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Romanos GN, Volioti AV, Hatzimanolis PI, Koutserimpas C, Samonis G. The "Phoenix Jaw" Phenomenon Revisited: Two Cases of Bisphosphonate-Related Mandible Osteonecrosis Surgically Treated with Complete Bone Regeneration. Kurume Med J 2022; 67:107-112. [PMID: 36123026 DOI: 10.2739/kurumemedj.ms6723004] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Bisphosphonate-related osteonecrosis of the jaws represents a well-recognized complication occurring in patients being administered drugs for the treatment of osteoporosis and/or malignant disease. Treatment of this condition, aiming to alleviate the symptoms and restore functional status, represents a challenge for the maxillofacial surgeon. Conservative management has been proposed for early stages of this condition, while surgical intervention is mandatory for advanced disease. Two cases of severe bisphosphonate-related osteonecrosis of the jaw that achieved complete osseous recontouring after partial mandibulectomy, are presented.
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Affiliation(s)
- George N Romanos
- Department of Oral and Maxillofacial Surgery, University Hospital of Heraklion
| | - Areti V Volioti
- Department of Oral and Maxillofacial Surgery, University Hospital of Heraklion
| | | | - Christos Koutserimpas
- Department of Orthopaedics and Traumatology, "251" Hellenic Air Force General Hospital
| | - George Samonis
- Department of Internal Medicine, University Hospital of Heraklion
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Sakai Y, Shindo T, Sato S, Takahashi A, Kunishima Y, Kato R, Itoh N, Okada M, Tachiki H, Taguchi K, Takayanagi A, Hotta H, Horita H, Matsukawa M, Matsuki M, Nishiyama K, Miyazaki A, Hashimoto K, Tanaka T, Masumori N. Antiresorptive agent-related osteonecrosis of the jaw (ARONJ) in urological malignancies: a multi-center retrospective study. J Bone Miner Metab 2021; 39:661-667. [PMID: 33704573 DOI: 10.1007/s00774-021-01207-4] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 01/14/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION We evaluated the incidence and risk factors for antiresorptive agent-related osteonecrosis of the jaw (ARONJ) in prostate and kidney cancer patients. MATERIALS AND METHODS We retrospectively reviewed the clinical data of 547 patients from 13 hospitals. Prostate and kidney cancer patients with bone metastases who were treated with a bone-modifying agent (BMA) between January 2012 and February 2019 were enrolled. Exclusion criteria were BMA use for hypercalcemia, a lack of clinical data, a follow-up period of less than 28 days and a lack of evaluation by dentists before BMA administration. The diagnosis and staging of ARONJ were done by dentists. RESULTS Two-hundred eighteen patients were finally enrolled in the study, including 168 prostate cancer patients and 50 kidney cancer patients. Of them, 49 (29%) prostate cancer patients and 18 (36%) kidney cancer patients needed tooth extraction prior to BMA initiation. The mean follow-up period after BMA initiation was 552.9 ± 424.7 days (mean ± SD). In the cohort, 23% of the patients were diagnosed with ARONJ in the follow-up period. The 1-year cumulative incidences of ARONJ were 9.4% and 15.4% in prostate and kidney cancer patients, respectively. Multivariate analysis indicated that kidney cancer, tooth extraction before BMA and a body mass index (BMI) ≥ 25 kg/m2 were significant predictors for ARONJ. CONCLUSION ARONJ is not a rare adverse event in urological malignancies. Especially, kidney cancer, high BMI patients and who needed tooth extraction before BMA were high risk for developing ARONJ.
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Affiliation(s)
- Yasuyuki Sakai
- Departments of Urology, Oral Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Tetsuya Shindo
- Department of Urology, Hakodate Goryoukaku Hospital, 38-3 Goryoukaku, Hakodate, 040-8611, Japan.
| | - Shunsuke Sato
- Department of Urology, NTT East Sapporo Hospital, Sapporo, Japan
| | - Atsushi Takahashi
- Department of Urology, Hakodate Goryoukaku Hospital, 38-3 Goryoukaku, Hakodate, 040-8611, Japan
| | | | - Ryuichi Kato
- Department of Urology, Muroran City General Hospital, Muroran, Japan
| | - Naoki Itoh
- Department of Urology, NTT East Sapporo Hospital, Sapporo, Japan
| | - Manabu Okada
- Department of Urology, Obihiro Kyokai Hospital, Obihiro, Japan
| | - Hitoshi Tachiki
- Department of Urology, Steel Memorial Muroran Center, Muroran, Japan
| | - Keisuke Taguchi
- Department of Urology, Oji General Hospital, Tomakomai, Japan
| | - Akio Takayanagi
- Department of Urology, JCHO Hokkaido Hospital, Sapporo, Japan
| | - Hiroshi Hotta
- Department of Urology, Japanese Red Cross Asahikawa Hospital, Asahikawa, Japan
| | - Hiroki Horita
- Department of Urology, Hokkaido Saiseikai Otaru Hospital, Otaru, Japan
| | | | - Masahiro Matsuki
- Department of Urology, Japanese Red Cross Kushiro Hospital, Kushiro, Japan
| | - Koyo Nishiyama
- Oral Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Akihiro Miyazaki
- Oral Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Kohei Hashimoto
- Departments of Urology, Oral Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Toshiaki Tanaka
- Departments of Urology, Oral Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Naoya Masumori
- Departments of Urology, Oral Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
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Nakai Y, Kanaki T, Yamamoto A, Tanaka R, Yamamoto Y, Nagahara A, Nakayama M, Kakimoto KI, Ishibashi M, Nishimura K. Antiresorptive agent-related osteonecrosis of the jaw in prostate cancer patients with bone metastasis treated with bone-modifying agents. J Bone Miner Metab 2021; 39:295-301. [PMID: 32886176 DOI: 10.1007/s00774-020-01151-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 07/01/2020] [Accepted: 08/25/2020] [Indexed: 12/24/2022]
Abstract
INTRODUCTION The incidence rate and risk factors of antiresorptive agent-related osteonecrosis of the jaw (ARONJ) in prostate cancer patients with bone metastasis are not clear. MATERIALS AND METHODS We retrospectively reviewed patients' records of prostate cancer patients with bone metastasis who were treated with zoledronic acid or denosumab between 1/Dec/2008 and 31/Mar/2019. ARONJ-free survival rate was analyzed with Kaplan-Meier analysis, and risk factors for ARONJ were analyzed with Cox proportional hazard model. RESULTS We identified 124 and 67 patients treated with zoledronic acid and denosumab, respectively. Seventy-six patients were hormone sensitive, and 115 patients were castration resistant when they started bone-modifying agents (BMA). Twenty-eight patients developed ARONJ during the observation period (median: 23 months, range 1-130 months). Their number of doses of BMA ranged 3-69 (median: 21.5). The 2-year ARONJ-free survival rate was 91.1%, and the 5-year ARONJ-free survival rate was 72.5%. There was no significant difference in the incidence rate of ARONJ between zoledronic acid and denosumab. However, multivariate analysis revealed that use of denosumab (hazard ratio [HR] 3.67, 95% confidence interval [CI] 1.01-13.31; p = 0.0484), serum calcium < 9.2 mg/dL (HR 3.16, 95% CI 1.10-9.13; p = 0.033)), and concomitant or prior use of chemotherapeutic agents (HR 4.71, 95% CI 1.51-14.71; p = 0.0076) were independent risk factors for the development of ARONJ. CONCLUSION Almost one-quarter of patients had a risk of developing ARONJ within 5 years after starting BMA. Low serum calcium, use of chemotherapeutic agents, and use of denosumab might contribute to the development of ARONJ.
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Affiliation(s)
- Yasutomo Nakai
- Department of Urology, Osaka International Cancer Institute, 3-1-69, Otemae, Chuo-ku, Osaka, 541-8567, Japan
| | - Tomohiro Kanaki
- Department of Urology, Osaka International Cancer Institute, 3-1-69, Otemae, Chuo-ku, Osaka, 541-8567, Japan
| | - Akinaru Yamamoto
- Department of Urology, Osaka International Cancer Institute, 3-1-69, Otemae, Chuo-ku, Osaka, 541-8567, Japan
| | - Ryo Tanaka
- Department of Urology, Osaka International Cancer Institute, 3-1-69, Otemae, Chuo-ku, Osaka, 541-8567, Japan
| | - Yoshiyuki Yamamoto
- Department of Urology, Osaka International Cancer Institute, 3-1-69, Otemae, Chuo-ku, Osaka, 541-8567, Japan
| | - Akira Nagahara
- Department of Urology, Osaka International Cancer Institute, 3-1-69, Otemae, Chuo-ku, Osaka, 541-8567, Japan
| | - Masashi Nakayama
- Department of Urology, Osaka International Cancer Institute, 3-1-69, Otemae, Chuo-ku, Osaka, 541-8567, Japan
| | - Ken-Ichi Kakimoto
- Department of Urology, Osaka International Cancer Institute, 3-1-69, Otemae, Chuo-ku, Osaka, 541-8567, Japan
| | - Miki Ishibashi
- Department of Dentistry, Osaka International Cancer Institute, Osaka, Japan
| | - Kazuo Nishimura
- Department of Urology, Osaka International Cancer Institute, 3-1-69, Otemae, Chuo-ku, Osaka, 541-8567, Japan.
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FUJIMOTO DAICHI, OBATA NORIHIKO, MOTOYAMA YASUSHI, SATO HITOAKI, TAKAO YUMIKO, MIZOBUCHI SATOSHI. Continuous Mandibular Nerve Block for Intractable Mandibular Pain Due to Antiresorptive Agent-Related Osteonecrosis of the Jaw: A Case Report. Kobe J Med Sci 2020; 66:E90-E93. [PMID: 33431781 PMCID: PMC7837664] [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] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 06/19/2020] [Indexed: 06/12/2023]
Abstract
Antiresorptive agent-related osteonecrosis of the jaw (ARONJ) causes severe pain that cannot be controlled well by common analgesic drugs. This is a first case report of intractable mandibular pain due to ARONJ that was eliminated by a continuous mandibular nerve block. A 72-year-old woman with osteoporosis had been administered bisphosphonate. One year after extraction of her tooth, she was diagnosed as having ARONJ. Jaw pain was so severe that she was unable to open her mouth and eat. We performed a continuous mandibular nerve block through an indwelling catheter with levobupivacaine for pain management. After the procedure, her rest pain was markedly improved, and the pain induced by opening her mouth disappeared. We conclude that a continuous mandibular nerve block may be helpful in the management of ARONJ.
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Affiliation(s)
- DAICHI FUJIMOTO
- Division of Anesthesiology, Department of Surgery Related, Kobe University Graduate School of Medicine, Kobe, Japan
| | - NORIHIKO OBATA
- Division of Anesthesiology, Department of Surgery Related, Kobe University Graduate School of Medicine, Kobe, Japan
| | - YASUSHI MOTOYAMA
- Division of Anesthesiology, Department of Surgery Related, Kobe University Graduate School of Medicine, Kobe, Japan
| | - HITOAKI SATO
- Division of Anesthesiology, Department of Surgery Related, Kobe University Graduate School of Medicine, Kobe, Japan
| | - YUMIKO TAKAO
- Department of Anesthesiology and Pain medicine, Hyogo College of Medicine, Nishinomiya, Japan
| | - SATOSHI MIZOBUCHI
- Division of Anesthesiology, Department of Surgery Related, Kobe University Graduate School of Medicine, Kobe, Japan
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Nocini R, De Santis D, Luciano U, Zambotti T, Pancera P, Faccioni P, Zotti F, Zarantonello M, Finotti M, Bertajola A, Zangani A, Iurlaro A, Alberti C, Capocasale G, Donadello D, Bernardello F. The rule of hydrogen peroxide long term rinse during a particular alveolar bone healing after ONJ injuries in a patient with periodontal disease: a 4-year radiological follow up report of a mental nerve emergence migration. J BIOL REG HOMEOS AG 2020; 34:69-76. [PMID: 33541066] [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] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Bisphosphonate Related Osteonecrosis of the Jaw (BRONJ) is a pathology initially described in the early 2000s that has become increasingly common in clinical dentistry and maxillofacial practice due to the frequent use of bisphosphonates medical drugs (BPs) to treat various diseases such as osteoporosis, Paget's syndrome, osteomyelitis and in bone metastases secondary to tumors. Supragingival irrigation applied as monotherapy and in combination with root planning or BFs related bone necrosectomy revealed that supragingival irrigation with a variety of agents reduced the gingival microbial load and gingival inflammation. In this 4-year follow-up study we analyze the use of hydrogen peroxide (H2O2) as an antimicrobial agent for maintenance periodontal health, improving the longevity of teeth and oral cavity healing process.
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Affiliation(s)
- R Nocini
- Section of Oral and Maxillofacial Surgery, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Italy
| | - D De Santis
- Section of Oral and Maxillofacial Surgery, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Italy
| | - U Luciano
- Section of Oral and Maxillofacial Surgery, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Italy
| | - T Zambotti
- Section of Oral and Maxillofacial Surgery, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Italy
| | - P Pancera
- Section of Oral and Maxillofacial Surgery, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Italy
| | - P Faccioni
- Section of Oral and Maxillofacial Surgery, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Italy
| | - F Zotti
- Section of Oral and Maxillofacial Surgery, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Italy
| | | | | | | | - A Zangani
- Section of Oral and Maxillofacial Surgery, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Italy
| | - A Iurlaro
- Section of Oral and Maxillofacial Surgery, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Italy
| | - C Alberti
- Section of Oral and Maxillofacial Surgery, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Italy
| | - G Capocasale
- Section of Oral and Maxillofacial Surgery, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Italy
| | - D Donadello
- Section of Oral and Maxillofacial Surgery, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Italy
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Sánchez López JD, Cariati P, Rodríguez I, Carriel Araya S. Cervical abscess as an exceptional presentation of advance bisphosphonate-related osteonecrosis of the jaw: Case report and review of the literature. Reumatol Clin (Engl Ed) 2020; 16:250-251. [PMID: 29691163 DOI: 10.1016/j.reuma.2018.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Revised: 02/17/2018] [Accepted: 03/07/2018] [Indexed: 06/08/2023]
Affiliation(s)
- José Darío Sánchez López
- Servicio de Cirugía Oral y Maxilofacial, Complejo Hospitalario Universitario de Granada, Granada, España.
| | - Paolo Cariati
- Servicio de Cirugía Oral y Maxilofacial, Complejo Hospitalario Universitario de Granada, Granada, España
| | - Ismael Rodríguez
- Departamento de Cirugía Oral, Facultad de Odontología de la Universidad de Córdoba, Córdoba, Argentina
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Mendes V, Dos Santos GO, Calasans-Maia MD, Granjeiro JM, Moraschini V. Impact of bisphosphonate therapy on dental implant outcomes: An overview of systematic review evidence. Int J Oral Maxillofac Surg 2019; 48:373-381. [PMID: 30314708 DOI: 10.1016/j.ijom.2018.09.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 09/15/2018] [Accepted: 09/21/2018] [Indexed: 10/28/2022]
Abstract
The purpose of this overview was to assess the methods, quality, and outcomes of systematic reviews conducted to evaluate the impact of bisphosphonates on dental implants and the risk of developing bisphosphonate-related osteonecrosis of the jaw after dental implant surgery. An electronic search without date or language restriction was performed in the PubMed/MEDLINE, Cochrane CENTRAL, Web of Science, and LILACS databases (to January 2018). Eligibility criteria included systematic reviews that evaluated the impact of bisphosphonates on implant outcomes. The quality assessment of the included reviews was done using AMSTAR 2 guidelines. The protocol of this overview was registered in PROSPERO (CRD42018089617). The search and selection process yielded seven reviews, published between 2009 and 2017. None of the systematic reviews included in this study obtained the maximum score in the quality assessment. The scientific evidence available demonstrates that patients with a history of bisphosphonate use do not present a higher risk of dental implant failure or marginal bone loss compared to patients who have not used bisphosphonates. The literature also suggests that patients who undergo surgical trauma during the installation of dental implants may be more susceptible to bisphosphonate-related osteonecrosis of the jaw.
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Affiliation(s)
- V Mendes
- Department of Integrated Clinics, School of Dentistry, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil
| | - G O Dos Santos
- Department of Integrated Clinics, School of Dentistry, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil
| | - M D Calasans-Maia
- Department of Oral Surgery, School of Dentistry, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil
| | - J M Granjeiro
- National Institute of Metrology, Quality and Technology, Rio de Janeiro, Brazil; Cell Therapy Centre, Clinical Research Unit and Department of Dental Techniques, School of Dentistry, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil
| | - V Moraschini
- Department of Periodontology, School of Dentistry, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil.
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Andoh T, Murata H, Toyosaka A, Oomuro S, Ichikawa N. [A Case of Intracranial Epidural Abscess Secondary to Medication-Related Osteonecrosis of the Jaw]. Gan To Kagaku Ryoho 2019; 46:271-273. [PMID: 30914532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Recently, bisphosphonate and denosumab have been widely used for the treatment of bone metastasis of breast cancer. However, medication-related osteonecrosis of the jaw(MRONJ)has often been reported as a side effect of these drugs. We experienced a rare case of intracranial epidural abscess secondary to MRONJ. The patient died of the condition, although chemotherapy was effective. The mechanism of and therapy for MRONJ have not been clarified; therefore, its prevention should be emphasized.
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Coffey A, Mandel L. Mandibular Bisphosphonate Osteonecrosis: A Cautionary Tale. N Y State Dent J 2017; 83:34-38. [PMID: 29917339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The authors examined a 55-year-old female who had received eight intravenous infusions of a potent bisphosphonate (BP) for metastatic bone disease. A mandibular extraction was subsequently performed. At presentation, infection with suppuration and sequestrum formation were observed in the area of extraction. Both the oncologist and dental practitioner must be made aware that when BPs are going to be administered, dental care should be performed in a timely fashion. Prophylactic measures must be taken by the dentist if dental surgery is required for a patient who has received BP.
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Han XD, Tang MB, Oon HH. Discharging nodule on the jaw. Cutis 2016; 98:E3-E5. [PMID: 28040816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Xiuhui D Han
- Department of Dermatology, National Skin Centre, Singapore
| | - Mark By Tang
- Department of Dermatology, National Skin Centre, Singapore
| | - Hazel Hb Oon
- Department of Dermatology, National Skin Centre, Singapore
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Takaoka K, Yamamura M, Nishioka T, Abe T, Tamaoka J, Segawa E, Shinohara M, Ueda H, Kishimoto H, Urade M. Establishment of an Animal Model of Bisphosphonate-Related Osteonecrosis of the Jaws in Spontaneously Diabetic Torii Rats. PLoS One 2015; 10:e0144355. [PMID: 26659123 PMCID: PMC4684366 DOI: 10.1371/journal.pone.0144355] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Accepted: 11/17/2015] [Indexed: 01/01/2023] Open
Abstract
Background We evaluated the side effects of bisphosphonate (BP) on tooth extraction socket healing in spontaneously diabetic Torii (SDT) rats, an established model of non-obese type 2 diabetes mellitus, to develop an animal model of BP-related osteonecrosis of the jaws (BRONJ). Materials and Methods Male Sprague-Dawley (SD) rats and SDT rats were randomly assigned to the zoledronic acid (ZOL)-treated groups (SD/ZOL or SDT/ZOL) or to the control groups (SD/control or SDT/control). Rats in the SD/ZOL or SDT/ZOL groups received an intravenous bolus injection of ZOL (35 μg/kg) every 2 weeks. Each group consisted of 6 rats each. Twenty-one weeks after ZOL treatment began, the left maxillary molars were extracted. The rats were euthanized at 2, 4, or 8 weeks after tooth extraction, and the total maxillae were harvested for histological and histochemical studies. Results In the oral cavity, bone exposure persisted at the tooth extraction site in all rats of the SDT/ZOL group until 8 weeks after tooth extraction. In contrast, there was no bone exposure in SD/control or SDT/control groups, and only 1 of 6 rats in the SD/ZOL group showed bone exposure. Histologically, necrotic bone areas with empty lacunae, microbial colonies, and less invasion by inflammatory cells were observed. The number of tartrate-resistant acid phosphatase-positive osteoclasts was lower in the SDT/ZOL group than in the SD/control group. The mineral apposition rate was significantly lower in the SDT/ZOL group compared with the SD/control group. Conclusions This study demonstrated the development of BRONJ-like lesions in rats and suggested that low bone turnover with less inflammatory cell infiltration plays an important role in the development of BRONJ.
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Affiliation(s)
- Kazuki Takaoka
- Department of Oral and Maxillofacial Surgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
- * E-mail:
| | - Michiyo Yamamura
- Department of Oral and Maxillofacial Surgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Toshihiro Nishioka
- Department of Oral and Maxillofacial Surgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Tetsuya Abe
- Department of Oral and Maxillofacial Surgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Joji Tamaoka
- Department of Oral and Maxillofacial Surgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Emi Segawa
- Department of Oral and Maxillofacial Surgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Masami Shinohara
- Planning and Development Section, CLEA Japan, Inc., Meguro-ku, Tokyo, Japan
| | - Haruyasu Ueda
- Laboratory of Immunobiology, School of Pharmacy, Hyogo University of Health Sciences, Kobe, Hyogo, Japan
| | - Hiromitsu Kishimoto
- Department of Oral and Maxillofacial Surgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Masahiro Urade
- Department of Oral and Maxillofacial Surgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
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Song A, Yang P, Lyu C, Sun Q. [A case of bisphosphonate-related osteonecrosis of the jaw complicated with multi-periodontal abscesses]. Zhonghua Kou Qiang Yi Xue Za Zhi 2015; 50:164-166. [PMID: 26081856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Manzon L, Ettorre E, Viscogliosi G, Ippoliti S, Filiaci F, Ungari C, Fratto G, Agrillo A. Authors’ reply. Clin Interv Aging 2015; 10:1099. [PMID: 26359525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023] Open
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Guo Y, Wang D, An J, Peng X, Cai Z, Guo C. [Clinical analysis of 24 cases of bisphosphonate-related osteonecrosis of the jaw]. Zhonghua Kou Qiang Yi Xue Za Zhi 2014; 49:517-520. [PMID: 25476210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To retrospectively analyze the data of the patients with Bisphosphonate-related osteonecrosis of the jaw over the past five years in our hospital. METHODS Twenty-four patients with bisphosphonate-related osteonecrosis of the jaw treated in our hospital from 2009 to 2013 were included. The medication, bisphosphonate types, clinical signs and symptom, treatment methods and results were also analyzed. RESULTS Of the 24 cases, 20 cases suffered from malignant tumors and received intravenous infusion of bisphosphonates and 4 cases took oral bisphosphonates. Three of the 4 cases with osteoporosis had history of glucocorticoid (rheumatoid arthritis). All patients had oral clinical symptoms for an average of 11.6 months, and 19 patients had the history of tooth extraction. There were 11 cases with mandible involved, 10 cases with maxilla involved, and 3 cases with both mandible and maxilla involved. After conservative treatment (3 cases) or operation (21 cases), 10 cases had wound healing, 6 cases were stable with bone exposure, and 4 cases with died bone needed reoperation. During the follow-up period, there was one patient died of primary disease (renal carcinoma). CONCLUSIONS Both intravenous and oral application routes of bisphosphonates can induce osteonecrosis of the jaw. Bisphosphonate-related osteonecrosis of the jaw can be caused by alveolar trauma. The treatment modality is to relieve the clinical symptoms of bisphosphonate-related osteonecrosis of the jaw.
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Affiliation(s)
- Yuxing Guo
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing 100081, China
| | - Diancan Wang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing 100081, China
| | - Jingang An
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing 100081, China
| | - Xin Peng
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing 100081, China
| | - Zhigang Cai
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing 100081, China
| | - Chuanbin Guo
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing 100081, China.
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15
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Katkar RA, Katz J, Moreb JS, Nair MK. Multiple myeloma in bisphosphonate-affected jaws--a diagnostic challenge: case report. Quintessence Int 2014; 45:613-617. [PMID: 24847501 DOI: 10.3290/j.qi.a31962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To discuss the challenges in diagnosis and appropriate management of critical underlying pathoses if a patient presents with signs and symptoms indicative of different conditions that may coexist. SUMMARY This case features clinical and radiographic challenges in reaching a diagnosis in a middle- aged man undergoing bisphosphonate therapy for multiple myeloma. The patient had history of bisphosphonaterelated osteonecrosis of the jaw (BRONJ) in the mandible. The patient presented with pain and swelling in the anterior maxilla, associated with paresthesia of upper lip. The radiographic features were suggestive of BRONJ and invasive fungal sinusitis. MRI appearance was suggestive of malignant involvement by plasmacytoma or lymphoma. Although biopsy is usually not advocated in bisphosphonate-affected jaws, it was advised in this case and was positive for multiple myeloma. Vigilance is required to correlate clinical and radiologic findings and further investigations must be considered if malignancy is suspected.
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Zustin J, Reske D, Zrnc TA, Heiland M, Scheuer HA, Assaf AT, Friedrich RE. Pseudoepitheliomatous hyperplasia associated with bisphosphonate-related osteonecrosis of the jaw. In Vivo 2014; 28:125-131. [PMID: 24425847] [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] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a well-characterized oral complication of systemic therapy with bisphosphonates. Pseudoepitheliomatous hyperplasia was observed in some of the lesions. Because podoplanin expression has been linked to malignant lesions of the oral mucosa, we aimed to investigate podoplanin expression in the pseudoepitheliomatous hyperplasia. We analyzed archival paraffin- and plastic-embedded specimens from BRONJ using both conventional and immunohistochemical (AE1/AE3, D2-40) staining methods. Eleven out of seventeen BRONJ cases showed pseudoepitheliomatous hyperplasia. All these cases were positive for AE1/AE3 and pseudoepitheliomatous hyperplasia displayed a strong basal and parabasal reaction against podoplanin. The podoplanin expression in pseudoepitheliomatous hyperplasia in BRONJ specimens should not be considered a sign of malignancy. We discuss the current and possible future roles of surgical pathologists in diagnosing morphological changes associated with the development and therapy of BRONJ lesions.
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Affiliation(s)
- Jozef Zustin
- Institute of Pathology, University Medical Centre Hamburg Eppendorf, Martinistr.52, 20246 Hamburg, Germany.
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Affiliation(s)
- Liran Levin
- Division of Periodontology, Department of Oral Medicine, Infection, and Immunity, Harvard School of Dental Medicine, Boston, Massachusetts2Department of Periodontology, School of Graduate Dentistry, Rambam Health Care Campus, Faculty of Medicine, Technion, IIT, Haifa, Israel
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Assaf AT, Smeets R, Riecke B, Weise E, Gröbe A, Blessmann M, Steiner T, Wikner J, Friedrich RE, Heiland M, Hoelzle F, Gerhards F. Incidence of bisphosphonate-related osteonecrosis of the jaw in consideration of primary diseases and concomitant therapies. Anticancer Res 2013; 33:3917-3924. [PMID: 24023329] [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] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Since its first description by Marx in 2003, the etiology of bisphosphonate-related osteonecrosis of the jaw (BRONJ) is the subject of numerous scientific discussions for oral and maxillofacial surgeons. Many retrospective studies on its etiology and pathogenesis have been carried out to explain pathological mechanisms; most of them just take a close look at the issue of dosage and application. Recently, attempts have been made, to identify co-factors which might promote the development of BRONJ. PATIENTS AND METHODS The present study is based on data of 169 patients with osseous metastatic malignancies. All patients received intravenous bisphosphonate therapy. On the basis of medical history, malignancy, and primary treatment, the modality of bisphosphonate therapy, and existing comorbidities and medication were analyzed. The role of immunosuppressive drugs, influence of underlying diseases, and general factors such as age and gender were examined. The predictability of necrotic involvement, influenced by the underlying malignancy and its specific therapy, e.g. radiation and cytostatic therapy were analyzed and statistically evaluated. RESULTS A total of 8.9% (n=15) of patients developed BRONJ. The average time between diagnosis of malignancy and BRONJ was 80 months. Nine patients suffered from breast cancer, five had prostate cancer and one renal cancer. Separation into stage and histological subtype did not show any significant correlation, nor did age or gender, to the occurrence of BRONJ. However statistical analysis did show a significant correlation concerning monocytostatic (p=0.0215) and triple-cytostatic therapy (p=0.0137). The majority of patients with BRONJ (60%) received a bisphosphonate therapy including zoledronate. Single application with one bisphosphonate was administered in 28 cases; 44 patients had a medical history of different use of bisphosphonate. Concomitant medication did not suggest possible correlation, nor did accompanying diseases, arterial hypertension (33.33%) or arterial microcirculatory disturbances (20%). CONCLUSION The evaluation of our results is pioneering. The influence of cytostatics and combined therapy of cytotoxic drugs on the pathogenesis of BRONJ is demonstrated here statistically. We confirmed a drug- and dose-dependent occurrence of BRONJ. Further prospective studies should be performed to elucidate the role of tissue perfusion and oxygen saturation, and the influence of immunosuppressive drugs in relation to the occurrence of BRONJ, as well as on wound healing of initial lesions.
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Affiliation(s)
- Alexandre T Assaf
- DMD, Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.
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19
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Affiliation(s)
- C Prada García
- Servicio de Dermatología, Complejo Asistencial Universitario de León, León, Spain.
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Al-Zoman KH, AlBazie S, Robert AA, Baskaradoss JK, Alsuwyed AS, Ciancio S, Al-Mubarak S. Surgical management of bisphosphonate-related osteonecrosis of the jaw: report of three cases. J Palliat Care 2013; 29:52-57. [PMID: 23614172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Khalid H Al-Zoman
- Dental Department, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
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21
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Abstract
Bisphosphonates are widely used in the treatment of osteoporosis to reduce fracture risk. Because of their long retention time in bone and uncommon side effects, questions have been raised about the optimal duration of therapy. Potential side effects appear to be rare and may not be causally related. Although there is no strong science to guide "drug holidays," there appears to be some lingering antifracture benefit when treatment is stopped, so some time off treatment should be offered to most patients on long-term bisphosphonate therapy. For most patients with osteoporosis, the benefits of treatment outweigh the risks.
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Affiliation(s)
- Dima L Diab
- Division of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, Cincinnati VA Medical Center, University of Cincinnati, 3125 Eden Avenue, PO Box 670547, Cincinnati, OH 45267, USA.
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Bedogni A, Saia G, Bettini G, Tronchet A, Totola A, Bedogni G, Tregnago P, Valenti MT, Bertoldo F, Ferronato G, Nocini PF, Blandamura S, Dalle Carbonare L. Osteomalacia: the missing link in the pathogenesis of bisphosphonate-related osteonecrosis of the jaws? Oncologist 2012; 17:1114-9. [PMID: 22723507 DOI: 10.1634/theoncologist.2012-0141] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a well-documented adverse event from treatment with nitrogen-containing bisphosphonates (NBPs). During a preliminary histomorphometric study aimed at assessing the rate of bone remodeling in the jaws of patients with surgically resected BRONJ, we found a defect of bone mineralization (unpublished data). We hypothesized that osteomalacia could be a risk factor for BRONJ in patients taking NBPs. Therefore, we looked for static and dynamic histomorphometric evidence of osteomalacia in biopsies from subjects with and without BRONJ. METHODS This case-control study used histomorphometric analysis of bone specimens of patients using NBPs (22 patients with BRONJ and 21 patients without BRONJ) who required oral surgical interventions for the treatment/prevention of osteonecrosis. Patients were given tetracycline hydrochloride according to a standardized protocol before taking bone biopsies from their jaws. Biopsies with evidence of osteomyelitis or necrosis at histology were excluded from the study. Osteomalacia was defined as a mineralization lag time >100 days, a corrected mean osteoid thickness >12.5 mm, and an osteoid volume >10%. RESULTS In all, 77% of patients with BRONJ were osteomalacic compared with 5% of patients without BRONJ, according to histomorphometry. Because osteomalacia was found almost exclusively in NBP users with BRONJ, this is likely to be a generalized process in which the use of NBPs further deteriorates mechanisms of bone repair. CONCLUSIONS Osteomalacia represents a new and previously unreported risk factor for disease development. This finding may contribute to a better understanding of the pathogenesis of this disease and help with the development of strategies to increase the safety of NBP administration.
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Affiliation(s)
- Alberto Bedogni
- Section of Oral and Maxillofacial Surgery, Department of Surgery, Azienda Ospedaliera Universitaria Integrata, Square L.A. Scuro 10, 37134 Verona, Italy.
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Zadik Y, Benoliel R, Fleissig Y, Casap N. Painful trigeminal neuropathy induced by oral bisphosphonate-related osteonecrosis of the jaw: a new etiology for the numb-chin syndrome. Quintessence Int 2012; 43:97-104. [PMID: 22257870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
We describe the management of BRONJ triggered by dental implants in a patient on oral bisphosphonates. The sequestrum in the body of the mandible was large and involved the inferior alveolar nerve, causing a painful neuropathy. A successful outcome was obtained by combining conservative and surgical interventions.
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Affiliation(s)
- Yehuda Zadik
- Department of Oral Medicine, Hebrew University-Hadassah School of Dental Medicine, Jerusalem, Israel
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Leung FYC, Rabie ABM, Wong RWK. Osteoporosis, osteonecrosis, and orthodontics. World J Orthod 2009; 10:261-271. [PMID: 19885431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Osteoporosis, whether senile, postmenopausal, or corticosteroid-induced, has been shown to affect orthodontic tooth movement and the periodontium. There have also been reports of osteonecrosis related to oral bisphosphonate therapy during treatment for osteoporotic bone diseases. This article summarizes the current knowledge of the relationship between osteoporosis and osteonecrosis and their effects on orthodontic tooth movements. The information will be important in orthodontic treatment planning and realization.
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