Osteonecrosis of the jaw in patients treated with denosumab: A multicenter case series

Aljohani, Suad; Gaudin, Robert; Weiser, Julian; Tröltzsch, Matthias; Ehrenfeld, Michael; Kaeppler, Gabriele; Smeets, Ralf; Otto, Sven

doi:10.1016/j.jcms.2018.05.046

Cited by 56 publications

(59 citation statements)

References 50 publications

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“…The International Task Force on Osteonecrosis of the Jaw, supported by 14 international societies, names dental extraction and suppuration as the two most important risk factors for osteoporosis patients on bisphosphonates or denosumab. (66,67,134,139) There are steps that clinicians and patients can take to try to reduce the risk of ONJ. (66) Although roughly one-third of ONJ cases do not have any clear preceding event, the most common preceding events are local bone infection or trauma.…”

Section: Additional Recommendations and Rationalesmentioning

confidence: 99%

“…(132) The only other anti-osteoporosis drug associated with an increased risk of ONJ is denosumab, (133) and the risk appears to be comparable to that associated with bisphosphonates. (134) The exact incidence of ONJ remains unknown but is believed to be 0.001% or less annually in the general population (66,135) In patients with osteoporosis who are taking usual doses of bisphosphonates, the incidence is estimated to be only slightly higher-somewhere in the range of 0.001% (1/100,000) and 0.01% (1/10,000). (66,123) More than 90% of the medicationrelated cases occur in patients who have advanced cancer and bone metastases and are taking substantially higher drug doses, more frequently, and often intravenously, to prevent skeletal complications.…”

Section: Additional Recommendations and Rationalesmentioning

confidence: 99%

“…(66) Although roughly one-third of ONJ cases do not have any clear preceding event, the most common preceding events are local bone infection or trauma. (66,67,134,139) There are steps that clinicians and patients can take to try to reduce the risk of ONJ. First, prescribing clinicians should consider a patient's oral health before beginning bisphosphonates or denosumab.…”

Section: Additional Recommendations and Rationalesmentioning

confidence: 99%

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Secondary Fracture Prevention: Consensus Clinical Recommendations from a Multistakeholder Coalition

Conley

Adib²,

Adler

et al. 2019

Journal of Bone and Mineral Research

167

111

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Osteoporosis‐related fractures are undertreated, due in part to misinformation about recommended approaches to patient care and discrepancies among treatment guidelines. To help bridge this gap and improve patient outcomes, the American Society for Bone and Mineral Research assembled a multistakeholder coalition to develop clinical recommendations for the optimal prevention of secondary fracture among people aged 65 years and older with a hip or vertebral fracture. The coalition developed 13 recommendations (7 primary and 6 secondary) strongly supported by the empirical literature. The coalition recommends increased communication with patients regarding fracture risk, mortality and morbidity outcomes, and fracture risk reduction. Risk assessment (including fall history) should occur at regular intervals with referral to physical and/or occupational therapy as appropriate. Oral, intravenous, and subcutaneous pharmacotherapies are efficacious and can reduce risk of future fracture. Patients need education, however, about the benefits and risks of both treatment and not receiving treatment. Oral bisphosphonates alendronate and risedronate are first‐line options and are generally well tolerated; otherwise, intravenous zoledronic acid and subcutaneous denosumab can be considered. Anabolic agents are expensive but may be beneficial for selected patients at high risk. Optimal duration of pharmacotherapy is unknown but because the risk for second fractures is highest in the early post‐fracture period, prompt treatment is recommended. Adequate dietary or supplemental vitamin D and calcium intake should be assured. Individuals being treated for osteoporosis should be reevaluated for fracture risk routinely, including via patient education about osteoporosis and fractures and monitoring for adverse treatment effects. Patients should be strongly encouraged to avoid tobacco, consume alcohol in moderation at most, and engage in regular exercise and fall prevention strategies. Finally, referral to endocrinologists or other osteoporosis specialists may be warranted for individuals who experience repeated fracture or bone loss and those with complicating comorbidities (eg, hyperparathyroidism, chronic kidney disease). © 2019 American Society for Bone and Mineral Research.

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Section: Additional Recommendations and Rationalesmentioning

confidence: 99%

Section: Additional Recommendations and Rationalesmentioning

confidence: 99%

Section: Additional Recommendations and Rationalesmentioning

confidence: 99%

See 1 more Smart Citation

Secondary Fracture Prevention: Consensus Clinical Recommendations from a Multistakeholder Coalition

Conley

Adib²,

Adler

et al. 2019

Journal of Bone and Mineral Research

167

111

View full text Add to dashboard Cite

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“…Denosumab reduces bone resorption by binding to the receptor activator of nuclear factor‐kappa B ligand (RANKL), which causes decreased formation and activity of osteoclasts, and its association with MRONJ is well established . Longer treatment duration and higher doses are correlated with an increased risk for MRONJ.…”

Section: Medication‐related Osteonecrosis Of the Jawmentioning

confidence: 99%

A review and guide to drug‐associated oral adverse effects—Dental, salivary and neurosensory reactions. Part 1

Teoh

Moses

McCullough

2019

J Oral Pathology Medicine

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Numerous adverse drug reactions (ADR) manifest in the oral cavity and orofacial region. Dentists and other health professionals commonly encounter and manage these adverse effects however, due to lack of awareness and training, they are not always recognised as being drug‐induced nor reported to pharmacovigilance agencies. The broad diversity and increasing number of medications for which dental pharmacovigilance is needed can be overwhelming for all health professionals. Thus, the aim of this review and guide was to outline the common medications associated with orofacial side effects so as to improve recognition, management and reporting of ADR. Adverse effects discussed in Part 1 include drug‐induced bruxism, tardive dyskinesia, hairy tongue, gingival enlargement, hypersalivation, xerostomia, tooth discolouration and taste disturbance.

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“…MRONJ is more common in the mandible (around 2/3 of the cases) and less common in the maxilla (around 1/3 of the cases). In both jaws the molar and premolar regions are affected more frequently [3] [4] .…”

mentioning

confidence: 99%

Medication-related osteonecrosis of the jaw - a disease with many names

Otto

2019

Preprint

Self Cite

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Since the first description of medication induced necrosis of the jaw in 2003 by Marx, much has been written and published about this disease. In the following, we will examine this disease and examine its development-on the one hand which definitions exist, why they are defined differently and how they are classified. Definitions Definition of bisphosphonate-related osteonecrosis of the jaw in 2007 Defined by American As s ociation of Oral and Maxillofacial Surg eons Advis ory Tas k Force on Bis phos phonate-Related Os tenonecros is of the Jaws Definition of bisphosphonate-related osteonecrosis of the jaw in 2009 Defined by Salvatore Rug g iero et al. Definition of medication-related osteonecrosis of the jaw in 2014 Defined by Salvatore L. Rug g iero et al.

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Osteonecrosis of the jaw in patients treated with denosumab: A multicenter case series

Cited by 56 publications

References 50 publications

Secondary Fracture Prevention: Consensus Clinical Recommendations from a Multistakeholder Coalition

Secondary Fracture Prevention: Consensus Clinical Recommendations from a Multistakeholder Coalition

A review and guide to drug‐associated oral adverse effects—Dental, salivary and neurosensory reactions. Part 1

Medication-related osteonecrosis of the jaw - a disease with many names

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