Osteonecrosis of the jaws in patients assuming oral bisphosphonates for osteoporosis: A retrospective multi-hospital-based study of 87 Italian cases

Fede, Olga Di; Fusco, Vittorio; Matranga, Domenica; Solazzo, L; Gabriele, Mario; Gaeta, Giuseppe Lucio; Favia, G; Sprini, Delia; Peluso, Franco; Colella, Giuseppe; Vescovi, Paolo; Campisi, Giuseppina

doi:10.1016/j.ejim.2013.05.011

Cited by 25 publications

(13 citation statements)

References 56 publications

(66 reference statements)

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“…It is also the most prescribed drug for preventing and treating osteoporosis, as confirmed by Malden and Lopes (). The duration of NBP in the RA patients with ONJ in this study varied from 1 to 130 months, similar to that previously reported (2–120 months) (Di Fede et al , ) in the osteoporotic case series. Moreover, it is notable that the longer‐term use of oral NBPs, as is usual for RA therapy, may have a dose equivalence effect, potentially approximating to that of BP levels in bone, which is thought to be achieved only through high‐dose intravenous delivery.…”

Section: Discussionsupporting

confidence: 90%

“…In order to evaluate the site and characteristics of ONJ in the patients with RA in this study, we observed that the mandible was most prevalently involved (61.1%) and this fact has been published by other researchers in the field (Diniz-Freitas et al, 2012;Di Fede et al, 2013). Furthermore, a high percentage of cases (38.9%) did not present bone exposure, but they did display minor clinical and radiological signs, according to Bedogni et al (2012).…”

Section: Discussionmentioning

confidence: 70%

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BRONJ in patients with rheumatoid arthritis: a multicenter case series

et al. 2016

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OBJECTIVE: Osteonecrosis of the jaw (ONJ) is a potentially severe adverse effect of various medications (bisphosphonates, anti-resorptive, and anti-angiogenic drugs). ONJ pathogenesis is still unclear although some risk factors have been recognized. Of these, rheumatoid arthritis (RA) has been hypothesized as a potential risk factor for developing ONJ. This observational study will describe a multicenter case series of patients affected with RA and ONJ, and it will attempt to evaluate the association between features of ONJ and pharmacological, systemic, and site variables. METHODS: Demographic, pharmacological, and clinical data from 18 RA patients with ONJ were collected and registered from three Italian centers (i.e., Palermo, Verona, and Padua) from 2004 to 2013. RESULTS: Sixteen (88.9%) patients were in therapy for RA: 9 of 18 (50.0%) with systemic steroids, 3 of 18 (16.7%) with methotrexate, and 4 of 18 (22.2%) with both medications. Two patients were not receiving treatment for RA. All patients took NBPs for secondary osteoporosis (average NBP duration of 69 months, range: 20-130): Fifteen (83.3%) patients were treated with single NBPs, while three (16.7%) with different molecules; one patient was also treated with denosumab. Mandible was affected more frequently (66.7%) than maxilla (33.3%); one patient presented multiple ONJ events. CONCLUSIONS: This is the first multicenter case series in the international literature regarding our topic. Focusing on our data, it could be hypothesized that patients with RA may be more susceptible to ONJ than the majority of osteometabolic patients. In our opinion, it could be important to monitor also denosumab or other biological drug side effects.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 70%

BRONJ in patients with rheumatoid arthritis: a multicenter case series

et al. 2016

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“…58 As physicians manage patients with medical conditions, referral of patients to dentists is sometimes necessary to prevent complications that may result from medical therapy or deterioration of systemic disorders. 59 Therefore, involvement of special needs dentistry specialists in interprofessional care is important to ensure successful treatment outcome and attainment of overall well-being of patients. It was alarming, however, to see the significantly poor responses among the Australian respondents in our study regarding their awareness of special needs dentistry as a specialty, although this field of dentistry has been recognized in Australia for more than a decade.…”

Section: Resultsmentioning

confidence: 99%

Oral Health Education for Medical Students: Malaysian and Australian Students’ Perceptions of Educational Experience and Needs

Ahmad

Abuzar

Razak

et al. 2017

Journal of Dental Education

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Education in oral health is important to prepare future medical professionals for collaborative roles in maintaining patients' oral health, an important component of general health and well-being. The aims of this study were to determine the perceptions of medical students in Malaysia and Australia of the quality of their training in oral health care and their perceptions of their professional role in maintaining the oral health of their patients. A survey was administered in the classroom with final-year Malaysian (n=527; response rate=79.3%) and Australian (n=455; response rate: 60%) medical students at selected institutions in those countries. In the results, most of these medical students reported encountering patients with oral health conditions including ulcers, halitosis, and edentulism. A majority in both countries reported believing they should advise patients to obtain regular dental check-ups and eat a healthy diet, although they reported feeling less than comfortable in managing emergency dental cases. A high percentage reported they received a good education in smoking cessation but not in managing dental trauma, detecting cancerous lesions, or providing dietary advice in oral disease prevention. They expressed support for inclusion of oral health education in medical curricula. These students' experience with and perceptions of oral health care provide valuable information for medical curriculum development in these two countries as well as increasing understanding of this aspect of interprofessional education and practice now in development around the world.

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“…[28][29][30][31] Further symptoms associated with MRONJ are loosening of teeth due to destruction of the supporting bone and halitosis due to bacterial superinfection. 32 Dental, oral, and maxillofacial complications found in patients with MRONJ are varied. They might arise from progression of the disease or as a consequence of treatment modalities, thus resulting in functional problems such as impairment of chewing, loss of teeth, facial disfigurement, and the persistence of fistulas (►Fig.…”

Section: Medication-related Osteonecrosis Of the Jaw Presentationmentioning

confidence: 99%

Bisphosphonate and Medication-Related Osteonecrosis of the Jaw: A Review

Mücke

Krestan

Mitchell

et al. 2016

Semin Musculoskelet Radiol

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For patients with malignant disease taking bisphosphonates and denosumab, the incidence of medication-related osteonecrosis of the jaw (MRONJ) is up to 15% in contrast to 0.01% in patients with osteoporosis. Clinical presentation of MRONJ extends from asymptomatic exposure of bone in 94% of patients to severe cases of mandibular fractures in a minority of 4.5%. The strongest risk factors for MRONJ are invasive dental procedures and dental infections. Advances in imaging provide more preoperation information compared with panoramic radiograph. Prevention strategies are the elimination of potential risk factors leading to invasive dental procedures and maintenance of good oral hygiene prior to the administration of antiresorptive agents. Management of MRONJ depends on the underlying disease, extent of the necrosis, and the presence of contributing therapy. Conservative therapies include topical anti-infective rinses and systemic antibiotic therapy. The most important part of surgical therapy is to remove the exposed and necrotic bone. Several options for defect closure are possible from local tissue flaps to microvascular free flap procedures. The development of MRONJ in conjunction with dental implants is a severe side effect and should be avoided if potentially harmful medication has already been administered.

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Osteonecrosis of the jaws in patients assuming oral bisphosphonates for osteoporosis: A retrospective multi-hospital-based study of 87 Italian cases

Cited by 25 publications

References 56 publications

BRONJ in patients with rheumatoid arthritis: a multicenter case series

BRONJ in patients with rheumatoid arthritis: a multicenter case series

Oral Health Education for Medical Students: Malaysian and Australian Students’ Perceptions of Educational Experience and Needs

Bisphosphonate and Medication-Related Osteonecrosis of the Jaw: A Review

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