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Mittal A, Tamimi F, Molto C, Di Iorio M, Amir E. Benefit of adjuvant bisphosphonates in early breast cancer treated with contemporary systemic therapy: A meta-analysis of randomized control trials. Heliyon 2024; 10:e24793. [PMID: 38312616 PMCID: PMC10835314 DOI: 10.1016/j.heliyon.2024.e24793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 01/11/2024] [Accepted: 01/15/2024] [Indexed: 02/06/2024] Open
Abstract
Background The absolute and relative benefits of adjuvant bisphosphonates on disease-free survival and overall survival in patients receiving contemporary systemic therapy for early breast cancer is uncertain. Methods Data from randomized trials of adjuvant bisphosphonates that recruited patients exclusively after 2000 and reported disease free survival and overall survival was utilized. Five-year disease-free survival and overall survival in bisphosphonates and control group along with associated hazard ratios were extracted. Absolute data were weighted by sample size and hazard ratios were pooled using inverse variance and random effects modelling. Meta-regression comprising linear regression weighted by sample size (mixed effects) was performed to explore association between disease and treatment related factors and absolute differences in benefit from bisphosphonates. Results Eleven trials comprising 24023 patients were included in the analysis. For disease free survival, pooled hazard ratio was 0.89 (0.81-0.97, p = 0.008) with a 1.5 % weighted mean difference favoring bisphosphonates over control. There was no significant overall survival benefit (0.92, 0.82-1.03, p = 0.16). Among patients receiving anthracycline and taxane based chemotherapy, there were no differences in either disease free survival (0.95, 0.80-1.12) or overall survival (1.04, 0.81-1.32). Meta-regression showed lower benefits in higher risk patients (node-positive, larger tumor size, estrogen receptor-, grade 3 or those receiving chemotherapy). Overall, 1 % (95 % CI 0.75-1.15) of patients experienced osteonecrosis of jaw related to zoledronic acid. Conclusions Compared to the Early Breast Cancer Trialist's Collaborative Group meta-analysis, benefit from adjuvant bisphosphonates is lower in recent trials especially in higher risk patients receiving contemporary chemotherapy. The balance between benefits and risks of adjuvant bisphosphonates should be considered in individual patients.
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Affiliation(s)
- Abhenil Mittal
- North East Cancer Centre, Health Sciences North, Northern Ontario School of Medicine (NOSM U), Sudbury, ON, Canada
- Princess Margaret Cancer Centre, Division of Medical Oncology, Toronto, ON, Canada
- University of Toronto, Department of Medicine, Toronto, ON, Canada
| | - Faris Tamimi
- Princess Margaret Cancer Centre, Division of Medical Oncology, Toronto, ON, Canada
- University of Toronto, Department of Medicine, Toronto, ON, Canada
| | - Consolacion Molto
- Princess Margaret Cancer Centre, Division of Medical Oncology, Toronto, ON, Canada
- University of Toronto, Department of Medicine, Toronto, ON, Canada
| | - Massimo Di Iorio
- Princess Margaret Cancer Centre, Division of Medical Oncology, Toronto, ON, Canada
- University of Toronto, Department of Medicine, Toronto, ON, Canada
| | - Eitan Amir
- Princess Margaret Cancer Centre, Division of Medical Oncology, Toronto, ON, Canada
- University of Toronto, Department of Medicine, Toronto, ON, Canada
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Ko SY, Hwang TY, Baek K, Park C. Incidence and severity of medication-related osteonecrosis of the jaw in patients with osteoporosis using data from a Korean nationwide sample cohort in 2002 to 2019: a retrospective study. J Yeungnam Med Sci 2024; 41:39-44. [PMID: 38173345 PMCID: PMC10834263 DOI: 10.12701/jyms.2023.01116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 11/21/2023] [Accepted: 11/29/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Medication-related osteonecrosis of the jaw (MRONJ) is a significant concern, particularly among patients taking bisphosphonates (BPs), denosumab, and selective estrogen receptor modulators (SERMs) for osteoporosis. Despite the known risks, large-scale cohort studies examining the incidence and severity of MRONJ are lacking. We aimed to ascertain the incidence and risk of MRONJ among these patients, whom we stratified by age groups, medication types, and duration of use. METHODS We utilized data from the National Health Insurance Service's sample cohort database, focusing on patients aged 40 years and above diagnosed with osteoporosis. The patients were divided into three groups: those prescribed BPs only, those prescribed SERMs only, and those prescribed both. RESULTS The overall incidence rate of MRONJ was 0.17%. A significantly higher incidence rate was observed among those taking osteoporosis medications, particularly among females with a relative risk of 4.99 (95% confidence interval, 3.21-7.74). The SERM group also had an incidence rate comparable to that of the BP group. Severity was assessed based on the invasiveness of the treatment methods, with 71.3% undergoing invasive treatment in the medication group. CONCLUSION This study provides valuable insights into the incidence and severity of MRONJ among a large cohort of patients with osteoporosis. It underscores the need for comprehensive guidance on MRONJ risks across different medication groups and sets the stage for future research focusing on specific populations and treatment outcomes.
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Affiliation(s)
- Su-Youn Ko
- Gyeongsangbuk-do Public Health Policy Institute, Daegu, Korea
| | - Tae-Yoon Hwang
- Department of Preventive Medicine and Public Health, Yeungnam University College of Medicine, Daegu, Korea
| | - Kiwook Baek
- Department of Occupational and Environmental Medicine, Yeungnam University Hospital, Daegu, Korea
| | - Chulyong Park
- Department of Preventive Medicine and Public Health, Yeungnam University College of Medicine, Daegu, Korea
- Department of Occupational and Environmental Medicine, Yeungnam University Hospital, Daegu, Korea
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Somay E. Comment on: Medication-related osteonecrosis of the jaw, a risk to reassess in osteoporotic patients. J Stomatol Oral Maxillofac Surg 2023; 124:101475. [PMID: 37072076 DOI: 10.1016/j.jormas.2023.101475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 04/15/2023] [Indexed: 04/20/2023]
Affiliation(s)
- Efsun Somay
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Baskent University, Ankara, Turkey.
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Fushimi M, Ohbayashi Y, Nakai F, Norikane T, Yamamoto Y, Nishiyama Y, Miyake M. The effect of zoledronic acid and denosumab on the mandible and other bones: a (18)F-NaF-PET study. Oral Radiol 2022; 38:594-600. [PMID: 35142984 DOI: 10.1007/s11282-022-00594-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 01/21/2022] [Indexed: 10/19/2022]
Abstract
OBJECTIVES The primary purpose of this study was to determine whether both zoledronic acid (ZA) and denosumab (Dmab) equally suppress bone remodeling of the normal mandible, and the secondary purpose was to determine the influence of ZA and Dmab on other normal bones. METHODS 18F-sodium fluoride-positron-emission-tomography (18F-NaF-PET) was used to perform quantitative analysis of the bone metabolism in various parts. The end points of the study were the mean standardized uptake value (SUV) of each member of the ZA group (n = 9), the Dmab group (n = 16), and the Control group (n = 23). RESULTS The SUV at the thoracic vertebrae in the ZA group were significantly lower than those of the Dmab and Control group (p < 0.05) In addition, the mean SUVs of the cervical vertebrae in the ZA group were significantly lower than those in the Control group (p < 0.05). There was no significant difference among ZA, Dmab and Control group in the other sites. There was no significant difference between the Dmab and Control groups at all sites. CONCLUSIONS The remodeling of mandible was not suppressed due to the treatment with anti-resorptive agents. Differences in the mechanisms of action between the BP and Dmab caused the specificity of the effect on the metabolism of normal bone.
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Aoki K, Matsunaga S, Ito S, Shibahara T, Nomura T, Matsuzaki H, Abe S, Yamaguchi A. Persistent bone resorption lacunae on necrotic bone distinguish bisphosphonate-related osteonecrosis of jaw from denosumab-related osteonecrosis. J Bone Miner Metab 2021; 39:737-747. [PMID: 33830351 DOI: 10.1007/s00774-021-01223-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 03/14/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Bisphosphonate and denosumab are widely used for the treatment of osteoporosis and bone metastasis of cancer to prevent excessive bone resorption. Osteonecrosis of the jaw is a serious adverse effect of bisphosphonate or denosumab referred to as bisphosphonate-related osteonecrosis of the jaw (BRONJ) or denosumab-related osteonecrosis of the jaw (DRONJ), respectively. Since bisphosphonate and denosumab inhibit bone resorption by different mechanism, we evaluated whether these drug types result in different histopathological characteristics related to bone resorption. MATERIALS AND METHODS We histopathologically investigated 10 cases of BRONJ, DRONJ, and suppurative osteomyelitis. Paraffin sections prepared from decalcified dissected jaw bones were used for histopathological observation, second harmonic generation imaging, and bone histomorphometry. The samples were also observed by a scanning electron microscope. RESULTS Numerous bone resorption lacunae were observed on the necrotic bone surface in almost all cases of BRONJ; however, such resorption lacunae were limited in DRONJ and suppurative osteomyelitis. Prominent bone resorption lacunae were also confirmed by second harmonic generation imaging and scanning electron microscopy in BRONJ, but not in DRONJ or suppurative osteomyelitis. As determined by bone histomorphometry, the number of bone resorption lacunae and the length of the erosion surface of resorption lacunae were significantly higher in BRONJ group than in the DRONJ and suppurative osteomyelitis groups. These parameters were correlated between the necrotic bones and the vital bones in BRONJ. CONCLUSIONS Persistent bone resorption lacunae on the necrotic bone surface are unique to BRONJ, providing a basis for distinguishing BRONJ from DRONJ and OM in histopathological diagnosis.
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Affiliation(s)
- Kazumitsu Aoki
- Department of Anatomy, Tokyo Dental College, 2-9-18 Kanda-Misaki-cho, Chiyoda-ku, Tokyo, 101-0061, Japan
- Department of Dentistry and Oral Surgery, Tokyo Metropolitan Bokutoh Hospital, 4-23-15 kotobashi, Sumida-ku, Tokyo, 130-8675, Japan
| | - Satoru Matsunaga
- Department of Anatomy, Tokyo Dental College, 2-9-18 Kanda-Misaki-cho, Chiyoda-ku, Tokyo, 101-0061, Japan
- Tokyo Dental College Research Branding Project, 2-9-18 Kanda-Misaki-cho, Chiyoda-ku, Tokyo, 101-0061, Japan
| | - Shinichirou Ito
- Department of Oral and Maxillofacial Surgery, Tokyo Dental College, 2-9-18 Kanda-Misaki-cho, Chiyoda-ku, Tokyo, 101-0061, Japan
| | - Takahiko Shibahara
- Department of Oral and Maxillofacial Surgery, Tokyo Dental College, 2-9-18 Kanda-Misaki-cho, Chiyoda-ku, Tokyo, 101-0061, Japan
| | - Takeshi Nomura
- Tokyo Dental College Research Branding Project, 2-9-18 Kanda-Misaki-cho, Chiyoda-ku, Tokyo, 101-0061, Japan
- Department of Oral Oncology and Maxillofacial Surgery, Ichikawa General Hospital, Tokyo Dental College, 5-11-13 Sugano, Ichikawa city, Chiba, 272-8513, Japan
| | - Hideo Matsuzaki
- Department of Dentistry and Oral Surgery, Tokyo Metropolitan Bokutoh Hospital, 4-23-15 kotobashi, Sumida-ku, Tokyo, 130-8675, Japan
| | - Shinichi Abe
- Department of Anatomy, Tokyo Dental College, 2-9-18 Kanda-Misaki-cho, Chiyoda-ku, Tokyo, 101-0061, Japan
- Tokyo Dental College Research Branding Project, 2-9-18 Kanda-Misaki-cho, Chiyoda-ku, Tokyo, 101-0061, Japan
| | - Akira Yamaguchi
- Tokyo Dental College Research Branding Project, 2-9-18 Kanda-Misaki-cho, Chiyoda-ku, Tokyo, 101-0061, Japan.
- Oral Health Science Center, Tokyo Dental College, 2-9-18 Kanda-Misaki-cho, Chiyoda-ku, Tokyo, 101-0061, Japan.
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Kim Y, Jung HI, Kim YK, Ku JK. Histologic analysis of osteonecrosis of the jaw according to the different aspects on quantitative light-induced fluorescence images. Photodiagnosis Photodyn Ther 2021; 34:102212. [PMID: 33588059 DOI: 10.1016/j.pdpdt.2021.102212] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 02/01/2021] [Accepted: 02/05/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Recurrence of osteonecrosis of the jaw has been reported after surgery. It is therefore necessary to develop a real-time diagnostic method, which can clearly distinguish the surgical margin from unaffected bone. METHODS We analyzed a sequestrum from a patient with medication-related osteonecrosis of the jaw (MRONJ). Quantitative light induced fluorescence (QLF) was applied to the sequestrum. RESULTS In this study, QLF demonstrated three types of fluorescence phenomena (Non-red-fluorescence, hyper-red-fluorescence, and hypo-red-fluorescence) on the sequestrum. Histology revealed geographical, microbiological, and immunological differences based on the fluorescence types on QLF. Non-red-fluorescence showed sclerotic and lamellar bone tissue, hyper-red-fluorescence showed an infectious state due to bacterial invasion and osteolysis, and hypo-red-fluorescence indicated predominantly granular tissue with inflammation, and the absence of bone matrix and bacterial colonies. Based on histologic analysis, we speculated that QLF may be a useful real-time diagnostic tool during surgery for MRONJ. CONCLUSIONS In conclusion, QLF can be useful in distinguishing between lamellar and infected bone, which are visually similar; QLF-guided ONJ surgery, preserving the Non-red-fluorescent areas and removing the hyper- and hypo-red-fluorescent areas of bone may be useful.
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Affiliation(s)
- Yesel Kim
- Department of Preventive Dentistry and Public Oral Health, Yonsei University college of dentistry, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Hoi-In Jung
- Department of Preventive Dentistry and Public Oral Health, Yonsei University college of dentistry, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
| | - Young-Kyun Kim
- Department of Oral and Maxillofacial Surgery, Section of Dentistry, Seoul National University Bundang Hospital, 300, Gumi-dong, Bundang-gu, Seongnam-si, 13620, Republic of Korea; Department of Dentistry & Dental Research Institute, School of Dentistry, Seoul National University, Seoul, 08826, Republic of Korea
| | - Jeong-Kui Ku
- Department of Oral and Maxillofacial Surgery, Armed Forces Capital Dental Hospital, Armed Forces Medical Command, 81, Saemaul-ro 117, Bundang-gu, Seongnam-si, 13634, Republic of Korea.
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Vigarios E, Epstein JB, Sibaud V. Oral mucosal changes induced by anticancer targeted therapies and immune checkpoint inhibitors. Support Care Cancer 2017; 25:1713-39. [PMID: 28224235 DOI: 10.1007/s00520-017-3629-4] [Citation(s) in RCA: 94] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 02/06/2017] [Indexed: 12/26/2022]
Abstract
Development of biological targeted therapies and immune checkpoint inhibitors has redefined the treatment for many cancers; however, the increasing use of new protocols has led to physicians observing a new spectrum of toxicities. To date, oral adverse events induced by these new anticancer therapies have been mainly reported using nonspecific terminology ("stomatitis," "mucosal inflammation," "mucositis") and remain poorly characterized, with the exception of mammalian target of rapamycin (mTOR) inhibitor-associated stomatitis. Oral toxicities of targeted therapies often display very characteristic features which clearly differ from classic oral injuries observed with cytotoxic chemotherapy and/or radiotherapy. In addition, they frequently affect more than 20% of treated patients and can lead to a significant morbidity or permanent treatment discontinuation. Oral mucosal toxicities described in this review include mTOR inhibitor-associated stomatitis (mIAS); stomatitis, benign migratory glossitis, and osteonecrosis of the jaw associated with multi-targeted kinase inhibitors of the VEGF and PDGF receptors; mucositis induced by EGFR inhibitors (in monotherapy or in combination with head and neck radiotherapy and/or chemotherapy); hyperkeratotic lesions with BRAF inhibitors; pigmentary changes and lichenoid reactions secondary to imatinib; and more recent data on the "Osler-Weber-Rendu-like syndrome" described with the antibody-drug conjugate, TDM-1. Finally, we provide, to our knowledge, the first available structured data on oral toxicities induced by the new recently FDA- and EMA-approved monoclonal antibodies targeting PD-1. Clinical management of these targeted therapy-related oral changes is also discussed.
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Nakamura M, Umetsu R, Abe J, Matsui T, Ueda N, Kato Y, Sasaoka S, Tahara K, Takeuchi H, Kinosada Y. Analysis of the time-to-onset of osteonecrosis of jaw with bisphosphonate treatment using the data from a spontaneous reporting system of adverse drug events. J Pharm Health Care Sci 2015; 1:34. [PMID: 26819745 PMCID: PMC4728763 DOI: 10.1186/s40780-015-0035-2] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 12/11/2015] [Indexed: 11/15/2022] Open
Abstract
Background Bisphosphonates (BPs) are potent antiresorptive agents used to treat osteoporosis and the complications associated with malignant bone metastasis. The aim of this study was to evaluate the incidence of bisphosphonate-related osteonecrosis of the jaw (BRONJ) using the Japanese Adverse Drug Event Report (JADER) database. In particular, we focused on the time-to-onset profile of BRONJ. Findings We analyzed reports of BRONJ in the JADER database and calculated the reporting odds ratio (ROR) of BPs potentially associated with BRONJ. We applied the weibull shape parameter to time-to-event data in JADER. The drugs selected for this investigation were seven BPs approved in Japan (alendronate [intraveneous, I.V.], pamidronate, and zoledronate as I.V. BPs; and alendronate (oral), etidronate, minodronate, and risedronate as oral BPs). We analyzed reports of BRONJ events associated with BPs in the JADER database from April 2004 to November 2014. The median value of BRONJ cases caused by alendronate (I.V.), pamidronate, zoledronate, alendronate (oral), etidronate, minodronate, and risedronate were 1342, 812, 486, 863, 1461, 432, and 730 days, respectively. The lower 95 % confidence interval of the Weibull-shape parameter β for I.V. BPs (pamidronate and zoledronate) exceeded 1. The risk of BRONJ with I.V. BPs increased over time. Conclusion Thus, the incidence of BRONJ with BP treatment should be closely monitored for a 3-year period. Further studies are required to draw conclusions, and we believe that this information about BRONJ induced by BPs will prove beneficial to patients and pharmacists.
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Affiliation(s)
- Mitsuhiro Nakamura
- Laboratory of Drug Informatics, Gifu Pharmaceutical University, 1-25-4 Daigaku-nishi, Gifu, 501-1196 Japan
| | - Ryogo Umetsu
- Laboratory of Drug Informatics, Gifu Pharmaceutical University, 1-25-4 Daigaku-nishi, Gifu, 501-1196 Japan ; Present address: Clinical Research, Innovation and Education Center, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba Ward, Sendai, Miyagi 980-8574 Japan
| | - Junko Abe
- Laboratory of Drug Informatics, Gifu Pharmaceutical University, 1-25-4 Daigaku-nishi, Gifu, 501-1196 Japan ; Medical Database Co., LTD, 3-11-10 Higashi, Shibuya-ku, Tokyo 150-0011 Japan
| | - Toshinobu Matsui
- Laboratory of Drug Informatics, Gifu Pharmaceutical University, 1-25-4 Daigaku-nishi, Gifu, 501-1196 Japan
| | - Natsumi Ueda
- Laboratory of Drug Informatics, Gifu Pharmaceutical University, 1-25-4 Daigaku-nishi, Gifu, 501-1196 Japan
| | - Yamato Kato
- Laboratory of Drug Informatics, Gifu Pharmaceutical University, 1-25-4 Daigaku-nishi, Gifu, 501-1196 Japan
| | - Sayaka Sasaoka
- Laboratory of Drug Informatics, Gifu Pharmaceutical University, 1-25-4 Daigaku-nishi, Gifu, 501-1196 Japan
| | - Kohei Tahara
- Laboratory of Pharmaceutical Engineering, Gifu Pharmaceutical University, 1-25-4 Daigaku-nishi, Gifu, 501-1196 Japan
| | - Hirofumi Takeuchi
- Laboratory of Pharmaceutical Engineering, Gifu Pharmaceutical University, 1-25-4 Daigaku-nishi, Gifu, 501-1196 Japan
| | - Yasutomi Kinosada
- United Graduate School of Drug Discovery and Medical Information Sciences, Gifu University, 1-1 Yanagido, Gifu, 501-1194 Japan
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Kim JW, Kong KA, Kim SJ, Choi SK, Cha IH, Kim MR. Prospective biomarker evaluation in patients with osteonecrosis of the jaw who received bisphosphonates. Bone 2013; 57:201-5. [PMID: 23954759 DOI: 10.1016/j.bone.2013.08.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Revised: 07/06/2013] [Accepted: 08/05/2013] [Indexed: 10/26/2022]
Abstract
Bone biomarkers have been suggested for the risk assessment for osteonecrosis of the jaw, a serious complication associated with bisphosphonate (BP) use; however, no consensus has been reached. This study investigated the possible associations between bone biomarkers and the development of bisphosphonates-related osteonecrosis of the jaw (BRONJ). This is a case-control study of 37 patients with BRONJ (age, 73.6±11.2years) who had at least 1 sample available at diagnosis, out of which, 35 were taking BPs for osteoporosis and 2 patients for bone metastasis. Age- and gender-matched 37 patients who had been exposed to BPs for >24months and had no evidence of BRONJ after dentoalveolar surgery served as control group. The association between biomarkers (osteocalcin [OC], deoxypyridinoline [DPD], C-terminal telopeptide of collagen I [CTX], N-terminal telopeptides [NTX], bone-specific alkaline phosphatase [BAP], and parathyroid hormone [PTH]) and BRONJ development, the effects of BP discontinuation on biomarkers, and the performance of biomarkers for risk assessment were investigated. In our study, the PTH levels were found to be significantly higher in BRONJ patients compared to controls (P<0.05). But the OC, DPD, CTX, NTX, and BAP levels were not significantly different between the 2 groups (P>0.05). The CTX level in reference to a 150pg/mL cutoff was also not significant for BRONJ development (P>0.05). Among BRONJ patients who discontinued BP, in a linear mixed model, only CTX showed a significant increase over time (β=0.002, P=0.007). The cutoff PTH level was >41.52pg/mL (AUC=0.719, P=0.009), and that of CTX was ≤0.094ng/mL (AUC=0.619, P=0.069). In conclusion, there is insufficient evidence for the risk prediction for BRONJ of current bone biomarkers; additional research is necessary.
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Affiliation(s)
- Jin-Woo Kim
- Department of Oral and Maxillofacial Surgery, Ewha Womans University, Seoul, Republic of Korea
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Kalra S, Jain V. Dental complications and management of patients on bisphosphonate therapy: A review article. J Oral Biol Craniofac Res 2013; 3:25-30. [PMID: 25737876 DOI: 10.1016/j.jobcr.2012.11.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2012] [Accepted: 11/01/2012] [Indexed: 12/19/2022] Open
Abstract
Bisphosphonates are group of drugs that inhibit bone resorption and are used to treat a range of pathologies including Paget's disease, osteoporosis, multiple myeloma and metastasis associated with breast or prostate cancer. The most common complication in patients on bisphosphonate therapy is osteonecrosis of jaw (ONJ) which can occur after any surgical dental procedure and the risk for the development of osteonecrosis of jaw is higher in patients receiving intravenous bisphosphonate therapy than in patients receiving oral bisphosphonate therapy. Typical presentation is in the form of non-extraction socket, presence of exposed bone, gingival swelling or purulent discharge, when local debridement and antibiotics are ineffective. At present, there is no effective treatment for bisphosphonate induced osteonecrosis, so prevention is extremely important. Maximum precautions should be taken in patients who are at the risk of development of ONJ especially when any dental surgical procedure like extractions, retrograde apicoectomies, periodontal surgery and implant placement is contemplated. Dentists and oral or maxillofacial surgeon must keep up to date with the latest approaches or guidelines to prevention and the risk factors, particularly when treating patients who are on bisphosphonates, or who will be taking bisphosphonates.
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