Non‐exposed bisphosphonate‐related osteonecrosis of the jaw: a critical assessment of current definition, staging, and treatment guidelines

Patel, Sumit; Choyee, S.; Uyanne, Jettie; Nguyen, Andrew; Lee, P.; Sedghizadeh, Parish P.; Kumar, Satish; Lytle, John J.; Shi, Songtao; Le, Anh D.

doi:10.1111/j.1601-0825.2012.01911.x

Cited by 80 publications

(80 citation statements)

References 35 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…[23][24][25][26][27][28][29][30] Finally, in 2014, an AAOMS special committee released a third position paper [31] changing the term from BRONJ to medicationrelated ONJ (MRONJ) in order to include cases linked to the treatment with denosumab and those arising after antiangiogenic drugs and targeted therapies; the document enlarged the definition of disease to include cases with 'bone that can be probed through an intraoral or extraoral fistula in the maxillofacial region that has persisted for longer than 8 weeks' and confirmed the existence of a 'stage 0 category' for patients with signs and symptoms without bone exposure. On the other hand, an international task force recently confirms the ASBMR 2007 definition without the AAOMS 2009 and 2014 amends.…”

Section: Definition Of Onjmentioning

confidence: 99%

Osteonecrosis of jaw beyond antiresorptive (bone-targeted) agents: new horizons in oncology

Fusco

Santini

Armento

et al. 2016

Expert Opinion on Drug Safety

View full text Add to dashboard Cite

Introduction: Osteonecrosis of the jaw (ONJ) is a clinically important, potentially painful and debilitating condition, which can affect the quality of life of cancer patients. Since 2003, ONJ appeared as a Bisphosphonate(BP)-related class effect, and the term Bisphosphonate-Related Osteonecrosis of the Jaw (BRONJ) was widespread. Areas Covered: Under discussion in this review is the fact that ONJ cases have been reported after treatment including antiangiogenic agents and other “targeted therapy”, with and without BPs. Consequently, the comprehensive term Medication-Related Osteonecrosis of the Jaw (MRONJ) has been introduced. The clinical aspects and the prognosis of ONJ associated with these new drugs are still less reported, but basing on their pharmacodynamics, they could be different from the well-known BRONJ. Accordingly, recommendations largely in use for BRONJ should be extended to these new forms, but critically applied and with respect to the individual risk assessment. Expert Opinion: There is a high risk of underdiagnoses for ONJ due to a lack of awareness, and too much restrictive or incomplete diagnostic criteria; at the same time, with regard to ONJ associated to the new non –antiresorptive agents, described here, we observe the strong need to improve the defining of any distinguished feature in their diagnosis, prevention and therapy

show abstract

Section: Definition Of Onjmentioning

confidence: 99%

Osteonecrosis of jaw beyond antiresorptive (bone-targeted) agents: new horizons in oncology

Fusco

Santini

Armento

et al. 2016

Expert Opinion on Drug Safety

View full text Add to dashboard Cite

show abstract

“…Since, there are still disagreements on BRONJ definition and staging systems, some researchers suggested their own staging systems. 35,36 Also, it is not known how the 8 week period determined for humans should be adapted to rats. In the present study, all extraction sockets were covered with mucosa, and there were no signs of bone exposure 8 weeks after tooth extractions.…”

Section: Discussionmentioning

confidence: 99%

Teriparatide and the treatment of bisphosphonate-related osteonecrosis of the jaw: a rat model

Ersan¹,

Ruijven²,

Bronckers³

et al. 2014

Dentomaxillofacial Radiology

View full text Add to dashboard Cite

Objectives: The objectives of this study were to establish a bisphosphonate-related osteonecrosis of the jaw (BRONJ) rat model and to analyse the effects of teriparatide (TP) on this model. Methods: Sprague-Dawley rats were divided into three groups: I-zoledronic acid (ZA, n 5 10); II-ZA and teriparatide (ZA 1 TP, n 5 10); III-control (n 5 10). Osteonecrosis was induced by administering zoledronic acid to groups ZA and ZA 1 TP. A week after the injections, rats underwent extraction of the first left mandibular molar. Following a four week period, TP was administered to the ZA 1 TP group for 28 days. Upon killing, extraction sockets were examined clinically, radiologically and histopathologically. Results: Clinical examination revealed necrotic bone exposure in none of the animals. MicroCT (mCT) examination showed that bone mineral density of the newly formed bone in the extraction socket was lower in the ZA group than in the ZA 1 TP group (p , 0.05). Histopathological examination revealed that only the ZA and ZA 1 TP groups developed osteonecrosis, and the osteonecrotic bone area in the ZA group was larger than that in the ZA 1 TP group (p , 0.05). Tartrate-resistant acid phosphatase (TRAcP) enzyme histochemistry revealed that the number of detached and large osteoclasts were higher in the ZA group than in other groups, whereas the number of apoptotic osteoclasts in both ZA and ZA 1 TP groups were higher than in the control group (p , 0.05). Conclusions: Our data indicate that bisphosphonate-related osteonecrosis of the jaw model used in the present study is an attractive model to investigate treatment modalities and that TP might be an effective treatment in BRONJ.

show abstract

“…Il n'existe cependant aucun consensus international. Toutefois, plusieurs articles récents montrent des taux plus élevés de « guérison » des ostéonécroses après traitement chirurgical qu'après traitement conservateur, même dans les stades précoces de déve-loppement pour lesquels les thérapeutiques interventionnistes ont été longtemps déconseillées [19][20][21][22]. Certains auteurs évoquent des traitements complémentaires comme l'oxygéno-thérapie hyperbare [23] mais son efficacité n'est pas prouvée.…”

Section: Discussionunclassified

Ostéonécrose des maxillaires : quand l’ancien traitement avec bisphosphonates est méconnu

Renoux

Folliguet

Nguyen

et al. 2014

Med Buccale Chir Buccale

View full text Add to dashboard Cite

Résumé -Introduction :La personne âgée est atteinte de polypathologies et polymédiquée. Les prescriptions sont faites par plusieurs médecins qui s'ignorent réciproquement, ce qui augmente le risque d'effets adverses. Observation : Le cas d'une patiente de 91 ans vivant dans un établissement d'hébergement pour personnes âgées dépendantes est rapporté. Quatre mois après une perfusion de zolédronate suite à une chute avec tassement vertébral, elle a consulté pour une gêne maxillaire gauche, ce qui a permis de découvrir un foyer d'ostéonécrose spontanée maxillaire. Un deuxième foyer d'ostéonécrose, mandibulaire, a été diagnostiqué trois semaines plus tard. Considérant l'âge de la patiente et l'absence de troubles fonctionnels, seul un débridement chirurgical superficiel a été réalisé. Discussion : L'apparition d'ostéonécroses spontanées bimaxillaires quatre mois après une perfusion unique de zolédronate étant peu probable, la recherche approfondie des antécédents de la patiente a permis de retrouver une prise de trois bisphosphonates oraux pendant sept ans sans aucun examen et suivi bucco-dentaire. L'interrogatoire médical des patients âgés atteints de troubles cognitifs étant difficile, la recherche de tous les médecins prescripteurs est nécessaire. Conclusion : La prise en charge de l'ostéonécrose associée aux bisphosphonates étant complexe, le chirurgien-dentiste joue un rôle important dans la prévention de cette pathologie.Abstract -Osteonecrosis of the jaws: when past bisphosphonates therapy is unknown. Introduction: Older people have multiple morbidities and are polymedicated. The medicines are prescribed by several doctors who are unaware of each other, hence the increased risk of adverse effects. Observation: We report the case of an institutionalized 91-year-old female patient. Following a fall resulting in a vertebral compression fracture, she received an infusion of zoledronic acid. Four months after this treatment, she consulted for left maxillary discomfort. A voluminous bone sequestrum revealed a maxillary osteonecrosis area. Right mandibular osteonecrosis was diagnosed three weeks later. Considering the patient's age and the lack of functional impairment, surgical debridement was the only procedure performed. Discussion: The emergence of spontaneous maxillary osteonecrosis four months after a single infusion of bisphosphonate being implausible, we searched her medical records for the physicians who treated the patient before her institutionalization. We found three oral bisphosphonate medications during seven years. No oral examination was performed during this therapy. The diagnosis of jaw osteonecrosis should lead the oral surgeon to look for past bisphosphonate therapy among other possible etiologies of this pathology. Indeed, this treatment is often forgotten by patients suffering from cognitive impairment. Conclusion: As the management of bisphosphonate-related osteonecrosis of the jaws is difficult, the oral surgeon has an important role in the prevention of this pathology. Mots clés :bisphospho...

show abstract

Non‐exposed bisphosphonate‐related osteonecrosis of the jaw: a critical assessment of current definition, staging, and treatment guidelines

Cited by 80 publications

References 35 publications

Osteonecrosis of jaw beyond antiresorptive (bone-targeted) agents: new horizons in oncology

Osteonecrosis of jaw beyond antiresorptive (bone-targeted) agents: new horizons in oncology

Teriparatide and the treatment of bisphosphonate-related osteonecrosis of the jaw: a rat model

Ostéonécrose des maxillaires : quand l’ancien traitement avec bisphosphonates est méconnu

Contact Info

Product

Resources

About