Oral avascular bone necrosis associated with chemotherapy and biphosphonate therapy

Pires, Fábio Ramôa; Miranda, Águida Maria Menezes Aguiar; Cardoso, Elaine; Cardoso, Alice; Fregnani, Eduardo Rodrigues; Pereira, Cláudio Maranhão; Corrêa, Maria Elvira P.; Almeida, Juliana Pereira; Alves, Fábio de Abreu; Lopes, Márcio Ajudarte; Almeida, Orlando José de

doi:10.1111/j.1601-0825.2005.01130.x

Cited by 71 publications

(55 citation statements)

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“…Reduction of pain and regression or even resolution of lesions of osteonecrosis have been observed in patients treated with antibiotics and mouth rinses, withdrawal of bisphosphonates, and removal of loose sequestra (31,45,48). Extensive resection has not consistently resulted in wound closure and may lead to worsening or progression of disease (25,27).…”

Section: Management Recommendationsmentioning

confidence: 99%

Systematic Review: Bisphosphonates and Osteonecrosis of the Jaws

2006

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Osteonecrosis of the jaws is a recently described adverse side effect of bisphosphonate therapy. Patients with multiple myeloma and metastatic carcinoma to the skeleton who are receiving intravenous, nitrogen-containing bisphosphonates are at greatest risk for osteonecrosis of the jaws; these patients represent 94% of published cases. The mandible is more commonly affected than the maxilla (2:1 ratio), and 60% of cases are preceded by a dental surgical procedure. Oversuppression of bone turnover is probably the primary mechanism for the development of this condition, although there may be contributing comorbid factors. All sites of potential jaw infection should be eliminated before bisphosphonate therapy is initiated in these patients to reduce the necessity of subsequent dentoalveolar surgery. Conservative débridement of necrotic bone, pain control, infection management, use of antimicrobial oral rinses, and withdrawal of bisphosphonates are preferable to aggressive surgical measures for treating this condition. The degree of risk for osteonecrosis in patients taking oral bisphosphonates, such as alendronate, for osteoporosis is uncertain and warrants careful monitoring.

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Section: Management Recommendationsmentioning

confidence: 99%

Systematic Review: Bisphosphonates and Osteonecrosis of the Jaws

2006

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“…En el primer caso (32 meses), el uso concomitante de esteroides pudo haber contribuido al desarrollo de ONM, por sus propiedades antiangiogénicas e inmunosupresoras 20 . Respecto a los antiagregantes plaquetarios, no tenemos otras referencias publicadas donde hayan sido valorados.…”

Section: Discussionunclassified

Osteonecrosis maxilar secundaria al uso de bisfosfonatos por vía oral: Exposición de tres casos clínicos relacionados con alendronato

et al. 2009

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Osteonecrosis of the jaw secondary to oral alendronate. Report of three cases (Rev Méd Chile 2009; 137: 275-9 Los BF por vía oral (VO) están recomendados en el tratamiento de la osteoporosis, la osteopenia, la enfermedad de Paget y la osteogénesis imperfecta en la infancia 2,3 . Aunque la indicación más prevalente es la osteoporosis 4,5 , que puede aparecer en la postmenopausia o en el contexto de otras enfermedades, como la enfermedad inflamatoria intestinal o la cirrosis biliar primaria y por el uso de otros fármacos, principalmente esteroides. No obstante, cualquiera que sea su etiología, los BF VO junto al calcio y la vitamina D juegan un papel fundamental en su tratamiento 6 .Los BF se toleran bien en general si se administran correctamente, no obstante, se han descrito diferentes efectos adversos y complicaciones asociadas a su uso. Los efectos secundarios más frecuentes de los BF VO son de tipo digestivo: erosiones, ulceraciones crónicas en la mucosa oral 7 , úlceras gástricas, esofagitis y estenosis esofágica 8 .

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“…On retrouve les traitements suivants : -corticoïdes [18,49,[84][85][86], -oestrogènes [87,89], -chimiothérapie cytotoxique [49,84], -hormonothérapie [19], -traitement antiangiogénique notamment le thalidomide [89,90], En décembre 2010, le laboratoire Roche, en accord avec l'agence européenne du médicament (EMA) et l'agence française de sécurité sanitaire des produits de santé (AFSSAPS), a informé les prescripteurs de l'Avastin® que ce dernier pouvait être un facteur de risque additionnel à la survenue d'ONM [91]. L'impact potentiel de l'activité antiangiogénique de l'Avastin® sur le mécanisme de développement des ONM est en cours d'évalua-tion.…”

Section: Autres Thérapeutiques Médicamenteuses (Concomitantes Ou Non)unclassified

Ostéonécroses des maxillaires dues aux bisphosphonates administrés par voie intraveineuse : incidence et facteurs de risque

Gunepin

Derache

Jaureguibery

et al. 2013

Med Buccale Chir Buccale

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Résumé -Administrés par voie intraveineuse, les bisphosphonates trouvent de nombreuses indications en oncologie et en hématologie (prise en charge des myélomes multiples, prévention des complications osseuses de certaines tumeurs malignes avancées, traitement des hypercalcémies malignes). Depuis 2003, de nombreuses publications ont rapporté un effet indésirable grave imputable aux bisphosphonates : l'ostéonécrose des maxillaires (ONM). Une revue de la littérature portant sur 10 ans de recherche montre que les données épidémiologiques relatives à cette pathologie restent contradictoires. L'incidence des ONM couramment acceptée (0,8 à 12 %) semble sous-estimée en raison des limites méthodologiques des études disponibles (durée de suivi des patients limitée, absence d'examen bucco-dentaire systématique, inhomogénéité des échantillons, etc.). L'absence de consensus autour des facteurs de risque de survenue des ONM résulte de ces mêmes limites méthodologiques. Ce manque de données hypothèque la compréhension des ONM et donc leur prévention et leur prise en charge thérapeutique. Un recueil systématisé et exhaustif des cas de ONM et de leur contexte de survenue (pathologie primaire, données relatives au traitement par bisphosphonates, facteurs de risque, etc.) devrait permettre de pallier ce problème.Abstract -Osteonecrosis of the jaw in patients treated with intravenous bisphosphonates: incidence and risk factors. Intravenous bisphosphonates are effective in the treatment and management of cancer-related conditions including hypercalcemia of malignancy, skeletal-related events associated with bone metastases in the context of solid tumors such as breast cancer, prostate cancer and lung cancer, and management of lytic lesions in the setting of multiple myeloma. In 2003, oral and maxillofacial surgeons first recognized and reported cases of non-healing exposed bone in the maxillofacial region in patients treated with intravenous bisphosphonates. This adverse effect was called bisphosphonate-related osteonecrosis of the jaw (BOJ). A review of literature based on ten years of research highlights a lack of reliable epidemiological data. BOJ incidence commonly accepted (0.8 to 12%) seems to be underestimated. The main raisons for conflicting results concerning BOJ incidence and risk factors are the weakness of study design, the underpowered study with the use of mixed samples (patients with different pathologies and treatments) during short follow-up. To increase level of evidence well designed studies are needed with a longer follow-up of patients, a systematic dental exam by a trained dentist, the set up of homogeneous samples, etc. The lack of reliable data prevents the scientific community from understanding BOJ and so from setting up effective prevention and treatments. A systematic and exhaustive data collection of cases of BOJ and their context of occurrence (primary disease, information concerning the treatment with bisphosphonates, risk factors, etc.) should overcome these problems.

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Oral avascular bone necrosis associated with chemotherapy and biphosphonate therapy

Abstract: Avascular bone necrosis is a serious oral side-effect of cancer chemotherapy, particularly in patients using biphosphonates, and antibiotic therapy and surgical debridation were not able to promote complete response in most cases.

Cited by 71 publications

References 20 publications

Systematic Review: Bisphosphonates and Osteonecrosis of the Jaws

Systematic Review: Bisphosphonates and Osteonecrosis of the Jaws

Osteonecrosis maxilar secundaria al uso de bisfosfonatos por vía oral: Exposición de tres casos clínicos relacionados con alendronato

Ostéonécroses des maxillaires dues aux bisphosphonates administrés par voie intraveineuse : incidence et facteurs de risque

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