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Clark A, Pretty I. Up to 7% of referrals to oral and maxillofacial surgery are related to medication-related osteonecrosis of the jaws: how much is really out there? BDJ Open 2022; 8:5. [PMID: 35194020 PMCID: PMC8863808 DOI: 10.1038/s41405-022-00097-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 11/30/2021] [Accepted: 12/06/2021] [Indexed: 12/02/2022] Open
Abstract
Introduction Medication-related osteonecrosis of the jaws (MRONJ) is generally described as rare; therefore, firm incidence data are challenging to ascertain. Aim Using two sites in Northwest England, ascertain the number of referrals to oral and maxillofacial surgery involving: Suspected MRONJ. Patients at risk of MRONJ requiring a dentoalveolar procedure.
Method All sequential referrals over a 2-year period were analysed. The referrals were categorised into ‘type’ of referral (stage 1). Any referral for MRONJ, or patient at risk, was then further examined (stage 2). Results A total of 2150 referrals were screened. The most common referral reasons were temporomandibular joint issues and hard tissue conditions. The proportion of referrals for suspected MRONJ was similar for both sites: 3.7% (site 1) and 3.4% (site 2). At site 1, 1.6% of all referrals were at risk of MRONJ referred for treatment. In site 2, 3.8% of all referrals were in this category. Conclusion Despite limitations, the finding that patients with or at risk of MRONJ potentially equates to 7% of all referrals represents a substantial proportion of OMFS practice. Therefore, there are clear benefits of collecting accurate data prospectively to understand the scale of this condition and its impact on services.
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Elting LS, Chang YC. Costs of Oral Complications of Cancer Therapies: Estimates and a Blueprint for Future Study. J Natl Cancer Inst Monogr 2020; 2019:5551358. [PMID: 31425598 DOI: 10.1093/jncimonographs/lgz010] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 02/04/2019] [Accepted: 05/01/2019] [Indexed: 11/13/2022] Open
Abstract
Oral complications of cancer treatment are common; however, their clinical and economic importance is often underappreciated. We reviewed the literature on the economic implications of oral complications, updating a previous report in the predecessor to this issue. We searched the Medline and Scopus databases for papers published as of December 31, 2017 that described the economic consequences of preventing and managing oral complications and reviewed the literature reporting the costs of oral mucositis, xerostomia, and osteonecrosis. Cost estimates were inflated to 2017 US dollars. We identified 16 papers describing the cost of managing mucositis, eight describing the cost of osteoradionecrosis, one describing the cost of bisphosphonate-associate osteonecrosis of the jaw, and four describing the cost of xerostomia. The incremental cost of oral mucositis was approximately $5000-$30 000 among patients receiving radiation therapy and $3700 per cycle among patients receiving chemotherapy. The incremental cost of mucositis-related hospitalization among stem cell transplant recipients exceeded $70 000. Conservative management of osteoradionecrosis (antibiotics, debridement) costs $4000-$35 000, although estimates as high as $74 000 have been reported. Hyperbaric oxygen therapy may add $10 000-$50 000 to the cost of therapy. Sialogogues are required for years for the management of xerostomia at a cost of $40-$200 per month. Serious (hospitalization, hyperbaric oxygen therapy) or long-term (sialogogues) outcomes are the major drivers of cost. Future research should address patients' out-of-pocket costs and the costs of oral complications of new treatments. Multisite studies, particularly those conducted by cooperative groups, should be prioritized.
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Affiliation(s)
- Linda S Elting
- Department of Health Services Research, University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - Yu-Chia Chang
- Department of Health Services Research, University of Texas M. D. Anderson Cancer Center, Houston, TX
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Yarom N, Shapiro CL, Peterson DE, Van Poznak CH, Bohlke K, Ruggiero SL, Migliorati CA, Khan A, Morrison A, Anderson H, Murphy BA, Alston-Johnson D, Mendes RA, Beadle BM, Jensen SB, Saunders DP. Medication-Related Osteonecrosis of the Jaw: MASCC/ISOO/ASCO Clinical Practice Guideline. J Clin Oncol 2019; 37:2270-2290. [PMID: 31329513 DOI: 10.1200/jco.19.01186] [Citation(s) in RCA: 179] [Impact Index Per Article: 35.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To provide guidance regarding best practices in the prevention and management of medication-related osteonecrosis of the jaw (MRONJ) in patients with cancer. METHODS Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology (MASCC/ISOO) and ASCO convened a multidisciplinary Expert Panel to evaluate the evidence and formulate recommendations. Guideline development involved a systematic review of the literature and a formal consensus process. PubMed and EMBASE were searched for studies of the prevention and management of MRONJ related to bone-modifying agents (BMAs) for oncologic indications published between January 2009 and December 2017. Results from an earlier systematic review (2003 to 2008) were also included. RESULTS The systematic review identified 132 publications, only 10 of which were randomized controlled trials. Recommendations underwent two rounds of consensus voting. RECOMMENDATIONS Currently, MRONJ is defined by (1) current or previous treatment with a BMA or angiogenic inhibitor, (2) exposed bone or bone that can be probed through an intraoral or extraoral fistula in the maxillofacial region and that has persisted for longer than 8 weeks, and (3) no history of radiation therapy to the jaws or metastatic disease to the jaws. In patients who initiate a BMA, preventive care includes comprehensive dental assessments, discussion of modifiable risk factors, and avoidance of elective dentoalveolar surgery (ie, surgery that involves the teeth or contiguous alveolar bone) during BMA treatment. It remains uncertain whether BMAs should be discontinued before dentoalveolar surgery. Staging of MRONJ should be performed by a clinician with experience in the management of MRONJ. Conservative measures comprise the initial approach to MRONJ treatment. Ongoing collaboration among the dentist, dental specialist, and oncologist is essential to optimal patient care.
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Affiliation(s)
- Noam Yarom
- Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.,Tel Aviv University, Tel Aviv, Israel
| | | | | | | | - Kari Bohlke
- American Society of Clinical Oncology, Alexandria, VA
| | - Salvatore L Ruggiero
- Hofstra North Shore-LIJ School of Medicine, Hempstead, NY.,Stony Brook School of Dental Medicine, Stony Brook, NY.,New York Center for Orthognathic and Maxillofacial Surgery, New York, NY
| | | | - Aliya Khan
- McMaster University, Hamilton, Ontario, Canada
| | - Archie Morrison
- Dalhousie University, Halifax, Nova Scotia, Canada.,Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
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Thomas C, Bartsch G, Walter C, Borgmann H, Brandt MP, Höfner T, Haferkamp A, Tsaur I. Advantages and Disadvantages of Bone Protective Agents in Metastatic Prostate Cancer: Lessons Learned. Dent J (Basel) 2016; 4:dj4030028. [PMID: 29563470 PMCID: PMC5806937 DOI: 10.3390/dj4030028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 07/30/2016] [Accepted: 08/17/2016] [Indexed: 11/16/2022] Open
Abstract
Nine out of ten metastatic prostate cancer (PCa) patients will develop osseous metastases. Of these, every second will suffer from skeletal-related events (SRE). SRE are associated with an increased risk for death, which is markedly increased in the presence of pathological fracture. Moreover, health insurance costs nearly double in the presence of SRE. Zoledronic acid and denosumab are both approved drugs for the prevention or delay of SRE in castration-resistant prostate cancer (CRPC) patients with osseous metastases. However, long-term treatment with one of these two drugs is associated with the development of medication-related osteonecrosis of the jaw (MRONJ). Routine inspections of the oral cavity before and during treatment are mandatory in these patients. Regarding imaging techniques, bone scintigraphy seems to be a promising tool to detect early stage MRONJ. Zoledronic acid does not reduce the incidence of SRE in hormone-sensitive PCa. First data shows 3-monthly application of zoledronic acid to be equi-effective to monthly application.
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Affiliation(s)
- Christian Thomas
- Department of Urology, University of Mainz, Langenbeckstraße 1, 55131 Mainz, Germany.
| | - Georg Bartsch
- Department of Urology, University of Mainz, Langenbeckstraße 1, 55131 Mainz, Germany.
| | - Christian Walter
- Department of Maxillofacial Surgery, University of Mainz, 55131 Mainz, Germany.
| | - Hendrik Borgmann
- Department of Urology, University of Mainz, Langenbeckstraße 1, 55131 Mainz, Germany.
| | | | - Thomas Höfner
- Department of Urology, University of Mainz, Langenbeckstraße 1, 55131 Mainz, Germany.
| | - Axel Haferkamp
- Department of Urology, University of Mainz, Langenbeckstraße 1, 55131 Mainz, Germany.
| | - Igor Tsaur
- Department of Urology, University of Mainz, Langenbeckstraße 1, 55131 Mainz, Germany.
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Ceponis P, Keilman C, Guerry C, Freiberger JJ. Hyperbaric oxygen therapy and osteonecrosis. Oral Dis 2016; 23:141-151. [PMID: 27062390 DOI: 10.1111/odi.12489] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 03/24/2016] [Indexed: 12/18/2022]
Abstract
Osteonecrosis of the jaw may be caused by radiation, medication, or infection. Optimal therapy requires a multimodal approach that combines surgery with adjuvant treatments. This review focuses on the use of adjunctive hyperbaric oxygen therapy for this condition. In addition to evidence regarding the basic and clinical science behind hyperbaric oxygen therapy, controversies in the field and economic implications are discussed.
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Affiliation(s)
- P Ceponis
- Hyperbaric Division, Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA.,Royal Canadian Medical Service, Canadian Armed Forces, Ottawa, ON, Canada
| | - C Keilman
- Hyperbaric Division, Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA
| | - C Guerry
- Hyperbaric Division, Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA
| | - J J Freiberger
- Hyperbaric Division, Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA
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Kiyama T, Tsuchiya M, Okada S, Oizumi T, Yamaguchi K, Sasaki K, Sugawara S, Endo Y. Phosphonocarboxylates Can Protect Mice against the Inflammatory and Necrotic Side Effects of Nitrogen-Containing Bisphosphonates by Inhibiting Their Entry into Cells via Phosphate Transporters. Biol Pharm Bull 2016; 39:712-20. [DOI: 10.1248/bpb.b15-00770] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Tomomi Kiyama
- Division of Oral Molecular Regulation, Graduate School of Dentistry, Tohoku University
- Division of Advanced Prosthetic Dentistry, Graduate School of Dentistry, Tohoku University
| | - Masahiro Tsuchiya
- Division of Aging and Geriatric Dentistry, Graduate School of Dentistry, Tohoku University
| | - Satoru Okada
- Division of Oral Molecular Regulation, Graduate School of Dentistry, Tohoku University
| | - Takefumi Oizumi
- Division of Oral Molecular Regulation, Graduate School of Dentistry, Tohoku University
| | - Kouji Yamaguchi
- Division of Oral Molecular Regulation, Graduate School of Dentistry, Tohoku University
| | - Keiichi Sasaki
- Division of Advanced Prosthetic Dentistry, Graduate School of Dentistry, Tohoku University
| | - Shunji Sugawara
- Division of Oral Molecular Regulation, Graduate School of Dentistry, Tohoku University
| | - Yasuo Endo
- Division of Oral Molecular Regulation, Graduate School of Dentistry, Tohoku University
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Solomon DH, Patrick AR, Schousboe J, Losina E. The potential economic benefits of improved postfracture care: a cost-effectiveness analysis of a fracture liaison service in the US health-care system. J Bone Miner Res 2014; 29:1667-74. [PMID: 24443384 PMCID: PMC4176766 DOI: 10.1002/jbmr.2180] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Revised: 01/02/2014] [Accepted: 01/10/2014] [Indexed: 01/13/2023]
Abstract
Fractures related to osteoporosis are associated with $20 billion in cost in the United States, with the majority of cost born by federal health-care programs, such as Medicare and Medicaid. Despite the proven fracture reduction benefits of several osteoporosis treatments, less than one-quarter of patients older than 65 years of age who fracture receive such care. A postfracture liaison service (FLS) has been developed in many health systems but has not been widely implemented in the United States. We developed a Markov state-transition computer simulation model to assess the cost-effectiveness of an FLS using a health-care system perspective. Using the model, we projected the lifetime costs and benefits of FLS, with or without a bone mineral density test, in men and women who had experienced a hip fracture. We estimated the costs and benefits of an FLS, the probabilities of refracture while on osteoporosis treatment, as well as the utilities associated with various health states from published literature. We used multi-way sensitivity analyses to examine impact of uncertainty in input parameters on cost-effectiveness of FLS. The model estimates that an FLS would result in 153 fewer fractures (109 hip, 5 wrist, 21 spine, 17 other), 37.43 more quality-adjusted life years (QALYs), and save $66,879 compared with typical postfracture care per every 10,000 postfracture patients. Doubling the cost of the FLS resulted in an incremental cost-effectiveness ratio (ICER) of $22,993 per QALY. The sensitivity analyses showed that results were robust to plausible ranges of input parameters; assuming the least favorable values of each of the major input parameters results in an ICER of $112,877 per QALY. An FLS targeting patients post-hip fracture should result in cost savings and reduced fractures under most scenarios.
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Affiliation(s)
- Daniel H Solomon
- Division of Rheumatology, Brigham and Women's Hospital, Boston, MA, USA; Division of Pharmacoepidemiology, Brigham and Women's Hospital, Boston, MA, USA
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