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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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A 5-year retrospective cohort study of denosumab induced medication related osteonecrosis of the jaw in osteoporosis patients. Sci Rep 2022; 12:8641. [PMID: 35606457 PMCID: PMC9126865 DOI: 10.1038/s41598-022-11615-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 04/20/2022] [Indexed: 11/08/2022] Open
Abstract
AbstractDenosumab has been suggested as a first-line therapy for osteoporotic patients. However, a standardized protocol for the prevention of denosumab induced medication-related osteonecrosis of the jaw (MRONJ) has not yet been established. The purpose of this study was to report denosumab induced MRONJ cases, and investigate the factors affecting the occurrence of MRONJ in patients who underwent denosumab and invasive dental treatment (especially tooth extraction) between October 2016 and March 2020. Four of the 98 patients developed MRONJ before and after tooth extraction. The participants were divided into two groups: receiving only denosumab (n = 51) and receiving bisphosphonate as first treatment and denosumab as second treatment (n = 47). There was no significant difference between groups in the occurrence of MRONJ and factors affecting MRONJ. Two out of 4 patients developed MRONJ regardless of invasive treatment after denosumab administration and proceeded with extraction; one patient developed MRONJ after denosumab administration and extraction. The other patient underwent a tooth extraction without osteoporosis treatment, and non-identified MRONJ developed after denosumab administration. MRONJ cases reported in this study show that MRONJ can develop as chronic inflammation without invasive dental treatment; therefore, implementing preventive dental treatment before initiating denosumab treatment is necessary to reduce the occurrence of MRONJ.
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Song M. Dental care for patients taking antiresorptive drugs: a literature review. Restor Dent Endod 2019; 44:e42. [PMID: 31799170 PMCID: PMC6875544 DOI: 10.5395/rde.2019.44.e42] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 10/04/2019] [Accepted: 10/09/2019] [Indexed: 12/13/2022] Open
Abstract
Antiresorptive drugs (ARDs), such as bisphosphonates or denosumab, that prevent bone resorption are widely used in patients with osteoporosis or with cancer that has metastasized to the bones. Although osteonecrosis of the jaw (ONJ) is a well-documented complication of ARD use, the benefits ARDs outweigh the complication. Thus, research has focused on finding ways to prevent or reduce the risk of developing ONJ. Dentists, as part of a multi-professional team, have a critical role in preventing ONJ. However, many dentists tend to hesitate to provide dental care to patients with ONJ, or tend to think that it is a problem to be dealt with by oral surgeons. This review gives an overview of ARD-related ONJ and provides the guidelines for dental care in patients taking ARDs to lower the risk of developing ONJ.
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Affiliation(s)
- Minju Song
- Department of Conservative Dentistry, College of Dentistry, Dankook University, Cheonan, Korea
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Wang W, Li M, Luo M, Shen M, Xu C, Xu G, Chen Y, Xia L. Naringenin inhibits osteoclastogenesis through modulation of helper T cells‐secreted IL‐4. J Cell Biochem 2017; 119:2084-2093. [PMID: 28834554 DOI: 10.1002/jcb.26370] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 08/22/2017] [Indexed: 12/22/2022]
Affiliation(s)
- Wengang Wang
- Department of OrthopaedicsThe First Affiliated Hospital of Zhengzhou UniversityZhengzhouHenanP.R. China
| | - Mingjun Li
- Department of OncologyThe First Affiliated Hospital of Zhengzhou UniversityZhengzhouHenanP.R. China
| | - Ming Luo
- Department of OrthopaedicsThe First Affiliated Hospital of Zhengzhou UniversityZhengzhouHenanP.R. China
| | - Mingkui Shen
- Department of OrthopaedicsThe First Affiliated Hospital of Zhengzhou UniversityZhengzhouHenanP.R. China
| | - Chen Xu
- Department of OrthopaedicsThe First Affiliated Hospital of Zhengzhou UniversityZhengzhouHenanP.R. China
| | - Genzhong Xu
- Department of OrthopaedicsThe First Affiliated Hospital of Zhengzhou UniversityZhengzhouHenanP.R. China
| | - Yaokun Chen
- Department of OrthopaedicsThe First Affiliated Hospital of Zhengzhou UniversityZhengzhouHenanP.R. China
| | - Lei Xia
- Department of OrthopaedicsThe First Affiliated Hospital of Zhengzhou UniversityZhengzhouHenanP.R. China
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Hur J, Ghosh A, Kim K, Ta HM, Kim H, Kim N, Hwang HY, Kim KK. Design of a RANK-Mimetic Peptide Inhibitor of Osteoclastogenesis with Enhanced RANKL-Binding Affinity. Mol Cells 2016; 39:316-21. [PMID: 26923188 PMCID: PMC4844938 DOI: 10.14348/molcells.2016.2286] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 01/24/2016] [Accepted: 01/26/2016] [Indexed: 01/28/2023] Open
Abstract
The receptor activator of nuclear factor κB (RANK) and its ligand RANKL are key regulators of osteoclastogenesis and well-recognized targets in developing treatments for bone disorders associated with excessive bone resorption, such as osteoporosis. Our previous work on the structure of the RANK-RANKL complex revealed that Loop3 of RANK, specifically the non-canonical disulfide bond at the tip, performs a crucial role in specific recognition of RANKL. It also demonstrated that peptide mimics of Loop3 were capable of interfering with the function of RANKL in osteoclastogenesis. Here, we reported the structure-based design of a smaller peptide with enhanced inhibitory efficiency. The kinetic analysis and osteoclast differentiation assay showed that in addition to the sharp turn induced by the disulfide bond, two consecutive arginine residues were also important for binding to RANKL and inhibiting osteoclastogenesis. Docking and molecular dynamics simulations proposed the binding mode of the peptide to the RANKL trimer, showing that the arginine residues provide electrostatic interactions with RANKL and contribute to stabilizing the complex. These findings provided useful information for the rational design of therapeutics for bone diseases associated with RANK/RANKL function.
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Affiliation(s)
- Jeonghwan Hur
- Department of Molecular Cell Biology, Sungkyunkwan University School of Medicine, Suwon 440-746,
Korea
| | - Ambarnil Ghosh
- Department of Molecular Cell Biology, Sungkyunkwan University School of Medicine, Suwon 440-746,
Korea
| | - Kabsun Kim
- Department of Pharmacology, Chonnam National University Medical School, Gwangju 501-746,
Korea
| | - Hai Minh Ta
- Department of Molecular Cell Biology, Sungkyunkwan University School of Medicine, Suwon 440-746,
Korea
| | - Hyunju Kim
- Department of Molecular Cell Biology, Sungkyunkwan University School of Medicine, Suwon 440-746,
Korea
| | - Nacksung Kim
- Department of Pharmacology, Chonnam National University Medical School, Gwangju 501-746,
Korea
| | - Hye-Yeon Hwang
- Department of Molecular Cell Biology, Sungkyunkwan University School of Medicine, Suwon 440-746,
Korea
| | - Kyeong Kyu Kim
- Department of Molecular Cell Biology, Sungkyunkwan University School of Medicine, Suwon 440-746,
Korea
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Matsui A, Kurihara J, Morishima H, Suzuki H, Sato S, Yamauchi K, Takahashi T. Medication related osteonecrosis of the jaw (MRONJ): A retrospective survey of a series of patients treated according to the AAOMS guidelines. JOURNAL OF ORAL AND MAXILLOFACIAL SURGERY MEDICINE AND PATHOLOGY 2015. [DOI: 10.1016/j.ajoms.2015.03.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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The role of "bone immunological niche" for a new pathogenetic paradigm of osteoporosis. Anal Cell Pathol (Amst) 2015; 2015:434389. [PMID: 26491648 PMCID: PMC4605147 DOI: 10.1155/2015/434389] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 09/09/2015] [Indexed: 12/13/2022] Open
Abstract
Osteoporosis is characterized by low bone mass and microarchitectural deterioration of bone tissue. The etiology and pathogenetic mechanisms of osteoporosis have not been clearly elucidated. Osteoporosis is linked to bone resorption by the activation of the osteoclastogenic process. The breakdown of homeostasis among pro- and antiosteoclastogenic cells causes unbalanced bone remodeling. The complex interactions among these cells in the bone microenvironment involve several mediators and proinflammatory pathways. Thus, we may consider the bone microenvironment as a complex system in which local and systemic immunity are regulated and we propose to consider it as an "immunological niche." The study of the "bone immunological niche" will permit a better understanding of the complex cell trafficking which regulates bone resorption and disease. The goal of a perfect therapy for osteoporosis would be to potentiate good cells and block the bad ones. In this scenario, additional factors may take part in helping or hindering the proosteoblastogenic factors. Several proosteoblastogenic and antiosteoclastogenic agents have already been identified and some have been developed and commercialized as biological therapies for osteoporosis. Targeting the cellular network of the "bone immunological niche" may represent a successful strategy to better understand and treat osteoporosis and its complications.
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de Molon RS, Shimamoto H, Bezouglaia O, Pirih FQ, Dry SM, Kostenuik P, Boyce RW, Dwyer D, Aghaloo TL, Tetradis S. OPG-Fc but Not Zoledronic Acid Discontinuation Reverses Osteonecrosis of the Jaws (ONJ) in Mice. J Bone Miner Res 2015; 30:1627-40. [PMID: 25727550 PMCID: PMC4995600 DOI: 10.1002/jbmr.2490] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 02/20/2015] [Accepted: 02/24/2015] [Indexed: 11/10/2022]
Abstract
Osteonecrosis of the jaws (ONJ) is a significant complication of antiresorptive medications, such as bisphosphonates and denosumab. Antiresorptive discontinuation to promote healing of ONJ lesions remains highly controversial and understudied. Here, we investigated whether antiresorptive discontinuation alters ONJ features in mice, employing the potent bisphosphonate zoledronic acid (ZA) or the receptor activator of NF-κB ligand (RANKL) inhibitor OPG-Fc, utilizing previously published ONJ animal models. Mice were treated with vehicle (veh), ZA, or OPG-Fc for 11 weeks to induce ONJ, and antiresorptives were discontinued for 6 or 10 weeks. Maxillae and mandibles were examined by μCT imaging and histologically. ONJ features in ZA and OPG-Fc groups included periosteal bone deposition, empty osteocyte lacunae, osteonecrotic areas, and bone exposure, each of which substantially resolved 10 weeks after discontinuing OPG-Fc but not ZA. Full recovery of tartrate-resistant acid phosphatase-positive (TRAP+) osteoclast numbers occurred after discontinuing OPG-Fc but not ZA. Our data provide the first experimental evidence demonstrating that discontinuation of a RANKL inhibitor, but not a bisphosphonate, reverses features of osteonecrosis in mice. It remains unclear whether antiresorptive discontinuation increases the risk of skeletal-related events in patients with bone metastases or fracture risk in osteoporosis patients, but these preclinical data may nonetheless help to inform discussions on the rationale for a "drug holiday" in managing the ONJ patient.
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Affiliation(s)
- Rafael Scaf de Molon
- Division of Diagnostic and Surgical Sciences, UCLA School of Dentistry, Los Angeles, CA, USA.,Department of Diagnosis and Surgery, School of Dentistry at Araraquara, S, ã, o Paulo State University, Araraquara, Brazil
| | - Hiroaki Shimamoto
- Department of Oral and Maxillofacial Radiology, Osaka University Graduate School of Dentistry, Osaka, Japan
| | - Olga Bezouglaia
- Division of Diagnostic and Surgical Sciences, UCLA School of Dentistry, Los Angeles, CA, USA
| | - Flavia Q Pirih
- Division of Associated Specialties, UCLA School of Dentistry, Los Angeles, CA, USA
| | - Sarah M Dry
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Paul Kostenuik
- Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, MI, USA
| | - Rogely W Boyce
- Department of Comparative Biology and Safety Sciences, Amgen Inc., Thousand Oaks, CA, USA
| | - Denise Dwyer
- Department of Comparative Biology and Safety Sciences, Amgen Inc., Thousand Oaks, CA, USA
| | - Tara L Aghaloo
- Division of Diagnostic and Surgical Sciences, UCLA School of Dentistry, Los Angeles, CA, USA
| | - Sotirios Tetradis
- Division of Diagnostic and Surgical Sciences, UCLA School of Dentistry, Los Angeles, CA, USA.,Molecular Biology Institute, UCLA, Los Angeles, CA, USA
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Eid A, Atlas J. The role of bisphosphonates in medical oncology and their association with jaw bone necrosis. Oral Maxillofac Surg Clin North Am 2015; 26:231-7. [PMID: 24794267 DOI: 10.1016/j.coms.2014.01.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Bisphosphonates, synthetic analogues to inorganic pyrophosphates found in the bone matrix, inhibit bone resorption. Bisphosphonates and their related effects on the jaw have been established since 2001. The pathogenesis of bisphosphonate-related osteonecrosis of the jaw (BRONJ) is multifactorial and still under investigation. Currently, drugs with mechanisms of action involving remodeling suppression, osteoclast depression, and decreasing angiogenesis are under investigation for causing BRONJ-like symptoms. Further studies are needed to determine the effective length of use of biphosponates and the efficacy of drug holidays to prevent BRONJ.
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Affiliation(s)
- Ahmed Eid
- General Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 0462, Houston, TX 77030, USA.
| | - Jennifer Atlas
- Hematology and Oncology, Comprehensive Cancer Center of Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA
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Rashad A, Smeets R, Heiland M. RANK-Ligand inhibitor associated osteonecrosis of the jaw. GMS INTERDISCIPLINARY PLASTIC AND RECONSTRUCTIVE SURGERY DGPW 2013; 2:Doc17. [PMID: 26504708 PMCID: PMC4582495 DOI: 10.3205/iprs000037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Osteonecrosis of the jaw may be caused by many different triggers. One of them is described to be the drug or medication related osteonecrosis of the jaw. Since many years bisphosphonates induced the dreaded diagnosis. Recently a drug named denosumab is reported to show similar effects on the jaw. In this case report we present a RANK-Ligand inhibitor associated osteonecrosis of the lower jaw and discuss the lights and shadows of this newly introduced drug.
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Affiliation(s)
- Ashkan Rashad
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ralf Smeets
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Max Heiland
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Abstract
Polycystic ovary syndrome (PCOS) is the most frequent endocrinopathy in reproductive-aged women. The majority of hirsute patients are diagnosed with PCOS. Hyperandrogenemia, central obesity and insulin resistance may protect patients with PCOS from osteoporosis, whereas increased cortisol levels, low growth hormone and amenorrhea may be associated with decreased bone mineral density (BMD). Recent studies suggested that insulin resistance in PCOS is associated with decreased vitamin D levels that could not be explained by obesity alone. Vitamin D treatment may therefore have positive effects on insulin sensitivity and perhaps also hyperandrogenemia in patients with PCOS. In the present article, we review the evidence of changed BMD, bone mineral turnover and vitamin D status in PCOS and hirsutism compared with healthy women and the effects of medical intervention on BMD in PCOS.
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Affiliation(s)
- Dorte Glintborg
- a Department of Endocrinology, Odense University Hospital, Sdr. Boulevard 29, 5000 Odense C, Denmark
| | - Anne Pernille Hermann
- a Department of Endocrinology, Odense University Hospital, Sdr. Boulevard 29, 5000 Odense C, Denmark
| | - Marianne Andersen
- a Department of Endocrinology, Odense University Hospital, Sdr. Boulevard 29, 5000 Odense C, Denmark
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Glintborg D, Hermann AP, Rasmussen LM, Andersen M. Plasma osteoprotegerin is associated with testosterone levels but unaffected by pioglitazone treatment in patients with polycystic ovary syndrome. J Endocrinol Invest 2013; 36:460-5. [PMID: 23211475 DOI: 10.3275/8767] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Increased osteoprotegerin (OPG) levels are associated with increased cardiovascular risk and decreased bone resorption. Pioglitazone treatment reduces the inflammatory state but may decrease bone mineral density (BMD). OPG levels during pioglitazone treatment have not previously been evaluated in polycystic ovary syndrome (PCOS). RESEARCH DESIGN AND METHODS Plasma OPG levels were measured in 30 PCOS patients before and after randomized treatment with 30 mg pioglitazone/placebo for 16 weeks. Fourteen age- and body mass index-matched healthy women were included as controls. Clinical and hormonal evaluations and whole body dual-energy X-ray absorptiometry scans were performed in all participants. RESULTS OPG levels were comparable in PCOS patients [12.0 (10.5-14.6) ng/ml] and controls [12.9 (11.7-14.9) ng/ml]. In PCOS patients (no.=30), OPG levels were positively associated with testosterone (r=0.43), PRL (r=0.47), Pyridinoline cross-linked carboxyterminal telopeptide of type I collagen (r=0.43), and hip BMD, whereas inverse associations were found between OPG levels and triglyceride (r=-0.49) and free fatty acid levels during euglycemic clamps (r=-0.38), all p<0.05. Pioglitazone treatment significantly decreased inflammatory markers, insulin sensitivity, and BMD without affecting OPG levels. CONCLUSIONS OPG levels were comparable in PCOS patients and controls and unchanged during insulin sensitizing treatment with pioglitazone. OPG levels were associated with BMD in PCOS. Future studies need to evaluate OPG as a marker of cardiovascular disease in PCOS.
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Affiliation(s)
- D Glintborg
- Department of Endocrinology and Metabolism, Odense University Hospital, Kløvervænget 6, 3rd floor, DK-5000 Odense C, Denmark.
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Aliprantis AO, Stolina M, Kostenuik PJ, Poliachik SL, Warner SE, Bain SD, Gross TS. Transient muscle paralysis degrades bone via rapid osteoclastogenesis. FASEB J 2011; 26:1110-8. [PMID: 22125315 DOI: 10.1096/fj.11-196642] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
A unilateral injection of botulinum toxin A (BTxA) in the calf induces paralysis and profound loss of ipsalateral trabecular bone within days. However, the cellular mechanism underlying acute muscle paralysis-induced bone loss (MPIBL) is poorly understood. We hypothesized that MPIBL arises via rapid and extensive osteoclastogenesis. We performed a series of in vivo experiments to explore this thesis. First, we observed elevated levels of the proosteoclastogenic cytokine receptor activator for nuclear factor-κB ligand (RANKL) within the proximal tibia metaphysis at 7 d after muscle paralysis (+113%, P<0.02). Accordingly, osteoclast numbers were increased 122% compared with the contralateral limb at 5 d after paralysis (P=0.04) and MPIBL was completely blocked by treatment with human recombinant osteoprotegerin (hrOPG). Further, conditional deletion of nuclear factor of activated T-cells c1 (NFATc1), the master regulator of osteoclastogenesis, completely inhibited trabecular bone loss (-2.2±11.9%, P<0.01). All experiments included negative control assessments of contralateral limbs and/or within-animal pre- and postintervention imaging. In summary, transient muscle paralysis induced acute RANKL-mediated osteoclastogenesis resulting in profound local bone resorption. Elucidation of the pathways that initiate osteoclastogenesis after paralysis may identify novel targets to inhibit bone loss and prevent fractures.
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Affiliation(s)
- Antonios O Aliprantis
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Steger GG, Bartsch R. Denosumab for the treatment of bone metastases in breast cancer: evidence and opinion. Ther Adv Med Oncol 2011; 3:233-43. [PMID: 21957430 DOI: 10.1177/1758834011412656] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Denosumab, a fully human monoclonal antibody, targets the receptor activator of nuclear factor-kappaB (RANK) ligand, a protein essential for osteoclast differentiation, activity and survival. Loss of osteoclasts from the bone surface reduces bone turnover and bone loss in malignant and benign diseases. In breast cancer, bone metastases are frequently observed; cancer treatment-induced bone loss (CTIBL) may result as a consequence of endocrine treatment or chemotherapy. Furthermore, preclinical studies suggest a direct role of the RANK/RANK-ligand pathway in breast tumorigenesis. This paper reviews preclinical and clinical data on denosumab in breast cancer. MATERIALS AND METHODS Studies were identified through the Medline database. Key search terms included: AMG-162, bisphosphonates, denosumab, RANK-ligand and zoledronic acid. Information available in abstract form only was retrieved from major oncology meetings, such as the American Society of Clinical Oncology (ASCO) annual meeting, ASCO breast meeting, European Cancer Organization, European Society of Medical Oncology and the San Antonio Breast Cancer Symposium. RESULTS Denosumab was consistently well tolerated throughout clinical trials, although the observed incidence of osteonecrosis of the jaw was comparable to that with bisphosphonates. Efficacy as determined by a reduction of skeletal-related events was at least equal to zoledronic acid, and superior in one phase III study conducted in patients with metastatic breast cancer. Clinical trials investigating the role of denosumab for the prevention of CTIBL and breast cancer recurrences are currently ongoing. CONCLUSION In conclusion, denosumab appears to be an effective and safe treatment option in patients with bone metastases from breast cancer with the potential of also preventing CTIBL.
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Affiliation(s)
- Guenther G Steger
- Department of Medicine, Clinical Division of Oncology, Comprehensive Cancer Centre, Medical University of Vienna, Vienna, Austria
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16
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Whelan AM, Raman-Wilms L. Denosumab: A New Injectable Treatment for Postmenopausal Osteoporosis. Can Pharm J (Ott) 2011. [DOI: 10.3821/1913-701x-144.2.72] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background/Introduction: Osteoporosis results in a significant increase in fractures, leading to morbidity and mortality. Adherence is a concern with commonly used antiresorptive agents, the bisphosphonates. Denosumab, which inhibits bone resorption by a different mechanism and is administered subcutaneously every 6 months, may provide an advantage in decreasing fracture risk in those with osteoporosis. Objective: To review the available data with respect to the mechanism of action, efficacy and safety of denosumab for the management of postmenopausal osteoporosis. Methods: Several databases were searched to identify phase III randomized controlled trials (RCT) that examined the effect of denosumab on bone mineral density (BMD) and/or fracture rate and the safety of denosumab in the management of postmenopausal osteoporosis. Results: In 2 of the 4 trials identified, denosumab was significantly better than placebo at increasing BMD, and in 1 trial reduced the risk of vertebral, nonvertebral and hip fractures. No head-to-head trials comparing fracture risk reduction of denosumab to bisphosphonates were found, however, 2 trials did report increased BMD with denosumab compared to alendronate. In the 4 studies reviewed, adverse effects reported more frequently with denosumab included rash and eczema, as well as bronchitis and influenza-like illness. There is potential for an increased risk of other infections and malignancies. Conclusions: The results of RCT trials suggest that denosumab is effective at maintaining or increasing BMD compared to placebo or alendronate in women with either osteopenia or osteoporosis and in 1 trial demonstrated a significant reduction in fracture rate compared to placebo. Overall, denosumab appeared to be well tolerated in the studies reviewed. Continued monitoring is needed to determine long-term safety and efficacy.
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Affiliation(s)
- Anne Marie Whelan
- College of Pharmacy and the Department of Family Medicine (Whelan), Dalhousie University, Halifax, Nova Scotia; and the Leslie Dan Faculty of Pharmacy, University of Toronto and The Anne Johnston Health Station (Raman-Wilms), Toronto, Ontario. Contact
| | - Lalitha Raman-Wilms
- College of Pharmacy and the Department of Family Medicine (Whelan), Dalhousie University, Halifax, Nova Scotia; and the Leslie Dan Faculty of Pharmacy, University of Toronto and The Anne Johnston Health Station (Raman-Wilms), Toronto, Ontario. Contact
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Charopoulos I, Orme S, Giannoudis PV. The role and efficacy of denosumab in the treatment of osteoporosis: an update. Expert Opin Drug Saf 2011; 10:205-17. [PMID: 21208140 DOI: 10.1517/14740338.2010.516249] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Bone strength determinants such as bone mineral density and bone quality parameters are determined by life-long remodeling of skeletal tissue. Denosumab is a fully human mAb receptor activator of NF-κB ligand, which selectively inhibits osteoclastogenesis, the end product of a cascade interaction among numerous systemic and local factors and osteoblasts. It has been approved for clinical use by the FDA in the US and by the European Medicines Agency in Europe since June 2010 (trade name Prolia(™), Amgen, Thousand Oaks, CA, USA). AREAS COVERED This review establishes the concerns and provides insights in issues concerning the cost-effectiveness and safety profile of this new pharmaceutical agent. There is an effort to clarify the special characteristics and the anti-catabolic role of denosumab in the bone tissue homeostasis and more specifically its potential clinical applications and clinical results in the field of postmenopausal osteoporosis. EXPERT OPINION Administrated as a subcutaneous injection every 6 months, denosumab has been shown to decrease bone turnover and increase bone mineral density in postmenopausal women with low bone mass or osteoporosis and reduce vertebral, hip and nonvertebral fracture risk in postmenopausal women with osteoporosis. The rapid, sustained and reversible effect in suppressing osteoclastic bone resorption, the return of responsiveness on rechallenge, its good tolerability and ease of administration are features that distinguish it from other antiresorptive therapies.
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Affiliation(s)
- Ioannis Charopoulos
- University of Leeds, School of Medicine, Academic Department of Trauma & Orthopaedics, UK.
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Trouvin AP, Goëb V. Receptor activator of nuclear factor-κB ligand and osteoprotegerin: maintaining the balance to prevent bone loss. Clin Interv Aging 2010; 5:345-54. [PMID: 21228900 PMCID: PMC3010170 DOI: 10.2147/cia.s10153] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2010] [Indexed: 12/30/2022] Open
Abstract
Bone remodeling requires a precise balance between resorption and formation. It is a complex process that involves numerous factors: hormones, growth factors, vitamins, and cytokines, and notably osteoprotegerin (OPG) and receptor activator for nuclear factor-κB (RANK) ligand. The signaling pathway OPG/RANK/RANKL is key to regulation for maintaining the balance between the activity of osteoblasts and osteoclasts in order to prevent bone loss and ensure a normal bone turnover. In this review, the RANK/RANKL/OPG pathway is described. The multiple interactions of various factors (hormones, cytokines, growth factors, and vitamins) with the OPG/RANK/RANKL pathway are also commented on. Finally, the effects of denosumab, a human monoclonal antibody that binds to RANKL and thereby inhibits the activation of osteoclasts, and of strontium ranelate are also described. Indeed, these two new drugs afford appreciable assistance in daily care practice, helping to prevent bone loss in patients with osteoporosis.
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Affiliation(s)
| | - Vincent Goëb
- Department of Rheumatology, Rouen University Hospital, Rouen, France
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19
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Bartsch R, Steger GG, Gnant M, Ziebermayr R. Breast Cancer: Rank Ligand Inhibition. Breast Care (Basel) 2010; 5:320-325. [PMID: 21779214 PMCID: PMC3132956 DOI: 10.1159/000321122] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Breast cancer and bone health are closely linked. Early menopause induced by gonadotropin-releasing hormone analogues or chemotherapy as well as aromatase inhibitors reduce oestrogen levels, thereby causing cancer treatment-induced bone loss (CTIBL). Furthermore, bone metastases are commonly found in advanced disease. Current treatment options for bone lesions comprise systemic anti-tumour therapy, irradiation, surgery and bisphosphonates. The main mechanism of osteolysis, osteoclast activation, is induced by the RANK ligand and suppressed by osteoprotegerin (OPG). A human antibody targeting the RANK ligand, denosumab, had superior activity compared to OPG and was therefore further developed in the clinical setting. This article reviews clinical data on denosumab. Data were obtained by searching the Medline database and abstracts from the ASCO annual meeting, ASCO breast meeting, ECCO, ESMO, and the San Antonio Breast Cancer Symposium. Clinical trials have demonstrated that denosumab reduces markers of bone turnover, and suggest equal efficacy to bisphosphonates in reducing the rate of skeletal-related events. While overall fewer side effects were observed, a numerically increased rate of osteonecrosis of the jaw was reported. Denosumab was well tolerated, and clinical activity was similar to bisphosphonates in metastatic disease. Trials of denosumab in the prevention of CTIBL are ongoing.
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Affiliation(s)
- Rupert Bartsch
- Department of Medicine I (Centre for Haematology, Stem Cell Transplantation, Haemostasis and Medical Oncology), Academic Teaching Hospital Elisabethinen, Linz, Austria
- Department of Medicine I and Cancer Centre, Clinical Division of Oncology, Vienna, Austria
| | - Guenther G. Steger
- Department of Medicine I and Cancer Centre, Clinical Division of Oncology, Vienna, Austria
| | - Michael Gnant
- Department of Surgery, Medical University of Vienna, Austria
| | - Reinhard Ziebermayr
- Department of Medicine I (Centre for Haematology, Stem Cell Transplantation, Haemostasis and Medical Oncology), Academic Teaching Hospital Elisabethinen, Linz, Austria
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Krum SA, Chang J, Miranda-Carboni G, Wang CY. Novel functions for NFκB: inhibition of bone formation. Nat Rev Rheumatol 2010; 6:607-11. [PMID: 20703218 DOI: 10.1038/nrrheum.2010.133] [Citation(s) in RCA: 112] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
NFκB is a family of transcription factors involved in immunity and the normal functioning of many tissues. It has been well studied in osteoclasts, and new data indicate an important role for NFκB in the negative regulation of bone formation. In this article, we discuss how NFκB activation affects osteoblast function and bone formation. In particular, we describe how reduced NFκB activity in osteoblasts results in an increase in bone formation via enhanced c-Jun N-terminal kinase (JNK) activity, which regulates FOSL1 (also known as Fra1) expression. Furthermore, we discuss how estrogen and NFκB crosstalk in osteoblasts acts to oppositely regulate bone formation. Future NFκB-targeting treatments for osteoporosis, rheumatoid arthritis and other inflammatory bone diseases could lead to increased bone formation concurrent with decreased bone resorption.
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Affiliation(s)
- Susan A Krum
- UCLA Orthopaedic Hospital, Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
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21
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Inflammatory responses improve with milk ribonuclease-enriched lactoferrin supplementation in postmenopausal women. Inflamm Res 2010; 59:971-8. [DOI: 10.1007/s00011-010-0211-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2009] [Revised: 01/14/2010] [Accepted: 04/27/2010] [Indexed: 10/19/2022] Open
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22
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Aghaloo TL, Felsenfeld AL, Tetradis S. Osteonecrosis of the jaw in a patient on Denosumab. J Oral Maxillofac Surg 2010; 68:959-63. [PMID: 20149510 DOI: 10.1016/j.joms.2009.10.010] [Citation(s) in RCA: 189] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2009] [Accepted: 10/03/2009] [Indexed: 01/15/2023]
Affiliation(s)
- Tara L Aghaloo
- Section of Oral and Maxillofacial Surgery, School of Dentistry, University of California, Los Angeles, Los Angeles, CA 90095, USA.
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Kawatani M, Osada H. Osteoclast-targeting small molecules for the treatment of neoplastic bone metastases. Cancer Sci 2009; 100:1999-2005. [PMID: 19673888 PMCID: PMC11159880 DOI: 10.1111/j.1349-7006.2009.01294.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2009] [Revised: 07/10/2009] [Accepted: 07/10/2009] [Indexed: 11/29/2022] Open
Abstract
Osteoclasts are highly specialized cells that resorb bone, and their abnormal activity is implicated in a variety of human bone diseases. In neoplastic bone metastasis, the bone destruction caused by osteoclasts is not only associated with the formation and progression of metastatic lesions, but also could contribute to frequent complications such as severe pain and pathological fractures, which greatly diminish the quality of life of patients. Bisphosphonates, potent antiresorptive drugs, have been shown to have efficacy for treating bone metastases in many types of cancer, and the development of various molecularly targeted agents is currently proceeding. Thus, inhibition of osteoclast function is now established as an important treatment strategy for bony metastases. This review focuses on promising small molecules that disrupt osteoclast function and introduces our chemical/biological approach for identifying osteoclast-targeting small molecular inhibitors.
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Affiliation(s)
- Makoto Kawatani
- Antibiotics Laboratory, Chemical Biology Department, Advanced Science Institute, RIKEN, Wako-shi, Saitama, Japan
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Saag KG, Geusens P. Progress in osteoporosis and fracture prevention: focus on postmenopausal women. Arthritis Res Ther 2009; 11:251. [PMID: 19849819 PMCID: PMC2787277 DOI: 10.1186/ar2815] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
In the past decade, we have witnessed a revolution in osteoporosis diagnosis and therapeutics. This includes enhanced understanding of basic bone biology, recognizing the severe consequences of fractures in terms of morbidity and short-term re-fracture and mortality risk and case finding based on clinical risks, bone mineral density, new imaging approaches, and contributors to secondary osteoporosis. Medical interventions that reduce fracture risk include sufficient calcium and vitamin D together with a wide spectrum of drug therapies (with antiresorptive, anabolic, or mixed effects). Emerging therapeutic options that target molecules of bone metabolism indicate that the next decade should offer even greater promise for further improving our diagnostic and treatment approaches.
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Affiliation(s)
- Kenneth G Saag
- Division of Clinical Immunology and Rheumatology, Center for Education and Research on Therapeutics, University of Alabama at Birmingham, 820 Faculty Office Tower, 510 20th Street South, Birmingham, AL 35294-3708, USA
| | - Piet Geusens
- Department of Internal Medicine, Subdivision of Rheumatology, Maastricht University Medical Center, P. Debyelaan 25, Postbus 5800, 6202 AZ Maastricht, The Netherlands & Biomedical Research Institute, University Hasselt, Agoralaan, gebouw D, B-3590 Diepenbeek, Belgium
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