databases were searched using the key words "bisphosphonates", "osteonecrosis", "jaw", and "children". Literature reviews, case reports, abstracts, theses, textbooks, and book chapters were excluded. Studies involving children and young adults (younger than 24 years of age) were included. A total of 56 publications were identified. After applying the eligibility criteria, only seven articles remained. Although no cases of osteonecrosis were identified, all studies had weaknesses such as a limited sample size or the absence of risk factors for the development of osteonecrosis. There is general consensus that this subject should be of concern and that further studies should be conducted before any definitive opinion is reached. It is believed that patients with secondary osteoporosis who use bisphosphonates continuously should be followed up during adulthood, since bone turnover decreases over the years.
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Affiliation(s)
- Nathália Tuany Duarte
- Special Care Dentistry Centre (CAPE), Department of Stomatology of the University of São Paulo School of Dentistry, São Paulo, Brazil; Oral Pathology, Department of Stomatology of the University of São Paulo School of Dentistry, São Paulo, Brazil
| | - Bruna de Oliveira Rech
- Special Care Dentistry Centre (CAPE), Department of Stomatology of the University of São Paulo School of Dentistry, São Paulo, Brazil; Oral Pathology, Department of Stomatology of the University of São Paulo School of Dentistry, São Paulo, Brazil
| | - Isabela Godoy Martins
- Special Care Dentistry Centre (CAPE), Department of Stomatology of the University of São Paulo School of Dentistry, São Paulo, Brazil
| | - Juliana Bertoldi Franco
- Oral Pathology, Department of Stomatology of the University of São Paulo School of Dentistry, São Paulo, Brazil; Division of Dentistry of the Clinics Hospital, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Karem Lopez Ortega
- Special Care Dentistry Centre (CAPE), Department of Stomatology of the University of São Paulo School of Dentistry, São Paulo, Brazil; Oral Pathology, Department of Stomatology of the University of São Paulo School of Dentistry, São Paulo, Brazil.
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Challenges of delivery of dental care and dental pathologies in children and young people with osteogenesis imperfecta. Eur Arch Paediatr Dent 2019; 20:473-480. [PMID: 30868445 DOI: 10.1007/s40368-019-00424-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Accepted: 02/25/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Osteogenesis imperfecta (OI) is the most common inherited disorder of bone fragility in children, increasing fracture risk 100-fold and can feature dental and facial bone involvement causing additional morbidities. AIM To assess the utilisation of tertiary dental services by children and young people with OI attending a supra-regional multi-disciplinary OI service and review of the pathology identified and interventions undertaken. DESIGN Case notes review of the current caseload of children and young people (0-18 years) with OI at a large regional OI specialist centre (n = 92). Primary outcome was whether an initial dental assessment was arranged in a tertiary dental centre and the corresponding attendance. RESULTS 49% had a tertiary dental assessment arranged, of whom 82% attended (one quarter requiring several appointments) and 18% did not attend (DNA).Those travelling > 100 miles had a DNA rate of 47%. Assessed children had dentinogenesis imperfecta (24%, 50% in Type III OI), radiographs (95%), caries (41%), required extraction under general anaesthesia (38%) and malocclusion (30%). 48% of the total cohort received bisphosphonates. CONCLUSION Tertiary dental assessment encountered barriers to uptake of recommended referral in all patients, often due to geographic factors of travel distance, yet when implemented did identify pathology in a large proportion and many resulted in dental intervention. These emphasise the relevance of specialist dental assessment in OI, particularly in the modern context of increased use of bisphosphonates. This is challenging to achieve and several models of delivery of care may need to be considered in this chronic childhood condition.
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Xue XM, Liu YQ, Pang P, Sun CF. Congenital Loss of Permanent Teeth in a Patient With Congenital Insensitivity to Pain With Anhidrosis due to 2 Novel Mutations in the NTRK1 Gene. J Oral Maxillofac Surg 2018; 76:2582.e1-2582.e9. [DOI: 10.1016/j.joms.2018.06.170] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 06/20/2018] [Accepted: 06/28/2018] [Indexed: 01/24/2023]
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Hernandez M, Phulpin B, Mansuy L, Droz D. Use of new targeted cancer therapies in children: effects on dental development and risk of jaw osteonecrosis: a review. J Oral Pathol Med 2016; 46:321-326. [DOI: 10.1111/jop.12516] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Magali Hernandez
- Pediatric Dentistry Department; CHRU of Nancy; Vandoeuvre-les-Nancy France
- Pediatric Dentistry Department; Faculty of Dentistry; Nancy France
| | - Bérengère Phulpin
- Head and Neck Surgery and Dental Units; Oncology Surgery Department; Institute of Cancerology of Lorraine; Vandoeuvre-lès-Nancy France
- Oral Surgery Department; Faculty of Dentistry; Nancy France
| | - Ludovic Mansuy
- Pediatric Oncology Department; CHRU of Nancy; Vandoeuvre-les-Nancy France
| | - Dominique Droz
- Pediatric Dentistry Department; CHRU of Nancy; Vandoeuvre-les-Nancy France
- Pediatric Dentistry Department; Faculty of Dentistry; Nancy France
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Soares AP, do Espírito Santo RF, Line SRP, Pinto MDGF, Santos PDM, Toralles MBP, do Espírito Santo AR. Bisphosphonates: Pharmacokinetics, bioavailability, mechanisms of action, clinical applications in children, and effects on tooth development. ENVIRONMENTAL TOXICOLOGY AND PHARMACOLOGY 2016; 42:212-217. [PMID: 26895384 DOI: 10.1016/j.etap.2016.01.015] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 01/18/2016] [Accepted: 01/20/2016] [Indexed: 06/05/2023]
Abstract
Bisphosphonates (BPs) avidly bind to calcium crystals and inhibit osteoclastic bone resorption, making them useful for treatment of skeletal disorders such as osteoporosis, Paget's disease, osteogenesis imperfecta and metastatic bone diseases. BPs therapeutically act by causing toxic effects on osteoclasts or interfering with specific intracellular pathways in those cells. BPs that possess nitrogen in their composition are called nitrogen-containing BPs (NBPs) and include alendronate, pamidronate, risedronate, ibandronate, and zoledronate. Simple BPs or non-NBPs do not have nitrogen in their composition, include etiodronate and clodronate, and were the first to be tested in animals and clinically used. Because BPs may be administered to pregnant women or children during deciduous and permanent teeth development, it is expected that they might disturb tooth eruption and development. A review of current literature on pharmacokinetics, bioavailability, mechanisms of action, and clinical applications of BPs in children, and their effects on tooth eruption and development is presented.
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Affiliation(s)
- Ana Prates Soares
- Multidisciplinary Institute of Health, Federal University of Bahia - UFBA, Rua Rio de Contas, 58, Quadra 17, Lote 58, Candeias, Vitória da Conquista, BA CEP 45.029-094, Brazil.
| | - Renan Fernandes do Espírito Santo
- Faculty of Pharmacy, Federal University of Bahia - UFBA, Rua Barão de Jeremoabo, S/N, Campus Universitário de Ondina, Ondina, Salvador, BA CEP 40.170-115, Brazil.
| | - Sérgio Roberto Peres Line
- Piracicaba Dental School, University of Campinas - UNICAMP, Av. Limeira, 901, Areião, Piracicaba, SP CEP 13.414-903, Brazil.
| | - Maria das Graças Farias Pinto
- School of Veterinary Medicine and Zootechny, Federal University of Bahia - UFBA, Av. Ademar de Barros, 500, Ondina, Salvador, BA CEP 40.170-110, Brazil.
| | - Pablo de Moura Santos
- Professor Edgard Santos University Hospital, Federal University of Bahia - UFBA, Rua Augusto Viana, S/N, Canela, Salvador, BA CEP 40.110-060, Brazil.
| | - Maria Betânia Pereira Toralles
- Institute of Health Sciences, Federal University of Bahia - UFBA, Av. Reitor Miguel Calmon, S/N, Vale do Canela, Salvador, BA CEP 40.110-902, Brazil.
| | - Alexandre Ribeiro do Espírito Santo
- Institute of Health Sciences, Federal University of Bahia - UFBA, Av. Reitor Miguel Calmon, S/N, Vale do Canela, Salvador, BA CEP 40.110-902, Brazil.
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Sinikumpu JJ, Ojaniemi M, Lehenkari P, Serlo W. Severe osteogenesis imperfecta Type-III and its challenging treatment in newborn and preschool children. A systematic review. Injury 2015; 46:1440-6. [PMID: 25943292 DOI: 10.1016/j.injury.2015.04.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Revised: 04/09/2015] [Accepted: 04/12/2015] [Indexed: 02/02/2023]
Abstract
Osteogenesis imperfecta (OI) is a group of genetic disorders, of which Type III is the most severe among survivors. The disease is characterised in particular by bone fragility, decreased bone mass and increased incidence of fractures. Other usual findings are muscle hypotonia, joint hypermobility and short stature. Fractures and weak bones may consequently cause limb and spinal deformity and chronic physical disability. Bisphosphonates have revolutionised the treatment of newborn children with severe OI type III. Surgery is still needed in most patients due to high frequency of the fractures. In this systematic review we describe the present state-of-art in treating the most severe type of OI in newborn and preschool children with their bone fractures.
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Affiliation(s)
- Juha-Jaakko Sinikumpu
- Division of Paediatric Surgery and orthopaedics, Oulu University Hospital; Oulu Cranifacial Centre, Oulu; Medical Research Center Oulu; PEDEGO Research Center, Finland.
| | - Marja Ojaniemi
- Institute of Clinical Medicine, Department of Pediatrics, University of Oulu and Department of Pediatrics and Adolescence, Oulu University Hospital; Medical Research Center Oulu; PEDEGO Research Center, Finland
| | - Petri Lehenkari
- Surgery Clinic, Oulu University Hospital; Department of Anatomy and Molecular Cell Biology; Oulu University; Medical Research Center Oulu, Finland
| | - Willy Serlo
- Department of Children and Adolescents, Oulu University Hospital; Oulu Craniofacial Centre, Oulu; Medical Research Center Oulu; PEDEGO Research Center, Finland
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Baroncelli GI, Bertelloni S. The use of bisphosphonates in pediatrics. Horm Res Paediatr 2015; 82:290-302. [PMID: 25376487 DOI: 10.1159/000365889] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Accepted: 07/09/2014] [Indexed: 11/19/2022] Open
Abstract
Bisphosphonates are widely used for the prevention and treatment of osteoporosis in adulthood. In the last years, bisphosphonates have been increasingly used in pediatric patients for the treatment of a growing number of disorders associated with osteoporosis, resistant hypercalcemia or heterotopic calcifications. The use of bisphosphonates in pediatric patients has been proven safe; however, the risk of potential severe consequences into adulthood should be kept in mind. Well-defined criteria for bisphosphonates treatment in pediatric patients are not specified, therefore an accurate selection of patients who could benefit from bisphosphonates is mandatory. A strict follow-up of pediatric patients receiving long-term bisphosphonate therapy is strongly recommended. The purpose of this mini review is to provide a summary of current knowledge on some main general aspects of the structure, mechanisms of action, pharmacokinetics, and bioavailability of bisphosphonates, and to focus on the latest advances of bisphosphonate treatment in pediatric patients. Particular attention has been paid to the common and potential adverse effects of bisphosphonate treatment, and some suggestions concerning the clinical approach and general measures for bisphosphonate treatment in pediatric patients are reported.
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Affiliation(s)
- Giampiero I Baroncelli
- Pediatric Unit I, Department of Obstetrics, Gynecology and Pediatrics, University Hospital, Pisa, Italy
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Abstract
A dozen years ago the identification of causal mutations in the low-density lipoprotein receptor-related protein 5 (LRP5) gene involved in two rare bone disorders propelled research in the bone field in totally new directions. Since then, there have been an explosion in the number of reports that highlight the role of the Wnt/β-catenin pathway in the regulation of bone homeostasis. In this review we discuss some of the most recent reports (in the past 2 years) highlighting the involvement of the members of the LRP family (LRP5, LRP6, LRP4, and more recently LRP8) in the maintenance of bone and their implications in bone diseases. These reports include records of new single nucleotides polymorphisms (SNPs) and haplotypes that suggest variants in these genes can contribute to subtle variation in bone traits to mutations that give rise to extreme bone phenotypes. All of these serve to further support and reinforce the importance of this tightly regulated pathway in bone. Furthermore, we discuss provocative reports suggesting novel approaches through inhibitors of this pathway to treat rarer diseases such as Osteoporosis-Pseudoglioma Syndrome (OPPG), Osteogenesis Imperfecta (OI), and Sclerosteosis/Van Buchem disease. It is hoped that by understanding the role of each component of the pathway and their involvement in bone diseases that this knowledge will allow us to develop new, more effective therapeutic approaches for more common diseases such as post-menopausal osteoporosis, osteoarthritis, and rheumatoid arthritis as well as these rarer bone diseases.
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Affiliation(s)
- N Lara-Castillo
- Department of Oral and Craniofacial Sciences, UMKC School of Dentistry, 650 East 25th Street, Kansas City, MO, 64108, USA,
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12
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[Ewing sarcoma located in the mandible: A case report]. Arch Pediatr 2015; 22:626-9. [PMID: 25896628 DOI: 10.1016/j.arcped.2015.03.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Revised: 10/08/2014] [Accepted: 03/13/2015] [Indexed: 11/23/2022]
Abstract
Ewing sarcoma is the second most common primary malignant bone cancer in children and adolescents. Clinical presentation is usually dominated by local pain and a palpable mass. These symptoms justify imaging investigations: the first one, when an osseous lesion is suspected, is usually a conventional radiograph in two planes. Ewing sarcoma appears as a poorly defined osteolytic lesion that may frequently be associated with cortical erosion or laminar periosteal response ("onion skin"). However, this aspect is not pathognomonic and the definitive diagnosis is made by biopsy. Absence of pain or an unusual localization can lead to misdiagnosis. We report the case of a 7-year-old boy with Ewing sarcoma located in the mandible with a clinical picture including progressive mandibular swelling but no pain.
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Biggin A, Briody JN, Ormshaw E, Wong KKY, Bennetts BH, Munns CF. Fracture during intravenous bisphosphonate treatment in a child with osteogenesis imperfecta: an argument for a more frequent, low-dose treatment regimen. Horm Res Paediatr 2014; 81:204-10. [PMID: 24356182 DOI: 10.1159/000355111] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Accepted: 08/19/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Intravenous bisphosphonate therapy is the mainstay of medical treatment in osteogenesis imperfecta (OI) and has been shown to increase bone mass, decrease bone pain, improve mobility, and reduce the incidence of fractures. Sclerotic metaphyseal lines parallel to the growth plate are seen on long bone radiographs following cyclical intravenous therapy. These areas create stress risers within the bone that may act as foci for subsequent fractures as exemplified in this clinical case. METHODS An 8-year-old girl with OI sustained a distal radial fracture following 3 years of treatment with 6-monthly intravenous zoledronate. Her diagnosis, response to treatment, and subsequent fracture at a sclerotic metaphyseal line is described. RESULTS Peripheral quantitative computer tomography was used to characterise the presence of multiple stress risers at the distal forearm. Trabecular bone mineral density fluctuated from 34 to 126% compared to neighbouring 2-mm regions. CONCLUSION There remain many unanswered questions about optimal bisphosphonate treatment regimens in children with OI. The formation of stress risers following intravenous bisphosphonate treatment raises the hypothesis that a more frequent and low-dose bisphosphonate regimen would provide more uniform dosing of bone in the growing child and reduce the likelihood of fractures compared to current treatment practices.
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Affiliation(s)
- Andrew Biggin
- Institute of Endocrinology and Diabetes, The Sydney Children's Hospitals Network, Westmead, N.S.W., Australia
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Foster BL, Ramnitz MS, Gafni RI, Burke AB, Boyce AM, Lee JS, Wright JT, Akintoye SO, Somerman MJ, Collins MT. Rare bone diseases and their dental, oral, and craniofacial manifestations. J Dent Res 2014; 93:7S-19S. [PMID: 24700690 DOI: 10.1177/0022034514529150] [Citation(s) in RCA: 86] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Hereditary diseases affecting the skeleton are heterogeneous in etiology and severity. Though many of these conditions are individually rare, the total number of people affected is great. These disorders often include dental-oral-craniofacial (DOC) manifestations, but the combination of the rarity and lack of in-depth reporting often limit our understanding and ability to diagnose and treat affected individuals. In this review, we focus on dental, oral, and craniofacial manifestations of rare bone diseases. Discussed are defects in 4 key physiologic processes in bone/tooth formation that serve as models for the understanding of other diseases in the skeleton and DOC complex: progenitor cell differentiation (fibrous dysplasia), extracellular matrix production (osteogenesis imperfecta), mineralization (familial tumoral calcinosis/hyperostosis hyperphosphatemia syndrome, hypophosphatemic rickets, and hypophosphatasia), and bone resorption (Gorham-Stout disease). For each condition, we highlight causative mutations (when known), etiopathology in the skeleton and DOC complex, and treatments. By understanding how these 4 foci are subverted to cause disease, we aim to improve the identification of genetic, molecular, and/or biologic causes, diagnoses, and treatment of these and other rare bone conditions that may share underlying mechanisms of disease.
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Affiliation(s)
- B L Foster
- National Institute for Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - M S Ramnitz
- National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20892, USA
| | - R I Gafni
- Skeletal Clinical Studies Unit, Craniofacial and Skeletal Diseases Branch, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD, USA
| | - A B Burke
- Skeletal Clinical Studies Unit, Craniofacial and Skeletal Diseases Branch, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD, USA
| | - A M Boyce
- Skeletal Clinical Studies Unit, Craniofacial and Skeletal Diseases Branch, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD, USA Bone Health Program, Division of Orthopedics and Sports Medicine, Children's National Medical Center, Washington, DC, USA Division of Endocrinology and Diabetes, Children's National Medical Center, Washington, DC, USA
| | - J S Lee
- Office of Clinical Director, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD, USA
| | - J T Wright
- Department of Pediatric Dentistry, School of Dentistry, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - S O Akintoye
- Department of Oral Medicine, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - M J Somerman
- National Institute for Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD 20892, USA National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD, USA
| | - M T Collins
- Skeletal Clinical Studies Unit, Craniofacial and Skeletal Diseases Branch, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD, USA
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