Managing the care of patients receiving antiresorptive therapy for prevention and treatment of osteoporosis

Hellstein, John W.; Adler, Robert A.; Edwards, Beatrice J.; Jacobsen, Peter L.; Kalmar, John R.; Koka, Sreenivas; Migliorati, Cesar A.; Ristic, Helen

doi:10.14219/jada.archive.2011.0108

Cited by 317 publications

(109 citation statements)

References 129 publications

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“…Dentists regard the incidence of ONJ as a critical problem. An advisory committee of the ADA Council concluded that discontinuing BP may not only reduce the risk of ONJ, but may also have a negative effect on bone status especially in osteoporosis patients who have a high risk of fracture [9]. However, the position papers for BRONJ or ONJ from JSBMR and the American Association of Oral and Maxillofacial Surgeons (AAOMS) recommended a discontinuation of antiresorptive agents both before and after invasive dental procedures [8,10].…”

Section: Discussionmentioning

confidence: 99%

“…Of these, 14 respondents had discontinued BP for 3 months, and 1 had discontinued BP for 6 months. 9. What was the result of osteoporosis treatment after a discontinuation?…”

Section: Respondentsmentioning

confidence: 99%

“…To address this situation, several position papers, consensus papers, and guidelines have been published globally [6][7][8][9][10]. These have focused on the definition, pathophysiology, risk factors, prevalence, and incidence of ONJ; imaging modalities for diagnosing ONJ; management strategies; and stage-specific treatment strategies.…”

Section: Introductionmentioning

confidence: 99%

“…Medical professionals claim that there is a potential increase in adverse events, such as fractures, during drug discontinuation; however, dentists support the practice of drug discontinuation to reduce the incidence of ONJ and possible lawsuits if ONJ occurs. Based on the positive effect of oral health care in preventing ONJ in patients with malignancies [12,13], an advisory committee from the American Dental Association (ADA) Council on Scientific Affairs and an international consensus paper have recommended oral health care before invasive dental procedures, but not the discontinuation of BP and Dmab in osteoporosis patients [9,11]. However, most Japanese medical professionals are less likely to recommend maintenance of oral hygiene, even though it is recommended in the Japanese BRONJ position paper.…”

Section: Introductionmentioning

confidence: 99%

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Impact of Osteonecrosis of the Jaw on Osteoporosis Treatment in Japan: Results of a Questionnaire-Based Survey by the Adequate Treatment of Osteoporosis (A-TOP) Research Group

Taguchi

Shiraki

Tsukiyama³

et al. 2015

Calcif Tissue Int

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Dentists request a discontinuation of antiresorptive agents, such as bisphosphonate, before and after tooth extractions to prevent osteonecrosis of the jaw (ONJ). However, little is known about how this affects ONJ and osteoporosis treatment and how medical professionals and dentists cooperate to treat ONJ in patients with osteoporosis. This study aimed to clarify the impact of ONJ on osteoporosis treatment in Japan. A structured questionnaire including 14 key clinical queries was sent to 488 medical professionals as part of the Japanese Osteoporosis Intervention Trial (JOINT)-04, and 206 responses were received. A total of 173 respondents had received discontinuation requests from dentists. Of these, 28 respondents experienced 30 adverse events including ten fractures and one incidence of ONJ. The respondents who refused discontinuation requests observed no cases of ONJ. Approximately 16 % of respondents had patients who discontinued osteoporosis treatment, following a requested drug discontinuation, after tooth extraction. Dentists requested discontinuations for many medications that were not associated with the incidence of ONJ. Approximately 76 % of respondents had never requested oral health care from dentists before osteoporosis treatment and 72 % reported no cooperation between dentists and medical professionals in their region. Our results suggest that drug discontinuation may increase adverse events and disturb osteoporosis treatment without completely preventing ONJ. Currently, both medical professionals and dentists in Japan still continue to recommend their own treatment position. A forum to share information about ONJ among medical professionals, dentists, and patients is required.

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Section: Discussionmentioning

confidence: 99%

“…Of these, 14 respondents had discontinued BP for 3 months, and 1 had discontinued BP for 6 months. 9. What was the result of osteoporosis treatment after a discontinuation?…”

Section: Respondentsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Impact of Osteonecrosis of the Jaw on Osteoporosis Treatment in Japan: Results of a Questionnaire-Based Survey by the Adequate Treatment of Osteoporosis (A-TOP) Research Group

Taguchi

Shiraki

Tsukiyama³

et al. 2015

Calcif Tissue Int

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“…When the duration of therapy is longer than 3 years or is less than 3 years but is combined with corticosteroids, the clinician should consider a 3-month "drug holiday" before elective oral surgery, to be extended for a further 3 months if warranted by the patient's systemic conditions [58]. In summary, the American Dental Association in 2011 recommended that OP therapy does not require alteration before dental procedures [3,59], but a recent review emphasized the importance of good dental hygiene in reducing risk and that consideration should be given to stopping antiresorptive therapy before major, invasive dental surgery [60].…”

Section: Antiresorptive Drugs For the Treatment Of Op Bisphosphonatesmentioning

confidence: 99%

Osteoporosis, bone mineral density and CKD–MBD: treatment considerations

et al. 2017

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Osteoporosis and chronic kidney disease (CKD) have both independently important potential impact on bone health. A significant number of patients with CKD stages 3a-5D have been shown to have low bone mineral density (BMD), leading to a strikingly elevated risk of fractures (mainly hip fractures) and higher associated morbidity and mortality. Mechanical properties of bone beyond age and menopausal status are additionally affected by intrinsic uremic factors. Therefore, we review in this article not only general concepts of osteoporosis and related consequences, but also the diagnostic and therapeutic implications of low BMD and bone fractures in CKD, beyond increased vascular calcification. Antiresorptive agents (mainly bisphosphonates) were not previously recommended when the estimated glomerular filtration rate (GFR) was lower than 30 ml/min/1.73 m. However, post-hoc analysis of large randomized clinical trials found that these drugs (i.e. alendronate, ribandronate, denosumab) had comparable efficacy in improving BMD and reducing fracture risk in individuals (mainly women) with moderate reductions of GFR (mostly CKD stages 3-4). Therefore, at least in the absence of clear abnormalities of CKD-related mineral metabolism disturbances, bone antiresorptive agents (and maybe anabolic agents) that are or will be approved for general osteoporosis may be appropriate for CKD. Nephrologists should probably not ignore any longer fracture risk assessment, especially in patients with additional risk factors for osteoporosis if results will impact treatment decisions. However, although different therapeutic agents have been shown to reduce the risk of fracture in CKD patients with low BMD, specific prospective studies, with or without bone biopsies, in CKD are urgently needed.

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Bisphosphonates for advanced prostate cancer

Macherey

Monsef

Jahn

et al. 2017

Cochrane Database of Systematic Reviews

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Background The prevalence and incidence of pain and skeletal complications of metastatic bone disease such as pathologic fractures, spinal cord compression and hypercalcemia is high and an important contributor to morbidity, poor performance status and decreased quality of life. Moreover, pathologic fractures are associated with increased risk of death in people with disseminated malignancies. Therefore, prevention of pain and fractures are important goals in men with prostate cancer at risk for skeletal complications. Objectives To assess the effects of bisphosphonates in men with bone metastases from prostate cancer. Search methods We identified studies by electronic search of bibliographic databases including the Cochrane Controlled Trials Register and MEDLINE on 13 July 2017 and trial registries. We handsearched the Proceedings of American Society of Clinical Oncology (to July 2017) and reference lists of all eligible trials identified. This is an update of a review last published in 2006. Selection criteria We included randomized controlled studies comparing the effectiveness of bisphosphonates in men with bone metastases from prostate cancer. Data collection and analysis Two review authors independently extracted data and assessed the quality of trials. We defined the proportion of participants with pain response as the primary end point; secondary outcomes were skeletal-related events, mortality, quality of life, adverse events, analgesic consumption and disease progression. We assessed the quality of the evidence for the main outcomes using the GRADE approach. Main results We included 18 trials reporting on 4843 participants comparing the effect of bisphosphonate administration to control regimens. Primary outcome: there was no clear difference in the proportion of participants with pain response (RR 1.15, 95% CI 0.93 to 1.43; P = 0.20; I 2 = 0%; 3 trials; 876 participants; low quality evidence). In absolute terms, bisphosphonates resulted in a pain response in 40 more participants per 1000 (19 fewer to 114 more).

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Managing the care of patients receiving antiresorptive therapy for prevention and treatment of osteoporosis

Cited by 317 publications

References 129 publications

Impact of Osteonecrosis of the Jaw on Osteoporosis Treatment in Japan: Results of a Questionnaire-Based Survey by the Adequate Treatment of Osteoporosis (A-TOP) Research Group

Impact of Osteonecrosis of the Jaw on Osteoporosis Treatment in Japan: Results of a Questionnaire-Based Survey by the Adequate Treatment of Osteoporosis (A-TOP) Research Group

Osteoporosis, bone mineral density and CKD–MBD: treatment considerations

Bisphosphonates for advanced prostate cancer

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