Bisphosphonate-associated Osteonecrosis of the Jaw in Ontario: A Survey of Oral and Maxillofacial Surgeons

Khan, Aliya; Rios, Lorena P.; Sándor, G; Khan, Nazir Ahmad; Peters, E. A.; Rahman, Mohammed O; Clokie, Cameron M. L.; Dore, Edward; Dubois, Sacha

doi:10.3899/jrheum.100221

Cited by 64 publications

(54 citation statements)

References 22 publications

(29 reference statements)

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“…Suppression of bone turnover may also play a role in the development of ONJ . The association of ONJ with potent antiresorptive drugs and the increased risk with higher doses of BPs and Dmab would be consistent with this contention . In Beagle dogs treated with high doses of BPs, areas of necrosis in the mandible sometimes develop, with nonviable osteocytes in the affected bone .…”

Section: Resultsmentioning

confidence: 77%

“…The incidence of ONJ in patients prescribed oral BPs for the treatment of osteoporosis ranges from 1.04 to 69 per 100,000 patient‐years . The incidence of ONJ in patients prescribed i.v.…”

Section: Resultsmentioning

confidence: 99%

“…The incidence of ONJ in oncology patients treated with i.v. BPs ranges from 0 to 12,222 per 100,000 patient‐years, and the incidence of ONJ in oncology patients treated with Dmab ranges from 0 to 2,316 per 100,000 patient‐years …”

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

Diagnosis and Management of Osteonecrosis of the Jaw: A Systematic Review and International Consensus

Khan

Morrison

Hanley

et al. 2014

Journal of Bone and Mineral Research

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1,066

1,033

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This work provides a systematic review of the literature from January 2003 to April 2014 pertaining to the incidence, pathophysiology, diagnosis, and treatment of osteonecrosis of the jaw (ONJ), and offers recommendations for its management based on multidisciplinary international consensus. ONJ is associated with oncology-dose parenteral antiresorptive therapy of bisphosphonates (BP) and denosumab (Dmab). The incidence of ONJ is greatest in the oncology patient population (1% to 15%), where high doses of these medications are used at frequent intervals. In the osteoporosis patient population, the incidence of ONJ is estimated at 0.001% to 0.01%, marginally higher than the incidence in the general population (<0.001%). New insights into the pathophysiology of ONJ include antiresorptive effects of BPs and Dmab, effects of BPs on gamma delta T-cells and on monocyte and macrophage function, as well as the role of local bacterial infection, inflammation, and necrosis. Advances in imaging include the use of cone beam computerized tomography assessing cortical and cancellous architecture with lower radiation exposure, magnetic resonance imaging, bone scanning, and positron emission tomography, although plain films often suffice. Other risk factors for ONJ include glucocorticoid use, maxillary or mandibular bone surgery, poor oral hygiene, chronic inflammation, diabetes mellitus, illfitting dentures, as well as other drugs, including antiangiogenic agents. Prevention strategies for ONJ include elimination or stabilization of oral disease prior to initiation of antiresorptive agents, as well as maintenance of good oral hygiene. In those patients at high risk for the development of ONJ, including cancer patients receiving high-dose BP or Dmab therapy, consideration should be given to withholding antiresorptive therapy following extensive oral surgery until the surgical site heals with mature mucosal coverage. Management of ONJ is based on the stage of the disease, size of the lesions, and the presence of contributing drug therapy and comorbidity. Conservative therapy includes topical antibiotic oral rinses and systemic antibiotic therapy. Localized surgical debridement is indicated in advanced nonresponsive disease and has been successful. Early data have suggested enhanced osseous wound healing with teriparatide in those without contraindications for its use. Experimental therapy includes bone marrow stem cell intralesional transplantation, low-level laser therapy, local platelet-derived growth factor application, hyperbaric oxygen, and tissue grafting.

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Section: Resultsmentioning

confidence: 77%

Section: Resultsmentioning

confidence: 99%

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Diagnosis and Management of Osteonecrosis of the Jaw: A Systematic Review and International Consensus

Khan

Morrison

Hanley

et al. 2014

Journal of Bone and Mineral Research

Self Cite

1,066

1,033

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“…It is similar to the occurrence of osteonecrosis of the jaw (ONJ) in the general population [6–8]. However, there is no research about investigating the prevalence of ONJ in those who BPs used for the osteoporosis therapy specifically.…”

Section: Introductionmentioning

confidence: 97%

Impact of Bisphosphonate-related Osteonecrosis of the Jaw on Osteoporotic Patients after Dental Extraction: A Population-Based Cohort Study

et al. 2015

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Background and AimsLittle is currently known about the risk of developing bisphosphonate-related osteonecrosis of the jaw (BRONJ). This study sought to determine the incidence of BRONJ in osteoporotic patients. We also sought to identify the nature and types of risk factors of osteonecrosis of jaw (ONJ) related to the use of oral bisphosphonates (BPs).Materials and MethodsData from the National Health Insurance system of Taiwan. This cohort study included 19,399 adult osteoporosis patients received dental extraction in 2000-2010 (osteoporosis cohort) and 38,669 age and gender matched comparisons selected from dental extraction people without osteoporosis and osteonecrosis history (comparison cohort). All study subjects were followed from the date of their dental extraction (index date) to the development of ONJ and were included in the study up to 2011 or were lost to the study, whichever occurred first. Cox proportional hazard regression was used to estimate the hazard ratio and 95% confidence intervals for the two cohorts.ResultsPatients with osteoporosis had a significantly higher risk to develop ONJ than healthy persons (adjusted HR, 2.05; 95% confidence interval, 1.58–2.65). The risk of ONJ increased with the severity of osteoporosis, no matter whether patient with cancer or not. A cumulative effect of dental extraction frequency may increase the risk of ONJ.ConclusionsWe concluded that ONJ is caused by a number of factors. Osteoporosis and past dental history play the very important roles, while BPs play the synergistic effect.

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“…À l'exception du syndrome pseudo-grippal qui se manifeste par une fièvre transitoire, une myalgie et des douleurs osseuses, les effets secondaires liés à l'acide zolédronique sont généralement considérés comme peu fréquents et légers comparés à ceux de nombreux traitements en cancérologie [16]. Cependant, il convient de tenir compte de la possibilité d'une altération de la fonction rénale et de l'apparition d'une ostéonécrose de la mâchoire [3,17]. Dans cette étude, une incidence de 0,6 % d'ostéonécrose de la mâchoire et de 0,2 % de fractures a été rapportée.…”

Section: Discussionunclassified

Traitement à domicile par l’acide zolédronique chez des patients atteints de tumeurs solides : observance et satisfaction du patient et de l’infirmier

Lebrét

Mouysset²,

Lortholary³

et al. 2013

Bulletin du Cancer

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Bisphosphonate-associated Osteonecrosis of the Jaw in Ontario: A Survey of Oral and Maxillofacial Surgeons

Cited by 64 publications

References 22 publications

Diagnosis and Management of Osteonecrosis of the Jaw: A Systematic Review and International Consensus

Diagnosis and Management of Osteonecrosis of the Jaw: A Systematic Review and International Consensus

Impact of Bisphosphonate-related Osteonecrosis of the Jaw on Osteoporotic Patients after Dental Extraction: A Population-Based Cohort Study

Traitement à domicile par l’acide zolédronique chez des patients atteints de tumeurs solides : observance et satisfaction du patient et de l’infirmier

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