Differences in the Knowledge and Experience of Physicians and Dentists About Medication-Related Osteonecrosis of the Jaw in Osteoporotic Patients

Yamori, Masashi; Tamura, Mitsumasa; Mikami, Masaki; Mōri, Toshio; Noi, Masaharu; Machida, Y; Koshinuma, Shinya; Yamamoto, Go

doi:10.1016/j.identj.2020.12.005

Cited by 17 publications

(18 citation statements)

References 9 publications

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“…In real-world clinical practice, there is cumulative evidence that highlights the need to improve bone health care in patients with prostate cancer [ 21 , 23 , 27 , 28 ]. Mitchell et al did a retrospective study utilizing the SEER database, including the patients with mCSPC, to evaluate the BMA prescribing patterns amongst oncologists and urologists [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

“…However, in the real world, there is a substantial evidence-practice gap among the physicians [ 5 ]. Yamori et al, in their questionnaire survey, noted that only 30% of physicians requested dental screening before initiating BMAs [ 27 ]. Similarly, Taguchi et al reported that 62% of physicians did not seek dental clearance before prescribing BMAs [ 28 ].…”

Section: Discussionmentioning

confidence: 99%

“…Dental screening is a strong recommendation for oncologists to request before prescribing BMAs. However, there is a significant proportion of oncologists who still do not refer patients for a dental screening [ 27 , 28 ]. Hence, there are multiple factors at various steps that can lead to inappropriate use of BMAs ( Figure 1 ).…”

Section: Need Of the Study: Barriers To Adhering To Guideline-based I...mentioning

confidence: 99%

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Improving Bone Health in Patients with Metastatic Prostate Cancer with the Use of Algorithm-Based Clinical Practice Tool

et al. 2022

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Background: The bone health of patients with locally advanced and metastatic prostate cancer is at risk from treatment-related bone density loss and skeletal-related events from metastatic disease in bones. Evidence-based guidelines recommend using denosumab or zoledronic acid at bone metastasis-indicated dosages in the setting of castration-resistant prostate cancer with bone metastases and at the osteoporosis-indicated dosages in the hormone-sensitive setting in patients with a significant risk of fragility fracture. For the concerns of jaw osteonecrosis, a dental evaluation is recommended before starting bone-modifying agents. The literature review suggests a limited evidence-based practice for bone health with prostate cancer in the real world. Both under-treatment and inappropriate dosing of bone remodeling therapies place additional risks to bone health. An incomplete dental work up before starting bone-modifying agents increases the risk of jaw osteonecrosis. Methods: We created an algorithm-based clinical practice tool to minimize the deviation from evidence-based guidelines at our center and provide appropriate bone health care to our patients by ensuring indication-appropriate dosing and dental screening rates. This order set was incorporated into the electronic medical record system for ordering a bone remodeling agent for prostate cancer. The tool prompts the clinicians to follow the appropriate algorithm in a stepwise manner to ensure a pretreatment dental evaluation and use of the correct dosage of drugs. Results: We analyzed the data from Sept 2019 to April 2022 following the incorporation of this tool. 0/35 (0%) patients were placed on inappropriate bone modifying agent dosing, and dental health was addressed in every patient before initiating treatment. We compared the change in the practice of prescribing and noted a significant difference in the clinician’s practice while prescribing denosumab/zoledronic acid before and after implementation of this tool [incorrect dosing: 24/41 vs. 0/35 (p < 0.00001)]; and an improvement in pretreatment dental checkup before and after implementation of the tool was noted to be [missed dental evaluation:12/41 vs. 0/35 (p < 0.00001)]. Conclusion: We found that incorporating an evidence-based algorithm in the order set while prescribing bone remodeling agents significantly improved our institutional clinical practice of indication-appropriate dosing and dental screening rates, and facilitated high-quality, evidence-based care to our patients with prostate cancer.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Need Of the Study: Barriers To Adhering To Guideline-based I...mentioning

confidence: 99%

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Improving Bone Health in Patients with Metastatic Prostate Cancer with the Use of Algorithm-Based Clinical Practice Tool

et al. 2022

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“…In addition to qualitative research, survey-based research has focused on communication issues related to ONJ between dentists and physicians, reporting that the lack of communication between dentists and physicians threatened ONJ prevention and the necessity to establish a forum to share information about ONJ between healthcare professionals, dentists and patients 17 18 32 33. A study in Australia analysed the communication among physicians, dentists and pharmacists regarding ONJ, showing that important communication targets could vary depending on each country’s medical system 34…”

Section: Discussionmentioning

confidence: 99%

“…These issues are barriers for effective MRONJ communications between dentists and physicians. Successful MRONJ treatment and prevention requires cooperation between dentists and physicians to share patient information 17 18…”

Section: Introductionmentioning

confidence: 99%

Qualitative focus group interview study of communication between patients, dentists and physicians for efficient osteonecrosis of the jaw practices

et al. 2022

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ObjectivesTo investigate problems and the current status of existing methods of communication between patients, dentists and physicians for the prevention and treatment of medication-related osteonecrosis of the jaw (MRONJ).DesignA focus group interview study with a descriptive design using qualitative content analysis of transcripts.SettingSecondary care in Korea.Participants3 patient groups and 4 health professional groups in a total of 32 participants including patients with osteoporosis or bone metastasis, dentists and physicians.ResultsThis study revealed that patients lacked medical knowledge of osteoporosis drugs, whereas dentists and physicians lacked each other’s expertise. All patients reported undergoing dental treatments during the osteoporosis drug treatment, but dentists and physicians had different MRONJ experiences depending on their work setting in primary or secondary care. Patients expressed dissatisfaction with the current system of communication with health professionals via letter as they found this to be a slow process. Dentists and physicians reported the need for effective communication because they felt defensive when sending and receiving medical consults.ConclusionsDespite the low incidence of MRONJ among patients with osteoporosis, it is difficult to treat; thus, it is necessary to inform dentists, physicians and patients about the importance of MRONJ prevention. To this end, close communication among all involved stakeholders about osteoporosis drugs is required.

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Cooperation between physicians and dentists for osteonecrosis of the jaw: a 2022 Japanese survey

Taguchi,

Hagino,

Inoue

et al. 2023

J Bone Miner Metab

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Differences in the Knowledge and Experience of Physicians and Dentists About Medication-Related Osteonecrosis of the Jaw in Osteoporotic Patients

Cited by 17 publications

References 9 publications

Improving Bone Health in Patients with Metastatic Prostate Cancer with the Use of Algorithm-Based Clinical Practice Tool

Improving Bone Health in Patients with Metastatic Prostate Cancer with the Use of Algorithm-Based Clinical Practice Tool

Qualitative focus group interview study of communication between patients, dentists and physicians for efficient osteonecrosis of the jaw practices

Cooperation between physicians and dentists for osteonecrosis of the jaw: a 2022 Japanese survey

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