Comparison of the prognosis of bisphosphonate-related osteonecrosis of the jaw caused by oral and intravenous bisphosphonates

Bisphosphonates (BPs) have been used in medical practice for the treatment of osteoporosis, bone metastasis, and multiple myeloma. Although many studies have been published, the treatment and prognosis of bisphosphonate-related osteonecrosis of the jaw (BRONJ) remain unclear. This study included 59 patients with BRONJ: 29 had taken oral BPs and 30 had taken intravenous (IV) BPs. All received conservative treatments. When separated sequestra were seen, a sequestrectomy was performed. Segmental mandibular resection was performed when pathological fractures were diagnosed. The outcomes of treatments were compared between groups. For patients treated with oral rinses or mandibular resection, the number in whom clinical healing was observed did not differ between the oral BP and IV BP groups. With regard to sequestrectomy, 94% of patients in the oral BP group showed improvement with this treatment compared to 50% in the IV BP group. The number of patients in whom clinical healing of BRONJ was achieved was statistically better in the oral BP group than in the IV BP group after 6 months of treatment (P<0.001). The results showed that >90% of patients treated with oral BPs could be cured. However, 50% of patients treated with IV BPs did not show an improvement. Additional research is needed to further increase the therapeutic efficacy for the resolution of BRONJ.

Use of ibandronate in the prevention of skeletal events in metastatic breast cancer

Bone metastasis from breast cancer often cause significant morbidity including pain, impaired mobility, pathological fracture, and spinal cord compression. Bisphosphonates play an important role in preventing these skeletal related events and are the standard of care for patients with bone metastasis from breast cancer. Ibandronate is a highly potent bisphosphonate available in both intravenous and oral preparations. It has been shown in clinical trials to be effective in reducing skeletal complications and also significantly improve quality of life up to 96 weeks. Unlike other intravenous bisphosphonates, ibandronate has minimal renal toxicity, allowing safe outpatient administration, reducing the need for hospital attendance and safety monitoring. Early trials have shown ibandronate may also be effective in high doses for palliation of opioid-resistant pain from bone metastasis, and as a second-line agent in patients developing a skeletal complication whilst receiving another bisphosphonate.

Predictors of oral bisphosphonate prescriptions in post-menopausal women with osteoporosis in a real-world setting in the USA

SUMMARY

We identified factors associated with oral bisphosphonate treatment in 50+-year-old female patients with a first fracture, osteoporosis diagnosis, or BMD < or =-2.5 in the Geisinger Health System electronic health record database. Treatment was positively associated with age, oral corticosteroids, and smoking, and negatively associated with body mass index and bone mineral density scores.

INTRODUCTION

To identify factors associated with oral bisphosphonate treatment in patients with an indicator for post-menopausal osteoporosis.

METHODS

Females age 50+ years with a first fracture, osteoporosis diagnosis, or bone mineral density (BMD) < or =-2.5 (index date) were identified in the Geisinger Health System electronic health record database. Treatment was defined as an oral bisphosphonate prescription order (risedronate sodium, ibandronate sodium, or alendronate) < or =90 days post-index date. Treatment rates were assessed and a multivariate logistic model was used to identify predictors of treatment separately for patients with fracture (FRAC) and with diagnosis or low BMD (ICD-9-BMD).

RESULTS

The FRAC group had 2,003 female patients with a mean (SD) age of 69.0 (+/-11.3) years and the ICD-9-BMD group had 12,976 female patients with a mean (SD) age of 66.9 (+/-10.0) years. Within 90 days of the index date of fracture, diagnosis, or low BMD score, 188 (9.4%) patients in the FRAC group and 5,395 (41.6%) in the ICD-9-BMD group received treatment. Treatment was positively associated with age and oral corticosteroids and negatively associated with body mass index and subsequent BMD in both groups. Smoking currently was positively associated with treatment in the ICD-9-BMD group.

CONCLUSION

Certain patient characteristics are predictors of physicians prescribing oral bisphosphonates. However, many patients remain untreated.