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Özalp Ö, Göksu O, Toru HS, Altay MA, Sindel A. Comparing the effects of low-level laser therapy and gaseous ozone as a preventive measure on medication-related osteonecrosis of the jaws following tooth extraction: a rat model. Eur J Med Res 2024; 29:359. [PMID: 38978136 PMCID: PMC11232170 DOI: 10.1186/s40001-024-01907-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 05/29/2024] [Indexed: 07/10/2024] Open
Abstract
OBJECTIVES Use of numerous medications such as tyrosine kinase inhibitors (sunitinib), monoclonal antibodies (bevacizumab), fusion proteins (aflibercept), mTOR inhibitors (everolimus), radiopharmaceuticals (radium 223), selective estrogen receptor modulators (raloxifene), and immunosuppressants (methotrexate and corticosteroids) has been reported to be a risk factor for development of medication-related osteonecrosis of the jaws till date. This study aimed to evaluate the preventive effect of low-level laser therapy (LLLT) and gaseous ozone on the onset of MRONJ following tooth extraction. MATERIALS AND METHODS A total of 40 male Wistar rats were randomly allocated into 4 groups of 10 rats each. The groups laser (L), ozone (O), and control (C) received weekly intraperitoneal injections of zoledronic acid (0.06 mg/kg), while group sham (S) received saline solution for 4 weeks. After the 4th injection, all subjects underwent mandibular first molar extraction and adjunctive laser or ozone was applied according to the groups. All the rats were sacrificed at 4 postoperative weeks for comparative histomorphometric evaluation of bone healing in extraction sites. RESULTS Laser and ozone groups demonstrated significantly higher bone formation compared to control group (p < 0.05), while no significant difference was found between laser and ozone groups (p = 1.00). Furthermore, the greatest bone formation was observed with the sham group (p < 0.05). CONCLUSIONS Findings of the current study support that adjunctive LLLT and ozone therapy following tooth extraction may help prevent MRONJ and improve bone healing in subjects under zoledronic acid therapy. CLINICAL RELEVANCE Since the introduction in 2003, great effort has been devoted to developing a certain management protocol for MRONJ. Several publications have appeared in recent years documenting promising results of adjunctive LLLT and ozone application in treatment of MRONJ. However, experimental data are limited on this regard and the present study, for the first time, aimed to evaluate and compare the effects of LLLT and ozone in prevention of MRONJ.
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Affiliation(s)
- Öznur Özalp
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Akdeniz University, Dumlupinar Boulevard, Campus, 07058, Antalya, Turkey
| | - Oğuzcan Göksu
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Akdeniz University, Dumlupinar Boulevard, Campus, 07058, Antalya, Turkey
| | - Havva Serap Toru
- Department of Pathology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Mehmet Ali Altay
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Akdeniz University, Dumlupinar Boulevard, Campus, 07058, Antalya, Turkey
| | - Alper Sindel
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Akdeniz University, Dumlupinar Boulevard, Campus, 07058, Antalya, Turkey.
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Medication-Related Osteonecrosis of the Jaws (MRONJ) in Children and Young Patients-A Systematic Review. J Clin Med 2023; 12:jcm12041416. [PMID: 36835951 PMCID: PMC9962332 DOI: 10.3390/jcm12041416] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 12/25/2022] [Accepted: 12/25/2022] [Indexed: 02/12/2023] Open
Abstract
Medication-related osteonecrosis of the jaw (MRONJ) is defined by the American Association of Oral and Maxillofacial Surgeons (AAOMS) as the presence of an exposed bone area in the maxillofacial region, present for more than eight weeks in patients treated with the use of antiresorptive or antiangiogenic agents, with no history of radiation or metastatic disease. Bisphosphonates (BF) and denosumab (DS) are widely used in adults for the management of patients with cancer and osteoporosis, and recently there has been an increase in their use in child and young patients for the management of disorders such as osteogenesis imperfecta (OI), glucocorticoid-induced osteoporosis, McCune-Albright syndrome (MAS), malignant hypercalcemia, and others. There are differences between case reports in adults compared to child and young patients related to the use of antiresorptive/antiangiogenic drugs and the development of MRONJ. The aim was to analyze the presence of MRONJ in children and young patients, and the relation with oral surgery. A systematic review, following the PRISMA search matrix based on the PICO question, was conducted in PubMed, Embase, ScienceDirect, Cochrane, Google Scholar, and manual search in high-impact journals between 1960 and 2022, publications in English or Spanish, including randomized and non-randomized clinical trials, prospective and retrospective cohort studies, cases and controls studies, and series and case reports. A total of 2792 articles were identified and 29 were included; all of them published between 2007 and 2022, identifying 1192 patients, 39.68% male and 36.24% female, aged 11.56 years old on average, using these drugs mainly for OI (60.15%); 4.21 years on average was the therapy time and 10.18 drug doses administered on average; oral surgery was observed in 216 subjects, reporting 14 cases of MRONJ. We concluded that there is a low presence of MRONJ in the child and youth population treated with antiresorptive drugs. Data collection is weak, and details of therapy are not clear in some cases. Deficiencies in protocols and pharmacological characterization were observed in most of the included articles.
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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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Neal TW, Schlieve T. Medication-Related Osteonecrosis of the Jaws in the Pediatric Population. J Oral Maxillofac Surg 2022; 80:1686-1690. [DOI: 10.1016/j.joms.2022.06.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 06/29/2022] [Accepted: 06/29/2022] [Indexed: 10/17/2022]
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Sharma D, Hamlet S, Vaquette C, Petcu EB, Ramamurthy P, Ivanovski S. Local delivery of hydrogel encapsulated vascular endothelial growth factor for the prevention of medication-related osteonecrosis of the jaw. Sci Rep 2021; 11:23371. [PMID: 34862395 PMCID: PMC8642483 DOI: 10.1038/s41598-021-02637-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 11/17/2021] [Indexed: 11/16/2022] Open
Abstract
The anti-angiogenic effects of bisphosphonates have been hypothesized as one of the major etiologic factors in the development of medication-related osteonecrosis of the jaw (MRONJ), a severe debilitating condition with limited treatment options. This study evaluated the potential of a gelatine-hyaluronic acid hydrogel loaded with the angiogenic growth factor, vascular endothelial growth factor (VEGF), as a local delivery system to aid in maintaining vascularization in a bisphosphonate-treated (Zoledronic Acid) rodent maxillary extraction defect. Healing was assessed four weeks after implantation of the VEGF-hydrogel into extraction sockets. Gross examination and histological assessment showed that total osteonecrosis and inflammatory infiltrate was significantly reduced in the presence of VEGF. Also, total vascularity and specifically neovascularization, was significantly improved in animals that received VEGF hydrogel. Gene expression of vascular, inflammatory and bone specific markers within the defect area were also significantly altered in the presence of VEGF. Furthermore, plasma cytokine levels were assessed to determine the systemic effect of locally delivered VEGF and showed similar outcomes. In conclusion, the use of locally delivered VEGF within healing extraction sockets assists bone healing and prevents MRONJ via a pro-angiogenic and immunomodulatory mechanism.
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Affiliation(s)
- Dileep Sharma
- College of Medicine and Dentistry, James Cook University, Cairns Campus, PO Box 6811, Cairns, 4870, Australia. .,Australian Institute of Tropical Health and Medicine, James Cook University, Cairns, Australia.
| | - Stephen Hamlet
- Menzies Health Institute Queensland, School of Medicine and Dentistry, Griffith University, Gold Coast Campus, Gold Coast, 4222, Australia
| | - Cedryck Vaquette
- School of Dentistry, Faculty of Health and Behavioral Sciences, The University of Queensland, Herston Campus, Brisbane, 4006, Australia
| | - Eugen Bogdan Petcu
- New York Institute of Technology College of Osteopathic Medicine (NYIT), Old Westbury, NY, 11545, USA.,School of Dentistry and Oral Health, Griffith University, Gold Coast, Australia
| | - Poornima Ramamurthy
- College of Medicine and Dentistry, James Cook University, Cairns Campus, PO Box 6811, Cairns, 4870, Australia
| | - Saso Ivanovski
- School of Dentistry, Faculty of Health and Behavioral Sciences, The University of Queensland, Herston Campus, Brisbane, 4006, Australia.
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Hanisch M, Maus M, Kleinheinz J. Implant-Prosthetic Restoration of a Patient with Osteogenesis Imperfecta: A Case Report. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18084169. [PMID: 33920808 PMCID: PMC8071102 DOI: 10.3390/ijerph18084169] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 03/25/2021] [Accepted: 04/13/2021] [Indexed: 12/23/2022]
Abstract
Osteogenesis imperfecta describes a group of genetic disorders that result from a defect in collagen type I and range in severity from a subtle increase in fracture frequency to death in the perinatal period. Osteogenesis imperfecta is mostly caused by mutations in the COL1A1 (17q21.33) and COL1A2 (7q21.3) genes. There have only been a few case reports of implant-prosthetic treatment for patients with osteogenesis imperfecta. These reports indicated that implants and augmentation procedures can be implemented in such patients. However, for patients receiving additional antiresorptive therapy, cautious approaches should be chosen and the risk of drug-associated osteonecrosis should be considered. The aim of this article is to report on the implant-prosthetic treatment of a patient with type I osteogenesis imperfecta.
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Affiliation(s)
- Marcel Hanisch
- Correspondence: ; Tel.: +49-(0)2-518347002; Fax: +49-(0)2-518347184
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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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Friedrich RE, Scheuer HA, Höltje W. The effect of bisphosphonate medication on orthodontics and orthognathic surgery in patients with osteogenesis imperfecta. GMS INTERDISCIPLINARY PLASTIC AND RECONSTRUCTIVE SURGERY DGPW 2019; 8:Doc06. [PMID: 31149556 PMCID: PMC6532328 DOI: 10.3205/iprs000132] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Introduction: Osteogenesis imperfecta (OI) is a genetic disease that primarily affects bone formation and metabolism. Craniofacial malformations belong to the broad spectrum of the OI phenotype. The introduction of bisphosphonate medications was intended to counteract the significant brittleness of the bones of OI patients. In connection with the application of bisphosphonates, drug-associated osteonecrosis of the jaw has become known as an undesirable effect of the therapeutically intended reduction of osteoclast activity. Originally, the pharmacological inhibition of bone loss was mainly used in oncological therapy. For some time now, osteoporosis has also been treated with substances that inhibit bone resorption. In OI, malposition of the jaws is relatively common, in particular retrognathia of the maxilla and progeny of the mandible. The literature discloses complications of orthognathic surgery in OI patients. Previous literature reviews suggest that bisphosphonate medication has no significant impact on the performance of and healing after oral surgery in OI patients. Materialandmethods: An essential prerequisite of a therapy adapted to the patient’s condition is the knowledge of the patient's medical history. This case report describes the orthodontic-surgical treatment of an OI patient and the treatment experience derived in dealing with the condition. The unusual circumstance of this case is that the patient had concealed both his underlying disease and his medication during the current treatment period. In addition, the relevant literature is evaluated for combining the keywords OI, orthodontic therapy, bisphosphonates, and orthognathic surgery. Results: Based on the literature and our own experience, it is concluded that orthodontic treatment with bisphosphonate medication can also be carried out in OI patients. However, considerably greater forces and longer time intervals should be scheduled for each treatment. Orthognathic surgery with bisphosphonate medication turned out to be uncomplicated in our own case, considering the underlying disease in the planning of surgical procedures. However, there have been very few reports of OI patients in whom orthodontic-surgical treatment of jaw malformation has been performed with bisphosphonate medication. Conclusion: Taking into account the reported experience of severe complications of orthognathic surgery, the multiple documented adjustments to the treatment strategy of OI patients should be taken seriously. The basic condition of therapy adapted to the disease is that the patient informs the practitioner in an appropriate manner about his or her state of health.
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Affiliation(s)
- Reinhard E Friedrich
- Department of Oral and Craniomaxillofacial Surgery, Eppendorf University Hospital, University of Hamburg, Hamburg, Germany
| | | | - Wolf Höltje
- Oral and Craniomaxillofacial Surgery, Klinikum Nord, Hamburg, Germany
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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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Ierardo G, Bossù M, D'Angeli G, Celli M, Sfasciotti G. Bisphosphonates therapy in children with Osteogenesis imperfecta: clinical experience in oral surgery. ACTA ACUST UNITED AC 2017; 10:311-316. [PMID: 29285334 DOI: 10.11138/orl/2017.10.3.311] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives To define the possible complications of oral surgery in childhood in patients affected by type 1 Osteogenesis imperfecta (OI) and treated with bisphosphonates (BP). Methods The study was conducted among 20 patients in childhood with an age range 8-14 (12 ♂ e 8 ♀) affected by OI. Patients were initially evaluated at the Policlinico Umberto I, University Hospital of Rome, Rare Disease Center Skeletal Dysplasia-Bone Metabolic Pathologies and after at the Policlinico Umberto I, University Hospital of Rome, Head and Neck Department, UOC Pediatric Dentistry. Results From this experience, we showed that a proper patient management from the medical and dental point of view can protect these patients from the risk of post-operative problems, such as onj, soft tissue flogos, intraoral and extraoral fistulas, failure to heal the post-extractive alveolus, infections, post-operative pain and pathological fractures. The follow-up, ranging from a minimum of 2 years to a maximum of 5 years, have not demonstrated the presence of particular complications or healing defects. Conclusions The clinical experiences observed in these patients are encouraging because no postoperative complications have been observed compared to patients non-affected by OI.
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Affiliation(s)
- G Ierardo
- Sapienza, University of Rome, Umberto I University Hospital of Rome, Rome, Italy
| | - M Bossù
- Sapienza, University of Rome, Umberto I University Hospital of Rome, Rome, Italy
| | - G D'Angeli
- Sapienza, University of Rome, Umberto I University Hospital of Rome, Rome, Italy
| | - M Celli
- Rare Disease Center Skeletal Dysplasia Bone, Department of Oral and Maxillo Facial Science, DAI Head and Neck UOC Pediatric Dentistry (Dir.: Prof. Antonella Polimeni)
| | - G Sfasciotti
- Sapienza, University of Rome, Umberto I University Hospital of Rome, Rome, Italy
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Okawa R, Kubota T, Kitaoka T, Kokomoto K, Ozono K, Nakano K. Oral manifestations of Japanese patients with osteogenesis imperfecta. PEDIATRIC DENTAL JOURNAL 2017. [DOI: 10.1016/j.pdj.2017.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Cheng N, Park J, Olson J, Kwon T, Lee D, Lim R, Ha S, Kim R, Zhang X, Ting K, Tetradis S, Hong C. Effects of Bisphosphonate Administration on Cleft Bone Graft in a Rat Model. Cleft Palate Craniofac J 2017; 54:687-698. [PMID: 28094562 DOI: 10.1597/15-356] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE Bone grafts in patients with cleft lip and palate can undergo a significant amount of resorption. The aim of this study was to investigate the effects of bisphosphonates (BPs) on the success of bone grafts in rats. DESIGN Thirty-five female 15-week-old Fischer F344 Inbred rats were divided into the following experimental groups, each receiving bone grafts to repair an intraoral CSD: (1) Graft/saline: systemic administration of saline and (2) systemic administration of zoledronic acid immediately following surgery (graft/BP/T0), (3) 1 week postoperatively (graft/BP/T1), and (4) 3 weeks postoperatively (graft/BP/T2). As an additional control, the defect was left empty without bone graft. MAIN OUTCOME MEASURES Microcomputed tomography and histologic analyses were performed in addition to evaluation of osteoclasts through tartrate-resistant acid phosphatase staining. RESULTS Bone volume fraction (bone volume/tissue volume) for the delayed BP treatment groups (graft/BP/T1 = 45.4% ± 8.8%; graft/BP/T2 = 46.1% ± 12.4%) were significantly greater than that for the graft/saline group (31.0% ± 7.9%) and the graft/BP/T0 (27.6% ± 5.9%) 6 weeks postoperatively (P < .05). Hematoxylin and eosin staining confirmed an evident increase in bone volume and fusion of defect margins with existing palatal bone in the graft/BP/T1 and graft/BP/T2 groups. The graft/BP/T0 group showed the lowest bone volume with signs of acute inflammation. CONCLUSIONS Delayed BP administration following cleft bone graft surgery led to significant increase in bone volume and integration compared with saline controls. However, BP injection immediately after the surgery did not enhance bone volume, and rather, may negatively affect bone graft incorporation.
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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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Abstract
This article reviews the manifestations and risk factors associated with osteoporosis in childhood, the definition of osteoporosis and recommendations for monitoring and prevention. As well, this article discusses when a child should be considered a candidate for osteoporosis therapy, which agents should be prescribed, duration of therapy and side effects. There has been significant progress in our understanding of risk factors and the natural history of osteoporosis in children over the past number of years. This knowledge has fostered the development of logical approaches to the diagnosis, monitoring, and optimal timing of osteoporosis intervention in this setting. Current management strategies are predicated upon monitoring at-risk children to identify and then treat earlier rather than later signs of osteoporosis in those with limited potential for spontaneous recovery. On the other hand, trials addressing the prevention of the first-ever fracture are still needed for children who have both a high likelihood of developing fractures and less potential for recovery. This review focuses on the evidence that shapes the current approach to diagnosis, monitoring, and treatment of osteoporosis in childhood, with emphasis on the key pediatric-specific biological principles that are pivotal to the overall approach and on the main questions with which clinicians struggle on a daily basis. The scope of this article is to review the manifestations of and risk factors for primary and secondary osteoporosis in children, to discuss the definition of pediatric osteoporosis, and to summarize recommendations for monitoring and prevention of bone fragility. As well, this article reviews when a child is a candidate for osteoporosis therapy, which agents and doses should be prescribed, the duration of therapy, how the response to therapy is adjudicated, and the short- and long-term side effects. With this information, the bone health clinician will be poised to diagnose osteoporosis in children and to identify when children need osteoporosis therapy and the clinical outcomes that gauge efficacy and safety of treatment.
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Affiliation(s)
- L M Ward
- Pediatric Bone Health Clinical and Research Programs, Children's Hospital of Eastern Ontario, Ottawa, ON, K1H 8L1, Canada.
- Department of Pediatrics, University of Ottawa, Ottawa, ON, Canada.
| | - V N Konji
- Pediatric Bone Health Clinical and Research Programs, Children's Hospital of Eastern Ontario, Ottawa, ON, K1H 8L1, Canada
| | - J Ma
- Pediatric Bone Health Clinical and Research Programs, Children's Hospital of Eastern Ontario, Ottawa, ON, K1H 8L1, Canada
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, ON, Canada
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Abstract
Osteogenesis imperfecta (OI) is an uncommon genetic bone disease associated with brittle bones and fractures in children and adults. Although OI is most commonly associated with mutations of the genes for type I collagen, many other genes (some associated with type I collagen processing) have now been identified. The genetics of OI and advances in our understanding of the biomechanical properties of OI bone are reviewed in this article. Treatment includes physiotherapy, fall prevention, and sometimes orthopedic procedures. In this brief review, we will also discuss current understanding of pharmacologic therapies for treatment of OI.
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Affiliation(s)
- Joseph L Shaker
- Endocrinology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Carolyne Albert
- Orthopaedic and Rehabilitation Engineering Center, Marquette University and Medical College of Wisconsin, Milwaukee, WI, USA ; Shriners Hospitals for Children, Chicago, IL, USA
| | - Jessica Fritz
- Orthopaedic and Rehabilitation Engineering Center, Marquette University and Medical College of Wisconsin, Milwaukee, WI, USA
| | - Gerald Harris
- Orthopaedic and Rehabilitation Engineering Center, Marquette University and Medical College of Wisconsin, Milwaukee, WI, USA ; Shriners Hospitals for Children, Chicago, IL, USA
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17
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Kos M. Incidence and risk predictors for osteonecrosis of the jaw in cancer patients treated with intravenous bisphosphonates. Arch Med Sci 2015; 11:319-24. [PMID: 25995747 PMCID: PMC4424249 DOI: 10.5114/aoms.2015.50964] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Revised: 04/13/2013] [Accepted: 04/23/2013] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION The aim of this study was to establish the incidence of bisphosphonate-related osteonecrosis of the jaws (BRONJ) in oncologic patients and to determine risk predictors with respect to this condition. MATERIAL AND METHODS This retrospective review included 197 oncologic patients treated from January 2005 to December 2010 with administration of bisphosphonates (BPs) as part of management. Sex, age, type of cancer diagnosed, period of substantial disease, oral surgery, type of bisphosphonate, number of doses, and cases of BRONJ diagnosis were recorded. The cumulative incidence and incidence rate of BRONJ were calculated. The factors that influenced BRONJ were assessed with multivariate logistic regression and with estimations of 95% confidence intervals and odd ratios. Values of p ≤ 0.05 were considered significant. RESULTS The BRONJ appeared in 9.64% of patients. The BRONJ incidence rate was 1 in 28 patients per year of BP treatment. Logistic regression showed that the odds of osteonecrosis increased 1.0172-fold with each given dose of BP. The BRONJ risk with zoledronate was 5-fold higher than that with pamidronate or ibandronate. The risk of BRONJ increased by 40-fold after dental surgery. CONCLUSIONS Period of BP administration and type of BP used are important risk predictors for the development of BRONJ in oncologic patients treated with intravenous administration of these drugs. Patient-related factors are dental or periodontal events connected with need for oral surgery.
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Affiliation(s)
- Marcin Kos
- Department of Maxillofacial Surgery, Klinikum Minden, Minden, Germany
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18
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Abstract
Osteonecrosis of the jaw to a certain extent has been with us for many years. But recently the advent of various medications such as bisphosphonates, VEGF inhibitors, tyrosine kinase inhibitors and humanized antibodies to osteoclastic action have resulted in thousands of cases. While the bisphosphonates continue to be the most common medication associated with osteochemonecrosis antibodies such as denosumab which irreversibly act on osteoclastic action are also being reported. This narrative review will serve as an update with a focus on some of the histopathologic features discussed and reviewed. Perhaps even more uncommonly seen in past reports a discussion of features possibly observed while grossing specimens will be discussed. At the end of this report is hoped that the pathologist will have a better understanding of the historical features, clinical settings, gross examination features as well as histopathologic features associated with osteochemonecrosis.
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Affiliation(s)
- John Hellstein
- grid.214572.70000000419368294University of Iowa, Iowa City, IA USA
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19
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Cheng A, Sambrook P, Goss A. Use of bisphosphonates in children. Aust Dent J 2014; 59:405. [PMID: 25145841 DOI: 10.1111/adj.12208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Andrew Cheng
- Oral and Maxillofacial Surgery Unit, The University of Adelaide, South Australia
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20
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Paiva-Fonseca F, Santos-Silva AR, Della-Coletta R, Vargas PA, Lopes MA. Alendronate-associated osteonecrosis of the jaws: a review of the main topics. Med Oral Patol Oral Cir Bucal 2014; 19:e106-11. [PMID: 23986020 PMCID: PMC4015053 DOI: 10.4317/medoral.19094] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Accepted: 05/29/2013] [Indexed: 11/21/2022] Open
Abstract
Bisphosphonates is a group of inorganic pyrophosphates analogues that suppress bone resorption by
inducing osteoclast inactivation, being frequently used for management of diseases affecting bone
metabolism, bone metastases and bone tumors. However, since 2003 many cases describing the presence
of necrotic bone exposures in the jaws have been described in patients receiving these drugs, what
represent a significant complication of bisphosphonates treatment. The overall incidence of
bisphosphonate-related osteonecrosis of the jaws is low, ranging from 0.7% to 12%, mainly observed
in those patients receiving intravenously treatment. Osteonecrosis of the jaws associated to oral
bisphosphonate, particularly alendronate, has also been reported by a number of authors. Considering
that alendronate is one of the most used drugs worldwide, specially for treatment of osteoporosis, a
better understanding of osteonecrosis of the jaws related to its use and how to manage these
patients is extremely important. Therefore, in the current manuscript the authors aim to review the
most important topics related to this pathological presentation. Key words:Bisphosphonates, alendronate, bisphosphonate-related osteonecrosis of the
jaws, osteonecrosis.
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Affiliation(s)
- F Paiva-Fonseca
- Faculdade de Odontologia de Piracicaba - UNICAMP, Departamento de Diagnóstico Oral - Semiologia, Av. Limeira, 901 CEP 13.414-903, Piracicaba - São Paulo - Brasil,
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21
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Bhatt RN, Hibbert SA, Munns CF. The use of bisphosphonates in children: review of the literature and guidelines for dental management. Aust Dent J 2014; 59:9-19. [PMID: 24495226 DOI: 10.1111/adj.12140] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2013] [Indexed: 11/30/2022]
Abstract
Bisphosphonates are inhibitors of osteoclastic bone resorption with therapeutic benefit in a variety of bone disorders in both adults and children. While these agents have been routinely used in adults for the past three decades, their more recent introduction into paediatric medicine means there is a paucity of data on long-term safety and effects on dental development. There is uncertainty regarding the dental management of children treated with bisphosphonates, particularly when invasive dental procedures, such as extractions and oral surgical procedures, are required. There are limited data with which to make recommendations about the dental management of patients treated with bisphosphonates, and there are no published recommendations that specifically address paediatric patients. This paper aims to outline paediatric uses and adverse effects of bisphosphonates and present recommendations on the dental management of children receiving bisphosphonates.
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Affiliation(s)
- R N Bhatt
- Department of Orthodontics and Paediatric Dentistry, Westmead Centre for Oral Health, Westmead, New South Wales
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Abstract
BACKGROUND Aneurysmal bone cysts (ABCs) in the sacrum pose a management challenge as their location usually means that surgical excision is not possible. Strategies such as embolization have been used previously but have the potential for significant side effects. We report the successful use of bisphosphonate treatment (zoledronic acid) in an 8-year-old boy who presented with an ABC that did not respond to embolization. METHODS The patient presented with pain and progressive limp. After radiologic and histologic confirmation of the diagnosis, embolization therapy was trialed, which was unsuccessful. At this point, he had severe pain and extremely limited mobility, requiring the use of a wheelchair. His ability to lie flat or sit erect was limited by the pain. Zoledronic acid therapy was subsequently commenced at 0.04 mg/kg per dose by intravenous infusion, at 4 monthly intervals, for a total of 2 years (7 doses). RESULTS The infusions were well tolerated, with rapid reduction in pain and resolution of previously severe immobility, from being bed and chair bound at baseline to normal independent ambulation over several months. This was associated with marked radiologic improvement. We postulate that the effect of treatment is a combination of the anti-inflammatory effect of zoledronic acid and the antiresorptive effect of osteoclast inhibition. CONCLUSIONS We conclude that bisphosphonates should be considered as possible second-line agents for ABCs. Further, study of a larger cohort would help to establish their efficacy in this setting. LEVEL OF EVIDENCE Level IV (case report, no comparator/control arm).
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Hennedige AA, Jayasinghe J, Khajeh J, Macfarlane TV. Systematic review on the incidence of bisphosphonate related osteonecrosis of the jaw in children diagnosed with osteogenesis imperfecta. EJOURNAL OF ORAL MAXILLOFACIAL RESEARCH 2014; 4:e1. [PMID: 24478911 PMCID: PMC3904727 DOI: 10.5037/jomr.2013.4401] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Accepted: 11/16/2013] [Indexed: 11/30/2022]
Abstract
Objectives To conduct a systematic review of epidemiological
literature to determine the incidence of bisphosphonate related osteonecrosis of
the jaw occurring either spontaneously or after dental surgery, in children and
adolescents diagnosed with osteogenesis imperfecta. Material and Methods MEDLINE, HMIC and EMBASE were used to search for English-language
articles published from 1946 - 2013. Inclusion criteria consisted of population
based studies of children and adolescents (24 years and younger) diagnosed with
osteogenesis imperfecta, only studies which included a dental examination, and patients
treated with intravenous bisphosphonates were included. Articles were excluded if
patients had any other co-morbidity which could affect osteonecrosis of the jaw,
and those which treated patients with oral bisphosphonates only. Results Five studies consisting of four retrospective cohort
studies and one case series were identified. Study populations ranged from 15 to
278 patients and number of subjects with osteogenesis imperfecta ranged from 15
to 221. Mean duration of intravenous bisphosphonate use ranged from 4.5 to 6.8 years.
All patients were clinically examined and no patients were found to have osteonecrosis
of the jaw. Conclusions There is no evidence to support hypothesis of causal
relationship between bisphosphonates and osteonecrosis of the jaw in children and
adolescents with osteogenesis imperfecta. More prospective studies on bisphosphonate
use in osteogenesis imperfecta needs to be carried out.
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Affiliation(s)
- Anusha Adeline Hennedige
- University of Aberdeen Dental School Aberdeen United Kingdom. ; Aberdeen Royal Infirmary, Oral and Maxillofacial Department United Kingdom
| | - Jap Jayasinghe
- University of Aberdeen Dental School Aberdeen United Kingdom
| | - Janette Khajeh
- University of Aberdeen Dental School Aberdeen United Kingdom
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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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25
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Christou J, Johnson AR, Hodgson TA. Bisphosphonate-related osteonecrosis of the jaws and its relevance to children--a review. Int J Paediatr Dent 2013; 23:330-7. [PMID: 23869707 DOI: 10.1111/ipd.12047] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Bisphosphonate-related osteonecrosis of the jaws (BRONJ) has been detailed extensively in adults, but to date, there have been no similar cases in children. Members of the dental team may treat children prescribed bisphosphonate therapy often for management of osteogenesis imperfecta (OI). There is uncertainty as to how best treat this patient group. This review explores the background of bisphosphonates, indications for their prescription in children, adverse effects with special emphasis on BRONJ, and protocols available to guide dental management.
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Affiliation(s)
- Joanna Christou
- Department of Oral Medicine, Eastman Dental Hospital and Eastman Dental Institute, UCLHT UCL, London, UK
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26
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Chronic Recurrent Multifocal Osteomyelitis. J Clin Immunol 2013; 33:1043-56. [DOI: 10.1007/s10875-013-9902-5] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Accepted: 04/29/2013] [Indexed: 01/26/2023]
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27
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Sharma D, Ivanovski S, Slevin M, Hamlet S, Pop TS, Brinzaniuc K, Petcu EB, Miroiu RI. Bisphosphonate-related osteonecrosis of jaw (BRONJ): diagnostic criteria and possible pathogenic mechanisms of an unexpected anti-angiogenic side effect. Vasc Cell 2013; 5:1. [PMID: 23316704 PMCID: PMC3606312 DOI: 10.1186/2045-824x-5-1] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Accepted: 12/10/2012] [Indexed: 12/16/2022] Open
Abstract
Recently, bisphosphonates (BPs) have been widely used in medical practice as anti-resorptive agents owing to their anti-osteoclatic action. In addition, these compounds are also used for their analgesic action and their potential anti-tumour effect. Patients treated with BPs may subsequently develop osteonecrosis of the jaw or maxillary bone after minor local trauma including dental work, recently labelled as bisphosphonate osteonecrosis of jaw (BRONJ). However, the etiopathogenic mechanisms of this pathological condition are poorly understood. Although, several pathways have been proposed for BRONJ occurrence, no single model can explain all morphological changes observed at the macro- and microscopic level. Recent research suggests that BPs may promote an anti-angiogenic effect which contributes directly to the clinical features associated with BRONJ. Remarkably, the anti-angiogenic effect promoting BRONJ might be in keeping with the anti-neoplastic action of BPs. The current review, presents clinical diagnostic criteria. In addition, based on our own experience we describe the histopathological criteria for diagnosis of BRONJ and the possible pathways which may lead to this frustrating pathological condition.
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Affiliation(s)
- Dileep Sharma
- Department of Anatomy and Doctoral School, University of Medicine and Pharmacy Targu Mures, Targu Mures, 540000, Romania.
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Ortega AJ“AJ, Campbell PM, Hinton R, Naidu A, Buschang PH. Local application of zoledronate for maximum anchorage during space closure. Am J Orthod Dentofacial Orthop 2012. [DOI: 10.1016/j.ajodo.2012.07.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Maines E, Monti E, Doro F, Morandi G, Cavarzere P, Antoniazzi F. Children and adolescents treated with neridronate for osteogenesis imperfecta show no evidence of any osteonecrosis of the jaw. J Bone Miner Metab 2012; 30:434-8. [PMID: 22065238 DOI: 10.1007/s00774-011-0331-3] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2011] [Accepted: 10/12/2011] [Indexed: 11/25/2022]
Abstract
Over recent years, several reports have been published on unusual cases of osteonecrosis of the jaw (ONJ) in adults using second- and third-generation nitrogen-containing bisphosphonates such as pamidronate, alendronate, risedronate and zoledronate, but no case has ever been reported either in children or in adult patients taking neridronate. Children and adolescents affected by osteogenesis imperfecta (OI) could belong to a high-risk group for ONJ because bone fragility in OI is associated with a connective tissue malfunction. The purpose of this study is to evaluate the incidence of ONJ in a pediatric population treated with neridronate for OI. A total of 102 pediatric patients with OI who received neridronate infusions for a mean of 6.81 years (SD ± 3.06 years) were clinically assessed for possible ONJ. Eligibility criteria for participation included patients between 1.2 and 24 years old who received cyclical neridronate infusions for at least 1 year. All the patients were reviewed to determine duration, dosage and cumulative dose of their bisphosphonate therapy and were examined clinically to assess their oral health status. We have not demonstrated any occurrence of ONJ in our patients. In conclusion, at the moment insufficient data are available to prove a greater risk of ONJ in children with OI than in children affected by other forms of bone fragility. However, cases may emerge in future because the risk of ONJ seems to be related to the cumulative dose and the duration of therapy.
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Affiliation(s)
- Evelina Maines
- Department of Life Sciences and Reproduction Sciences, Pediatric Clinic, University of Verona, General Hospital Giambattista Rossi, Piazzale Ludovico Antonio Scuro 10, 37134 Verona, Italy.
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Kühl S, Walter C, Acham S, Pfeffer R, Lambrecht JT. Bisphosphonate-related osteonecrosis of the jaws--a review. Oral Oncol 2012; 48:938-947. [PMID: 22525606 DOI: 10.1016/j.oraloncology.2012.03.028] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2012] [Revised: 03/27/2012] [Accepted: 03/28/2012] [Indexed: 01/25/2023]
Abstract
The aim was to evaluate the knowledge about bisphosphonate-related osteonecrosis of the jaws (BRONJ). A bibliographic search in Medline, PubMed and the Cochrane Register of controlled clinical trials was performed between 2003 and 2010 by using the terms bisphosphonate and osteonecrosis of the jaw. The amount of publications per year, the type of journal for publication, and the evidence level of the trial were evaluated. Next to this the incidences and the success of treatment strategies for BRONJ were identified. A total of 671 publications were reviewed. Since 2006 more than 100 publications on BRONJ per year (with an upward trend) have been published, mostly in dental journals. The evidence level could be determined for 176 publications and only one grade Ia study was found. The studies showed a wide variety in design, most of them being retrospective. The incidence of BRONJ is strongly dependent on oral or intravenous application and varies between 0.0% and 27.5%. There is no scientific data to sufficiently support any specific treatment protocol for the management of BRONJ. Further clinical studies are needed to evaluate the incidence and treatment strategies at a higher level of evidence. Therefore uniform study protocols would be favourable.
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Affiliation(s)
- Sebastian Kühl
- School of Dental Medicine, Department of Oral Surgery, Oral Radiology and Oral Medicine, University of Basel, Hebelstrasse 3, CH-4056 Basel, Switzerland.
| | - Christian Walter
- University Medical Center Mainz, Department of Oral and Maxillofacial Surgery, Augustusplatz 2, 55131 Mainz, Germany
| | - Stephan Acham
- School of Dental Medicine, Department of Oral Surgery, Oral Radiology, University of Graz, Auenbruggerplatz 12, 8036 Graz, Austria
| | - Roland Pfeffer
- School of Dental Medicine, Department of Oral Surgery, Oral Radiology and Oral Medicine, University of Basel, Hebelstrasse 3, CH-4056 Basel, Switzerland
| | - J Thomas Lambrecht
- School of Dental Medicine, Department of Oral Surgery, Oral Radiology and Oral Medicine, University of Basel, Hebelstrasse 3, CH-4056 Basel, Switzerland
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Vital SO, Gaucher C, Bardet C, Rowe P, George A, Linglart A, Chaussain C. Tooth dentin defects reflect genetic disorders affecting bone mineralization. Bone 2012; 50:989-97. [PMID: 22296718 PMCID: PMC3345892 DOI: 10.1016/j.bone.2012.01.010] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2011] [Revised: 01/06/2012] [Accepted: 01/14/2012] [Indexed: 01/27/2023]
Abstract
Several genetic disorders affecting bone mineralization may manifest during dentin mineralization. Dentin and bone are similar in several aspects, especially pertaining to the composition of the extracellular matrix (ECM) which is secreted by well-differentiated odontoblasts and osteoblasts, respectively. However, unlike bone, dentin is not remodelled and is not involved in the regulation of calcium and phosphate metabolism. In contrast to bone, teeth are accessible tissues with the shedding of deciduous teeth and the extractions of premolars and third molars for orthodontic treatment. The feasibility of obtaining dentin makes this a good model to study biomineralization in physiological and pathological conditions. In this review, we focus on two genetic diseases that disrupt both bone and dentin mineralization. Hypophosphatemic rickets is related to abnormal secretory proteins involved in the ECM organization of both bone and dentin, as well as in the calcium and phosphate metabolism. Osteogenesis imperfecta affects proteins involved in the local organization of the ECM. In addition, dentin examination permits evaluation of the effects of the systemic treatment prescribed to hypophosphatemic patients during growth. In conclusion, dentin constitutes a valuable tool for better understanding of the pathological processes affecting biomineralization.
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Affiliation(s)
- S. Opsahl Vital
- Dental School University Paris Descartes PRES Sorbonne Paris Cité, EA 2496, Montrouge, F-92120, France
- AP-HP, Odontology Department, Hôpitaux Universitaires Paris Nord Val de Seine (Bretonneau- Louis Mourier), F-75018, France
- Centre de référence des maladies rares du métabolisme du phosphore et du calcium, Kremlin Bicêtre, AP-HP, F-94275, France
| | - C. Gaucher
- Dental School University Paris Descartes PRES Sorbonne Paris Cité, EA 2496, Montrouge, F-92120, France
- AP-HP, Odontology Department, Hôpital Albert Chennevier, Créteil, F-94010, France
- Centre de référence des maladies rares du métabolisme du phosphore et du calcium, Kremlin Bicêtre, AP-HP, F-94275, France
| | - C. Bardet
- Dental School University Paris Descartes PRES Sorbonne Paris Cité, EA 2496, Montrouge, F-92120, France
| | - P.S. Rowe
- The Kidney Institute, University of Kansas Medical Center, Kansas City, KS, USA
| | - A. George
- Department of Oral Biology, University of Illinois in Chicago, Illinois 60612, USA
| | - A. Linglart
- Inserm, U986 Hôpital St Vincent de Paul AP-HP, Paris, F-75014, France
- Centre de référence des maladies rares du métabolisme du phosphore et du calcium, Kremlin Bicêtre, AP-HP, F-94275, France
| | - C. Chaussain
- Dental School University Paris Descartes PRES Sorbonne Paris Cité, EA 2496, Montrouge, F-92120, France
- AP-HP, Odontology Department, Hôpitaux Universitaires Paris Nord Val de Seine (Bretonneau- Louis Mourier), F-75018, France
- Centre de référence des maladies rares du métabolisme du phosphore et du calcium, Kremlin Bicêtre, AP-HP, F-94275, France
- Corresponding author at: Dental school University Paris Descartes PRES Sorbonne Paris Cité, EA 2496, Montrouge, France 2120. Fax: +33 158076724. (C. Chaussain)
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Wipff J, Adamsbaum C, Kahan A, Job-Deslandre C. Chronic recurrent multifocal osteomyelitis. Joint Bone Spine 2011; 78:555-60. [DOI: 10.1016/j.jbspin.2011.02.010] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2011] [Indexed: 11/29/2022]
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Öztürk F, Babacan H, İnan S, Gümüş C. Effects of bisphosphonates on sutural bone formation and relapse: A histologic and immunohistochemical study. Am J Orthod Dentofacial Orthop 2011; 140:e31-41. [DOI: 10.1016/j.ajodo.2010.11.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2010] [Revised: 11/01/2010] [Accepted: 11/01/2010] [Indexed: 10/14/2022]
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Abstract
A new paradigm has emerged for osteogenesis imperfecta as a collagen-related disorder. The more prevalent autosomal dominant forms of osteogenesis imperfecta are caused by primary defects in type I collagen, whereas autosomal recessive forms are caused by deficiency of proteins which interact with type I procollagen for post-translational modification and/or folding. Factors that contribute to the mechanism of dominant osteogenesis imperfecta include intracellular stress, disruption of interactions between collagen and noncollagenous proteins, compromised matrix structure, abnormal cell-cell and cell-matrix interactions and tissue mineralization. Recessive osteogenesis imperfecta is caused by deficiency of any of the three components of the collagen prolyl 3-hydroxylation complex. Absence of 3-hydroxylation is associated with increased modification of the collagen helix, consistent with delayed collagen folding. Other causes of recessive osteogenesis imperfecta include deficiency of the collagen chaperones FKBP10 or Serpin H1. Murine models are crucial to uncovering the common pathways in dominant and recessive osteogenesis imperfecta bone dysplasia. Clinical management of osteogenesis imperfecta is multidisciplinary, encompassing substantial progress in physical rehabilitation and surgical procedures, management of hearing, dental and pulmonary abnormalities, as well as drugs, such as bisphosphonates and recombinant human growth hormone. Novel treatments using cell therapy or new drug regimens hold promise for the future.
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Affiliation(s)
- Antonella Forlino
- Bone and Extracellular Matrix Branch, NICHD, NIH, Bethesda, USA
- Department of Biochemistry, Section of Medicine and Pharmacy, University of Pavia, Italy
| | - Wayne A. Cabral
- Bone and Extracellular Matrix Branch, NICHD, NIH, Bethesda, USA
| | | | - Joan C. Marini
- Bone and Extracellular Matrix Branch, NICHD, NIH, Bethesda, USA
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Ozturk F, Babacan H, Gumus C. Effects of zoledronic acid on sutural bone formation: a computed tomography study. Eur J Orthod 2011; 34:141-6. [DOI: 10.1093/ejo/cjq160] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Huja SS, Mason A, Fenell CE, Mo X, Hueni S, D'Atri AM, Fernandez SA. Effects of Short-Term Zoledronic Acid Treatment on Bone Remodeling and Healing at Surgical Sites in the Maxilla and Mandible of Aged Dogs. J Oral Maxillofac Surg 2011; 69:418-27. [DOI: 10.1016/j.joms.2010.05.062] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2009] [Revised: 04/14/2010] [Accepted: 05/06/2010] [Indexed: 10/18/2022]
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Borromeo GL, Tsao CE, Darby IB, Ebeling PR. A review of the clinical implications of bisphosphonates in dentistry. Aust Dent J 2010; 56:2-9. [PMID: 21332734 DOI: 10.1111/j.1834-7819.2010.01283.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Bisphosphonates are drugs that suppress bone turnover and are commonly prescribed to prevent skeletal related events in malignancy and for benign bone diseases such as osteoporosis. Bisphosphonate associated jaw osteonecrosis (ONJ) is a potentially debilitating, yet poorly understood condition. A literature review was undertaken to review the dental clinical implications of bisphosphonates. The present paper briefly describes the postulated pathophysiology of ONJ and conditions with similar clinical presentations. The implications of bisphosphonates for implantology, periodontology, orthodontics and endodontics are reviewed. Whilst bisphosphonates have potential positive applications in some clinical settings, periodontology particularly, further clinical research is limited by the risk of ONJ. Prevention and management are reviewed, including guidelines for reducing cumulative intravenous bisphosphonate dose, cessation of bisphosphonates prior to invasive dental treatment or after ONJ development, and the use of serum beta-CTX-1 in assessing risk. In the context of substantial uncertainty, the implications of bisphosphonate use in the dental clinical setting are still being determined.
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Affiliation(s)
- G L Borromeo
- Melbourne Dental School, The University of Melbourne, Victoria, Australia.
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40
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Golden NH. Osteoporosis in anorexia nervosa. Expert Rev Endocrinol Metab 2010; 5:723-732. [PMID: 30764024 DOI: 10.1586/eem.10.52] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Anorexia nervosa is a condition associated with reduced bone mass and increased bone fragility, for which there is no known effective treatment. Anorexia nervosa usually has its onset during adolescence, the critical time when peak bone mass is accrued. Low bone mass is caused by reduced bone formation, as well as accelerated bone resorption. The etiology is multifactorial and includes poor nutrition, low bodyweight, sex hormone deficiency and hypercortisolism. Weight gain and resumption of menses is accompanied by some improvement in bone mass, but may not restore it to normal levels. Oral estrogen-replacement therapy is not effective in increasing bone mass in this disorder. The bisphosphonates, used in conjunction with nutritional rehabilitation and weight gain, have shown promise, but concerns about safety have limited their use. The aim of this article is to highlight recent recommendations regarding the assessment of fracture risk in children and adolescents, summarize the evidence for low bone mass and increased fracture risk in anorexia nervosa, and discuss approaches to the management of low bone mass in this disorder.
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Affiliation(s)
- Neville H Golden
- a Division of Adolescent Medicine, Stanford University School of Medicine, 770 Welch Road, Suite 433, Palo Alto, CA 94034, USA.
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41
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Yoneda T, Hagino H, Sugimoto T, Ohta H, Takahashi S, Soen S, Taguchi A, Toyosawa S, Nagata T, Urade M. Bisphosphonate-related osteonecrosis of the jaw: position paper from the Allied Task Force Committee of Japanese Society for Bone and Mineral Research, Japan Osteoporosis Society, Japanese Society of Periodontology, Japanese Society for Oral and Maxillofacial Radiology, and Japanese Society of Oral and Maxillofacial Surgeons. J Bone Miner Metab 2010; 28:365-83. [PMID: 20333419 DOI: 10.1007/s00774-010-0162-7] [Citation(s) in RCA: 209] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2009] [Accepted: 01/13/2010] [Indexed: 11/30/2022]
Abstract
Bisphosphonates (BPs) have been widely, efficiently, and safely used for the treatment of osteoporosis, malignant hypercalcemia, bone metastasis of solid cancers, and multiple myeloma bone diseases. Accumulating recent reports describe that surgical dental treatments in patients with cancer or osteoporosis who have been receiving intravenous or oral BPs are associated with osteonecrosis of the jaw (bisphosphonate-related osteonecrosis of the jaw, BRONJ). The accurate incidence, clinical backgrounds, and pathogenesis of BRONJ have been unclear and appropriate approaches for prevention and treatment have not been established to date. To address the current situation of BRONJ in Japan, the "Allied Task Force Committee of Bisphosphonate-Related Osteonecrosis of the Jaw," consisting of physicians specializing in bone biology, orthopedic surgery, rheumatology, obstetrics/gynecology, and medical oncology and dentists specializing in oral surgery, periodontology, dental radiology, and oral pathology, was organized. The committee attempted to propose a standard position paper for the treatment of BRONJ. The committee expects that this proposal will provide objective and correct scientific information on BRONJ and will serve as a reference for conducting dental procedures for patients receiving BPs and in designing prevention and treatment of BRONJ. However, because this position paper is not based on direct clinical evidence, it should be used as a reference, and a decision on treatment in each case should be made after an extensive discussion among physicians, dentists/oral surgeons, and the patients.
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Affiliation(s)
- Toshiyuki Yoneda
- Department of Biochemistry, Osaka University Graduate School of Dentistry, 1-8 Yamadaoka, Suita, Osaka 565-0871, Japan.
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42
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Kos M, Kuebler JF, Luczak K, Engelke W. Bisphosphonate-related osteonecrosis of the jaws: A review of 34 cases and evaluation of risk. J Craniomaxillofac Surg 2010; 38:255-9. [DOI: 10.1016/j.jcms.2009.06.005] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2008] [Revised: 06/01/2009] [Accepted: 06/05/2009] [Indexed: 11/26/2022] Open
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Hiraga T, Ninomiya T, Hosoya A, Nakamura H. Administration of the bisphosphonate zoledronic acid during tooth development inhibits tooth eruption and formation and induces dental abnormalities in rats. Calcif Tissue Int 2010; 86:502-10. [PMID: 20411381 DOI: 10.1007/s00223-010-9366-z] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2009] [Accepted: 04/03/2010] [Indexed: 02/04/2023]
Abstract
Bisphosphonates (BPs) are potent inhibitors of osteoclastic bone resorption and widely used for the treatment of osteoporosis and metastatic bone diseases. Recently, BPs have also been shown to benefit children with primary and secondary osteoporosis, including osteogenesis imperfecta; however, their long-term safety has not been established yet. Clinical and experimental studies have demonstrated that BPs delay or inhibit tooth eruption. The failure of tooth eruption causes several dental abnormalities. In this study, to determine the effects of BPs on tooth formation, the BP zoledronic acid (ZOL) was injected into 7- and 14-day-old rats, and the development of the mandibular teeth was examined. X-ray analysis demonstrated that ZOL inhibited the eruption of both incisors and molars and their formation, especially in the molar roots. Histological examination showed that, in ZOL-treated animals, alveolar bone remained unresorbed around tooth crowns, which injured ameloblasts and enamel matrix, leading to defects of the enamel. Furthermore, haphazard proliferation of odontogenic epithelium and mesenchyme associated with primitive tooth structures, which resembles human odontomas, was induced at the basal end of incisors but not around the molars. Tooth ankylosis to alveolar bone was occasionally observed in molars. These results suggest that administration of BPs during tooth development has the potential to inhibit tooth eruption and formation and to induce several types of dental abnormalities, which may be attributed to the altered osteoclastic activities.
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Affiliation(s)
- Toru Hiraga
- Department of Histology and Cell Biology, Matsumoto Dental University, 1780 Gobara-Hirooka, Shiojiri, Nagano, Japan.
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Ward LM, Petryk A, Gordon CM. Use of bisphosphonates in the treatment of pediatric osteoporosis. ACTA ACUST UNITED AC 2009. [DOI: 10.2217/ijr.09.58] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Uziel Y, Zifman E, Hashkes PJ. Osteoporosis in children: pediatric and pediatric rheumatology perspective: a review. Pediatr Rheumatol Online J 2009; 7:16. [PMID: 19835571 PMCID: PMC2768686 DOI: 10.1186/1546-0096-7-16] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2009] [Accepted: 10/16/2009] [Indexed: 11/18/2022] Open
Abstract
It is increasingly recognized that osteoporosis affects children as well as adults both as a primary problem and as secondary to various diseases, medications, and lifestyle issues. In this review, we emphasize the correct diagnosis of osteoporosis in children as opposed to adults, etiology, and pharmaceutical and non-pharmaceutical treatments. We especially focus on rheumatologic conditions associated with osteoporosis and management issues.
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Affiliation(s)
- Yosef Uziel
- Pediatric Rheumatology Unit, Pediatric Department, Meir Medical Center, Kfar Saba, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eyal Zifman
- Pediatric Rheumatology Unit, Pediatric Department, Meir Medical Center, Kfar Saba, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Philip J Hashkes
- Section of Pediatric Rheumatology, Dept of Rheumatic Diseases, Cleveland Clinic Foundation, Cleveland OH, USA
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46
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Huja SS, Fernandez SA, Phillips C, Li Y. Zoledronic acid decreases bone formation without causing osteocyte death in mice. Arch Oral Biol 2009; 54:851-6. [PMID: 19591974 DOI: 10.1016/j.archoralbio.2009.06.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2009] [Revised: 05/11/2009] [Accepted: 06/02/2009] [Indexed: 11/17/2022]
Abstract
Bisphosphonates have been associated with osteonecrosis of the jaw. The purpose of this study was to examine the effect of a potent bisphosphonate, zoledronic acid (ZA) on osteocyte viability and bone formation. Ten experimental C57BL/6 mice were administered ZA (0.1 mg/kg-i.p.) weekly for 9 weeks while four control mice did not receive the drug. A pair of calcein (30 mg/kg) labels was administered 10 and 3 days prior to sacrifice of the 34-week-old mice. Fresh mandibular and femoral sections were obtained to evaluate osteocyte viability using a lactate dehydrogenase (LDH) assay. In addition, sections from the femur, mandible and maxilla were prepared for standard histomorphometry. The operator was blinded for data collection to eliminate bias. Data on necrotic area/total bone area from the LDH sections were collected. In addition, standard histomorphometric variables including bone formation rate were calculated. Mixed models were used to analyse data. The osteocytes were overwhelmingly viable and no necrotic areas were detected in the mandible and femur of both groups. ZA was not directly cytotoxic to the mouse osteocytes. There was suppression in indices of bone formation at all skeletal sites of the ZA group compared to the control group. While ZA administration in mice does not produce necrotic osteocytes, it severely suppresses bone formation. Such reductions can have a profound effect on bone healing.
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Affiliation(s)
- S S Huja
- Division of Orthodontics, College of Dentistry, The Ohio State University, 305 W. 12th St., Columbus, OH 43210, USA.
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47
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Allen MR, Burr DB. The pathogenesis of bisphosphonate-related osteonecrosis of the jaw: so many hypotheses, so few data. J Oral Maxillofac Surg 2009; 67:61-70. [PMID: 19371816 DOI: 10.1016/j.joms.2009.01.007] [Citation(s) in RCA: 296] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2008] [Accepted: 01/20/2009] [Indexed: 11/20/2022]
Abstract
Bisphosphonate-related osteonecrosis of the jaw (BRONJ) has generated great interest in the medical and research communities yet remains an enigma, given its unknown pathogenesis. The goal of this review is to summarize the various proposed hypotheses underlying BRONJ. Although a role of the oral mucosa has been proposed, the bone is likely the primary tissue of interest for BRONJ. The most popular BRONJ hypothesis-manifestation of necrotic bone resulting from bisphosphonate--induced remodeling suppression--is supported mostly by indirect evidence, although recent data have shown that bisphosphonates significantly reduce remodeling in the jaw. Remodeling suppression would be expected, and has been shown, to allow accumulation of nonviable osteocytes, whereas a more direct cytotoxic effect of bisphosphonates on osteocytes has also been proposed. Bisphosphonates have antiangiogenic effects, leading to speculation that this could contribute to the BRONJ pathogenesis. Compromised angiogenesis would most likely be involved in post-intervention healing, although other aspects of the vasculature (eg, blood flow) could contribute to BRONJ. Despite infection being present in many BRONJ patients, there is no clear evidence as to whether infection is a primary or secondary event in the pathophysiology. In addition to these main factors proposed in the pathogenesis, numerous cofactors associated with BRONJ (eg, diabetes, smoking, dental extraction, concurrent medications) could interact with bisphosphonates and affect remodeling, angiogenesis/blood flow, and/or infection. Because our lack of knowledge concerning BRONJ pathogenesis results from a lack of data, it is only through the initiation of hypothesis-driven studies that significant progress will be made to understand this serious and debilitating condition.
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Affiliation(s)
- Matthew R Allen
- Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis, IN 46202, USA.
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48
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Landesberg R, Eisig S, Fennoy I, Siris E. Alternative indications for bisphosphonate therapy. J Oral Maxillofac Surg 2009; 67:27-34. [PMID: 19371812 DOI: 10.1016/j.joms.2008.12.006] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2008] [Accepted: 12/16/2008] [Indexed: 12/22/2022]
Abstract
Bisphosphonates are currently used in the treatment of osteoporosis (postmenopausal and steroid-induced), hypercalcemia of malignancy, Paget's disease of bone, multiple myeloma, and skeletally related events associated with metastatic bone disease in breast, prostate, lung, and other cancers. There are, however, numerous other conditions where a decrease in bone remodeling by bisphosphonates might aid in disease management. The focus of this review will be to discuss a select group of conditions for which bisphosphonate therapy may be efficacious. In this review we present several cases where bisphosphonates have been used as a primary or adjunctive treatment for giant cell lesions of the jaws. Use of bisphosphonate therapy for giant cell tumors of the appendicular skeleton, pediatric osteogenesis imperfecta, fibrous dysplasia, Gaucher's disease, and osteomyelitis will be discussed. Finally, we will review previous in vivo studies on the use of bisphosphonates to augment integration and to treat osteolysis surrounding failing orthopedic implants.
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Affiliation(s)
- Regina Landesberg
- Division of Oral and Maxillofacial Surgery, University of Connecticut Health Center, School of Dental Medicine, Farmington, CT 06032, USA.
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49
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50
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Osteogenesis imperfecta: Recent findings shed new light on this once well-understood condition. Genet Med 2009; 11:375-85. [DOI: 10.1097/gim.0b013e3181a1ff7b] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
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