Additional Bone Loss Research Articles

Impact of local and systemic factors on additional peri-implant bone loss.

To assess the impact of local and systemic factors on additional peri-implant bone loss. From a total of 253 patients, 193 were selected (126 women) and restored with 722 implants, in place for at least 1 year. Patients had previously attended the supportive periodontal/peri-implant therapy program at the Department of Implant Dentistry at the Federal University of Santa Catarina, Brazil. The study was divided according to physiologic (PBL < 2 mm) or additional bone loss (ABL >= 2 mm) evaluated from the time of prosthesis placement to the reassessment visit. Data collection and analysis included evaluation of systemic factors, such as history of periodontal disease, heart disease, hypertension, diabetes mellitus, hyperthyroidism/hypothyroidism, osteoporosis, kidney disease, alcohol abuse, smoking habits, chemotherapy, radiation therapy, menopause, and hormone replacement. Analysis of local factors included implant platform, diameter, location, time in function, and type of prosthesis. No systemic factors influenced ABL (P > .05). Considering local factors, only time in function and type of prosthesis influenced ABL (P < .05). Fixed partial dental prostheses and full-arch fixed prostheses present higher rates of ABL. In addition, all types of prostheses showed greater ABL when in function for more than 4 years.

Abstract 2143: Anti-TGFβ antibody treatment rescues doxorubicin- mediated bone loss in preclinical osteolytic breast cancer metastasis models.

Abstract Anthracyclines (doxorubicin) are one of the most effective and widely used chemotherapeutic agent for the treatment of several cancer types, including early stage and metastatic breast cancer. However, doxorubicin has been known to cause long-term bone damage and growth defects in patients with childhood cancers, which was also confirmed by several preclinical studies. This raises concern regarding the usage of doxorubicin for the treatment of patients with metastatic breast cancer who are already at increased risk of osteolytic bone damage leading to severe bone loss due to. A number of clinical and preclinical studies have indicated that doxorubicin causes both long term and short term bone damages by lowering bone mineral density, increasing bone loss and may disrupt bone homeostasis by directly affecting bone marrow stem cells, however, the underlying mechanism is poorly understood. We have previously reported that treatment with doxorubicin increases circulating levels of TGFβ, a cytokine which has been implicated in the increase in osteoclast differentiation and survival, suppression of osteoblast differentiation and has been associated with advancement of breast cancer to bone metastasis. We hypothesize, breast cancer patients undergoing doxorubicin treatment will experience accelerated bone loss due to an increase in serum TGFβ levels and blocking TGFβ will rescue this bone loss, at least partially. We have tested the efficacy of anti-TGFβ antibody 1D11, in blocking doxorubicin-mediated bone damage in cardiac injection and orthotopic models of breast cancer to bone metastasis. X-ray image analysis revealed that doxorubicin treatment resulted in an eightfold increase in osteolytic lesion areas (P=0.002) and microCT analysis has shown almost 50% decrease in BV/TV (P=0.0005), in a preclinical murine model metastatic breast cancer. Doxorubicin treatment has also decreased BV/TV in non-tumor bearing animals, suggesting a direct damaging effect of this agent to bone at the sites which are not affected by cancer infestation. As anticipated, treatment with anti-TGFβ antibody 1D11 was able to rescue doxorubicin-mediated bone loss in all three preclinical models tested. At the cellular level, direct effect of doxorubicin treatment on the bone marrow microenvironment included decreased osteoblast survival and reduced mineralized matrix formation and increased osteoclast formation, thereby affecting both bone formation and bone resorption. Taken together, we conclude that, doxorubicin therapy decreases bone formation and increases bone resorption causing additional bone loss in patients with osteolytic bone disease and an anti-TGFβ therapy may be affective in controlling that bone loss. Citation Format: Tapasi Rana, Anwesa Chakrabarti, Michael Freeman, Swati Biswas. Anti-TGFβ antibody treatment rescues doxorubicin- mediated bone loss in preclinical osteolytic breast cancer metastasis models. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 2143. doi:10.1158/1538-7445.AM2013-2143

Peri-implantitis Progression Around Thin Sputtered Hydroxyapatite-Coated Implants: Clinical and Radiographic Evaluation in Dogs

Soft and hard tissue responses to experimental peri-implantitis around thin sputter hydroxyapatite (HA)-coated implants were evaluated and compared to the responses to implants with other surface treatments. Forty-eight dental implants with four different surfaces--machined (M), sandblasted/acid-etched (SA), 1-μm thin sputter HA-coated (S), and plasma-sprayed HA-coated (P)--were inserted into the mandibles of six beagle dogs. Three months later, experimental peri-implantitis was induced with ligatures to allow plaque accumulation. After a 4-month period of active breakdown, the ligatures were removed, and plaque accumulation continued for 5 additional months (progression period). Radiographic marginal bone levels, probing depths, clinical attachment levels, and modified Gingival Index were evaluated at baseline, after the active breakdown period, and after the progression period. Significant increases in mean probing depths and clinical attachment levels were seen around all implants after active breakdown, but no significant differences were found during the progression period. Radiographic analysis revealed marginal bone loss of 1 to 1.7 mm during the active breakdown period. Additional bone loss occurred during the progression period (M 0.2 mm, SA 0.3 mm, S 0.2 mm, P 0.4 mm). Comparable tissue behavior was demonstrated around dental implants with all four surfaces under peri-implantitis conditions. Thin sputter HA-coated implants possess the favorable osteoconductive properties of calcium phosphate coatings without exacerbating further peri-implant tissue breakdown during the progression of peri-implantitis.

Supportive periodontal therapy and periodontal biotype as prognostic factors in implants placed in patients with a history of periodontitis

Objectives: To evaluate bone loss around implants placed in patients with a history of treated chronic periodontitis and who did or did not attend supportive periodontal therapy, after one year in function. Furthermore, the influence of periodontal biotype and level of plaque was also evaluated. Material and Methods: Forty-nine patients participated voluntarily in the study. All subjects had a history of chronic periodontitis, which had been previously treated. After the active treatment, 27 patients attended supportive periodontal therapy (SPT) and the rest did not (No SPT). The O’Leary plaque index and periodontal biotype were recorded for each subject and 246 Astra Tech® OsseospeedTM implants were radiographically analysed (123 placed in SPT patients and 123 in No SPT patients) at the time of loading and one year later, measuring marginal bone loss with the program Dental Studio NX 6.0®. The statistical analysis was performed with Windows SPSS, applying Pearson’s correlation index and the Kruskal-Wallis and U-Mann Whitney non-parametric tests. Results: Six patients were found to have periimplantitis and sixteen mucositis. The survival rate was 99.59% (100% SPT and 99.18% No SPT). Mean bone loss was 0.39 mm (range [-0.71 - 8.05]). Among SPT patients, 95% of the implants had losses less than or equal to the mean (mean bone loss of 0.16 mm) compared to 53.7% for the No SPT group (mean bone loss of 0.62 mm). A statistically significant relationship was demonstrated between bone loss around the implant and the patient’s periodontal biotype and plaque index. Conclusions: The marginal bone loss around implants in patients with treated chronic periodontitis is minimal if they are in a controlled SPT programme and there is individual control of plaque index. Moreover, the presence of a thin periodontal biotype represents a risk factor for additional bone loss. Key words:Peri-implantitis, chronic periodontitis, bacterial plaque, periodontal biotype.

Radiologic Evaluation of Bone Loss at Implants with Biocide Coated Titanium Abutments: A Study in the Dog

The objective of the present study is to evaluate bone loss at implant abutments coated with a soda-lime glass containing silver nanoparticles subjected to experimental peri-implantitis. Five beagle dogs were used in the experiments, 3 implants were installed in each quadrant of the mandibles. Glass/n-Ag coted abutments were connected to implant platform. Cotton floss ligatures were placed in a submarginal position around the abutment necks and the animals were subject to a diet which allowed plaque accumulation, and after 15 weeks the dogs were sacrificed. Radiographs of all implant sites were obtained at the beginning and at the end of the experimentally induced peri-implantitis. The radiographic examination indicated that significant amounts of additional bone loss occurred in implants without biocide coating, considering both absolute and relative values of bone loss. Percentages of additional bone loss observed in implants dressed with a biocide coated abutment were about 3 times lower (p<0.006 distal aspect; and p<0.031 at mesial aspect) than the control ones. Within the limits of the present study it seems promising the use of soda-lime glass/nAg coatings on abutments to prevent peri-implant diseases.

Predictors of inter‐proximal and midfacial recession following single implant treatment in the anterior maxilla: a multivariate analysis

A number of factors have been associated with soft tissue recession following single implant treatment. However, given the cross-sectional design of most of these studies and crude associations based on univariate analyses, such factors may only be considered risk indicators. The objective of the present retrospective cohort study using multivariate analyses was to identify predictors of recession. Patients who had been treated by two periodontists and two prosthodontists in 2006 and 2007 for a single implant in the anterior maxilla were re-examined in 2009 and their records were scrutinized. Subjects treated via flap surgery with and without ridge re-contouring were considered. Outcome variables were inter-proximal and midfacial recession. Explanatory variables included demographic data, the surgical approach and a number of local factors that were evaluated on radiographs taken pre-operatively or at permanent crown installation (baseline). Data pertaining to 97/115 (60 females, 37 males; mean age 51, SD 13, range 23-80) patients were available for evaluation. Significant bone loss was observed between baseline and re-examination at the implant surface (0.2-0.3mm, p<0.001) and tooth surface (0.3-0.5mm, p<0.001). Surgery with ridge re-contouring demonstrated 0.2mm additional bone loss at the distal tooth surface when compared to surgery without ridge re-contouring (p=0.034). This could be explained by a disparity in possible papilla-opening procedures (three versus one or two). As a result, regression analyses identified surgery with ridge re-contouring as a predictor of inter-proximal recession (OR≥3.4). Pre-operative bone level at the tooth surface was another predictor of inter-proximal recession (OR≥2.1). Recession of the distal papilla was also affected by a missing contact point (OR=221.9), the implant-to-tooth distance (OR=0.3) and the distance of the bone peak to the contact point (OR=2.9). Midfacial recession was only associated with a buccal shoulder position (OR=17.2). To optimize soft tissue levels around single implants, clinicians should limit papilla-opening procedures and pay utmost attention to a correct implant and contact point positioning.

Removal of Trabecular Metal Osteonecrosis Intervention Implant and Conversion to Primary Total Hip Arthroplasty

Core decompression and placement of the Trabecular Metal Osteonecrosis Intervention Implant have shown to be initially successful in treating early osteonecrosis. When treatment fails, however, patients often undergo primary total hip arthroplasty (THA) requiring removal of a previously inserted trabecular metal implant. We describe a technical tip for removal of a well-ingrown trabecular metal screw. A metal-cutting trephine placed over the screw allows for removal in an efficient manner while minimizing additional dissection and bone loss during conversion to THA.

Crestal Bone Loss Around Dental Implants; A Short Communication

Many studies described several parameters which are supposed to determine success or failure in longterm evaluations of dental implants. However, the relationship between crestal bone loss around implants and the location of implant-abutment connection in the bone still needs further investigations.The subgingival microgap between the implant and the abutment, which creates higher bone level resorption as a result of plaque accumulation, the polished surface of the implant, and the reestablishing of a biologic width are all possible factors which may increase the bone loss around dental implants which are inserted with a distance between the implant shoulder and the bone crest (DIB) 1 and >2 mm were recorded for 29.7% and 2.5% of the sides, respectively (3). To attain patients’ esthetic expectations regarding implantsupported restorations, it has been recommended that the rough/smooth implant border of non submerged implants be moved to slightly below the crest of the alveolar bone, resulting in a microgap/interface being located 1 to 2 mm below the gingival margin. To accomplish such a subgingival located implant shoulder, the apical part of the relatively smooth machined titanium surface is placed subcrestally. However, there is evidence both from experimental as well as from clinical studies that relatively smooth machined titanium surfaces are associated with additional crestal bone loss in such scenarios. It has therefore been recommended that the placement of the rough/smooth implant border into a subcrestal location is not favorable from a biological standpoint especially in esthetic regions or in areas of limited vertical bone height. In a study by Becker and his colleagues (4), it has been shown that cumulative survival rates for machined, screwshaped titanium fixtures placed in one and two stages as well as one-stage titanium plasma-sprayed screws up to the 2to 3-year follow-up examination were similar, indicating excellent clinical results. Radiographic measurements for changes in crestal bone loss were clinically insignificant for fixtures placed in one stage. For two-stage fixtures, maxillary changes were insignificant, whereas mandibular bone loss was statistically significant but clinically insignificant. Crestal Bone Loss Around Dental Implants; A Short Communication 2 of 4 Haemmerle et al. (1996) studied different amounts of bone loss which occurs when ITI implants are placed 1 mm subcrestal to the border of the rough to the polished surface (5). In this study it was found that a higher amount of bone loss is present when implants are placed with their polished surface in contact to the bone. Nowadays, it is believed that increased bone loss around implants with implant shoulder-to-bone crest distance (DIB) 0.5 mm. It has been shown that marginal bone loss (>0.5 mm) at implants was observed in 30% of subjects and 16% of implant sites. More advanced loss of marginal bone occurred in much fewer subjects and sites. Sites with marginal bone loss were in the sub-sample characterized by bleeding on probing, but only occasionally with deep (?6 mm) pockets. No matter whether bone loss around dental implants is the result of increased plaque accumulation, or an insufficient biologic width, probably also affected by the polished surface, it can be stated, that at least 1 mm of DIB should be present when dental implants are inserted. The location of implant-abutment connection regarding DIB may be an important factor that affects the success rates of dental implants.

CCAAT/enhancer binding protein β-deficiency enhances type 1 diabetic bone phenotype by increasing marrow adiposity and bone resorption.

Bone loss in type 1 diabetes is accompanied by increased marrow fat, which could directly reduce osteoblast activity or result from altered bone marrow mesenchymal cell lineage selection (adipocyte vs. osteoblast). CCAAT/enhancer binding protein beta (C/EBPβ) is an important regulator of both adipocyte and osteoblast differentiation. C/EBPβ-null mice have delayed bone formation and defective lipid accumulation in brown adipose tissue. To examine the balance of C/EBPβ functions in the diabetic context, we induced type 1 diabetes in C/EBPβ-null (knockout, KO) mice. We found that C/EBPβ deficiency actually enhanced the diabetic bone phenotype. While KO mice had reduced peripheral fat mass compared with wild-type mice, they had 5-fold more marrow adipocytes than diabetic wild-type mice. The enhanced marrow adiposity may be attributed to compensation by C/EBPδ, peroxisome proliferator-activated receptor-γ2, and C/EBPα. Concurrently, we observed reduced bone density. Relative to genotype controls, trabecular bone volume fraction loss was escalated in diabetic KO mice (-48%) compared with changes in diabetic wild-type mice (-22%). Despite greater bone loss, osteoblast markers were not further suppressed in diabetic KO mice. Instead, osteoclast markers were increased in the KO diabetic mice. Thus, C/EBPβ deficiency increases diabetes-induced bone marrow (not peripheral) adipose depot mass, and promotes additional bone loss through stimulating bone resorption. C/EBPβ-deficiency also reduced bone stiffness and diabetes exacerbated this (two-way ANOVA P < 0.02). We conclude that C/EBPβ alone is not responsible for the bone vs. fat phenotype switch observed in T1 diabetes and that suppression of CEBPβ levels may further bone loss and decrease bone stiffness by increasing bone resorption.

Angled Implant Abutments: A Practical Application of Available Knowledge

When dental implants are not placed parallel to adjacent teeth or contiguous implants, the clinician can use angled abutments to achieve proper restorative contours. However, increased stresses on implants and bone have been associated with use of angled abutments. In this regard, there are unresolved issues concerning implant survival and potential prosthetic complications that can arise when angled abutments are used to align prosthetic positions.The authors searched the dental literature for clinical trials that appraised the survival rate and complications (biological and technical) associated with pros-theses that are supported by angled abutments.The results of photoelastic stress assessments, finite element analysis and strain-gauge studies indicated that increased abutment angulations result in the placement of a greater amount of stress on prostheses and the surrounding bone than that associated with straight abutments. However, survival studies did not demonstrate a significant decrease of prostheses' longevity associated with angled abutments. Furthermore, there was no additional bone loss adjacent to implants that supported angled abutments compared with straight abutments, and angled abutments did not manifest an increased incidence of screw loosening.The use of angled abutments facilitates paralleling nonaligned implants, thereby making prosthesis fabrication easier. These abutments also can aid the clinician in avoiding anatomical structures when placing the implants. In addition, use of angled abutments can reduce treatment time, fees and the need to perform guided bone regeneration procedures.

A New Technique for Nonsurgical Retreatment of Teeth with Amalgam Root End Fillings: Case Series

Introduction The objective of this article was to show an alternative clinical approach to retreating teeth having had prior combined nonsurgical and surgical endodontic treatment with retrograde amalgam fillings. Nonsurgical retreatment performed alone has historically presented numerous challenges for the clinician and an uncertain outcome for the patient. Surgical retreatment has the potential disadvantages of additional root shortening, bone loss, and scarring. Methods Four cases are presented with recalls up to 5.5 years. Results The procedure was shown to be predictable and successful in this series. Root length was preserved, and surgery was avoided. Conclusions Nonsurgical amalgam removal from the root end may provide a desirable alternative to the more common and complicated option of combined nonsurgical and surgical endodontic retreatment.

Ostéodensitométrie : principes et indications

Fracture risk among patients with urolithiasis is underestimated. Indeed, vertebral fracture prevalence was reported to be increased fourfold compared to general population. Dual-energy X-ray absorptiometry scan is a reliable test to evaluate bone mineral density. To date, this test is not refunded by health public insurance for stone-forming patients with idiopathic hypercalciuria. We suggest that bone mineral density should be evaluated in this population especially when additional potential bone loss risk factors are present such as pathological fractures, menopause, heavy smoking, long term steroid treatment or endocrinopathy. Thus, it is mandatory to stress the point that a low calcium diet should be avoided in this population with a potential low bone mineral density.

Implant surface characteristics influence the outcome of treatment of peri-implantitis: an experimental study in dogs

To analyse the effect of surgical treatment of peri-implantitis without systemic antibiotics at different types of implants. Four implants representing four different implant systems - turned (Biomet 3i), TiOblast (Astra Tech AB), SLA (Straumann AG) and TiUnite (Nobel Biocare AB) were placed in the left side of the mandible in six dogs, 3 months after tooth extraction. Experimental peri-implantitis was initiated by placement of ligatures and plaque formation. The ligatures were removed when about 40-50% of the supporting bone was lost. Four weeks later, surgical therapy including mechanical cleaning of implant surfaces was performed. No systemic antibiotics or local chemical antimicrobial therapy were used. After 5 months, block biopsies were obtained and prepared for histological analysis. Two of the TiUnite implants were lost after surgical therapy. Radiographic bone gain occurred at implants with turned, TiOblast and SLA surfaces, while at TiUnite implants additional bone loss was found after treatment. Resolution of peri-implantitis was achieved in tissues surrounding implants with turned and TiOblast surfaces. Resolution of peri-implantitis following treatment without systemic or local antimicrobial therapy is possible but the outcome of treatment is influenced by implant surface characteristics.

Implantatbedingte Brüche des Schenkelhals-Konusadapters einer modularen Kurzschaft-Hüftendoprothese – Patientenmanagement und OP-Technik

In cases of unexpected and implant-related mechanical failures, optimal surgical treatment and provident information for the patients are mandatory. We describe the surgical method to revise the hip stem after fracture of the modular cone adapter of a short-stem hip prosthesis and the management of and information for all patients who have received a fracture-prone implant. We present two out of four cases in a series of fractures of the femoral neck cone adapter of a modular short-stem hip prosthesis. The patients in our hospital were male, aged 69 and 52 years with a body weight of 73 and 88 kg. Implant failures occurred 18 and 20 months after the index THA. Using special instruments available at short notice, the revision operation can be carried out with a primary implant (case 2) with reasonable technical expenditure, unless pathological-anatomic reasons do not allow it (case 1 with varus-flexion deformity and a rotational deviation that required a revision long-stem with combined correction osteotomy). Once the implants were fully integrated and tightly secured to the bone, they were loosened with flexible thin chisels. Drilling a hole and a thread into the fractured cone adapter allows the connection of a removal instrument for implant extraction. The clinical and radiological examination showed good results with an HSS of 100 points at 24 months follow-up. Our institution decided to inform all 54 patients who had received the failure-prone implant device. The provision of advice to the patients at risk proved to be effective. When using new implants and procedures, the surgeons must inform the patients of hitherto unknown risks. The recipients of a failure-prone implant must be provided with comprehensive information. It is advisable for both the clinic and the manufacturer to contact the patients and advise them on how to cope with the situation. In most cases, the revision operation of the stem component can be performed with a primary implant without significant additional bone loss.

Fixation of subtrochanteric extending/derotational femoral osteotomies with the Locking Compression Plate in ambulatory neuro-orthopaedic patients

Patients with neuro-orthopaedic disorders often develop hip flexion contractures or rotational hip deformities. Increasing deformities impair the already diminished walking abilities and proximal femoral osteotomies are often performed to maintain/improve walking abilities. Fixation of the osteotomies with condylar plates has been successfully used but does often not allow immediate postoperative full weight bearing. To avoid a substantial postoperative rehabilitation deficit and additional bone loss due to inactivity, a postoperative treatment with full weight bearing is, therefore, wishful. Newer fixed-angled implants with stronger anchoring in osteopenic bone might fit these demands. The objective of this study was to evaluate bone healing and the complication rate after proximal extending and/or derotational femoral osteotomy fixed with 3.5/4.5 Locking Compression Plate (LCP; Synthes(®)) and postoperative full weight bearing in ambulatory neuro-orthopaedic patients. Fifteen ambulatory neuro-orthopaedic patients (12 cerebral palsy [CP], 1 trisomy 21, 2 hemiparesis) with a mean age of 13.7years (range 7-22) with hip flexion contractures and/or rotational deformities underwent subtrochanteric (n=26) osteotomy between July 2004 and October 2007. All patients were allowed to bear their full weight postoperatively. We investigated the fusion rate, implant failure, and general complication rate until union had occurred. Fourteen patients (mean weight 42.0kg [range 21.8-59]) uneventfully achieved solid fusion. One patient (19years of age, 73kg) needed revision surgery due to implant failure with consecutive varus deformity and achieved solid fusion after the second intervention. Besides one superficial wound infection, no other complications occurred. Subtrochanteric extending and/or derotational osteotomies fixed with an LCP are a reliable procedure in neuro-orthopaedic patients. Most patients can be treated with early postoperative full weight bearing. However, in heavier patients, possible implant failure must be considered.

Reconstruction of Large Acetabular Defects Using Trabecular Metal Augments

Revision of cup and reconstruction of original center of rotation. High primary and secondary stability. Prevention of additional bone loss. Osseous defects at the anterior-cranial, cranial and posterior-cranial rim of acetabulum. Larger cavitary, medial or oval defects (Paprosky IIb-IIIb). Segmental defects (anterior column up to half of host bone, posterior column up to one third of host bone). Infection of total hip arthroplasty. Pelvic discontinuity (Paprosky IV). Exposure of acetabulum and detection of defects. Complete removal of soft tissue from acetabulum, reaming of sclerotic bone, if necessary. Adaptation of trial augments to close an oval defect to a round defect and to reach an uncontained defect, respectively. Adaptation of trial cup. In case of sufficient stability, fixation of final augment with two or three screws in cranial bone stock. The screws should be directed to iliosacral joint. Augmentation with allogenic bone chips is possible in the region of wedge and acetabulum as well. Sealing of rough augment surface with bone cement. Implantation of cup, fixation with screws. Application of insert. Depending on bone defects, full weight bearing is possible. In cases of severe bone defects, reduction of weight bearing to 20 kg for 6 weeks is recommended. Postoperative physiotherapy is possible in most cases. Between 2005 and 2007, 38 patients with acetabular defects type IIIa und IIIb according to Paprosky underwent reconstruction using the TMT system (Trabecular Metal Technology). After 25 months, a significant functional improvement was seen in all patients. The Merle d'Aubigné Score increased from 6 points preoperatively to 13 points postoperatively, the Harris Hip Score from 29 to 78 points. Two revisions were necessary because of loosening or migration of the cup.

Doxorubicin Therapy Causes Additional Bone Loss in Preclinical Osteolytic Breast Cancer Model

Introduction: Treatment of myeloma (MY) bone disease with bisphosphonates (BP) is standard of care. But renal toxicity due to BP treatment tends to be a major problem in MY patients, especially. Patients with reduced renal function (RF) and patients who had switched BP drugs are at highest risk. Toxicity appears typically after few month of treatment. We evaluated safety data about RF from MY patients, who were treated with ibandronate (IBD). The patients were stratified according to pretreatment and RF.Methods: In a prospective noninterventional study (NIS) about safety and efficacy of IBD in breast cancer patients it turned out that unintentionally MY patients were also included. Out of 3528 documented patients 93 MY patients were identified. We evaluated the data from these MY patients separately. The patients were subdivided in 4 groups according to their RF: GFR>90 (1), 60-90 (2), 30-59 (3) and <30 (4) ml/min. Since pretreatment with or without BP could be of influence, patients were analysed according to former pretreatment: no BP (I), IBD (II), and other BP (III). The kidney function was calculated every month over a period of six month. Results: 93 patients were available for evaluation. In 87 patients RF was documented over a minimum of 5 months. The initial RF was (1) n=11, (2) n=34, (3) n=36 and (4) n=12, respectively. There were no differences in renal function according to their pre-treatment. A total number of 620 infusions were documented. The IBD dosage was 6 mg in 89% of all infusions, 4 mg in 4%, 3 mg in 2% and 2 mg in 5%, respectively. In the subgroups (1-4) RF was stable over time (mean GFR+//0-SD ; difference over the time [ml/min]: (1): 116,8+//0-20,9; -3,38; (2): 74,7+//0-8.4; 2,04; (3): 46,1+//0-8,1; 3,7; (4): 20,4+//0-7; 13,37; all changes n.s.), but there was a trend for improved RF in patients with GFR<30 ml/min. The mean changes were similar in all groups irrespectively of the pretreatment. In 8 patients the treatment was terminated prematurely, due to disease progression (n=3), death due to MY during study period (n=2). Two patients were lost by follow up and one patient declined further treatment. Discussion: The data of this NIS suggest, that there is no evidence for renal toxicity of IBD in MY patients in all stages of renal function. Patients with worse kidney function (stage 4) had a trend of improvement of RF over the study period, however, the changes were not significant due to the limited number of patients.

Zoledronic Acid for Treatment of Osteopenia and Osteoporosis in Women with Primary Breast Cancer (BC) Undergoing Adjuvant Aromatase Inhibitor (AI) Therapy.

Abstract Background: Postmenopausal women with significant osteopenia/osteoporosis are at increased risk of fracture, a risk that is exacerbated by the use of Aromatase Inhibitors (AIs). Bisphosphonates may be used for these patients because there is no known interaction with estrogen and/or progesterone receptors (ER, PR). This study evaluated the concurrent use of zoledronic acid in patients with significant osteopenia or osteoporosis who received initial adjuvant letrozole therapy for primary BC, to determine if further bone mineral density (BMD) loss could be prevented.Methods: Postmenopausal women with Stage I-IIIa, ER and/or PR + BC, no evidence of metastatic disease, and a BMD T-score &amp;lt; -2.0 were treated with daily letrozole 2.5 mg/d, vitamin D 400 international units/d, calcium 500 mg twice daily, and 4 mg I.V. zoledronic acid every 6 months (for 5 years). The BMD was measured at baseline and at one year. Kruskall-Wallis p-value methodology was used as the method of statistical analysis. Since this was a single-arm study, the analysis plan was primarily descriptive. The primary endpoint was the mean change in lumbar spine (LS) BMD at 1 year.Results: 60 patients were enrolled; 46 completed 1 year of treatment. Mean patient age was 67 years, with 44% having taken prior tamoxifen. At 1 year (see figure 1), LS BMD increased 2.66% (p=0.01), femoral neck (FN) BMD increased 4.81% (p=0.01), and any measured endpoint (within the LS or FN) increased 4.55% (p=0.0052). 7% of patients experienced a fracture vs.13% with a pre-existing history of fracture before enrollment. No patients had disease recurrence during year 1. Toxicity was minimal with arthralgia as the most common complaint. There were no reports of osteonecrosis of the jaw.Conclusion: Zoledronic acid prevents additional bone loss in postmenopausal women with significant osteopenia or osteoporosis initiating letrozole. Treatment with zoledronic acid was associated with an improvement in BMD. Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 2103.

(ii) Implant removal in revision hip surgery

Implant removal is a major part of revision hip surgery. A complication, such as fracture or perforation during implant removal, more common in the presence of surrounding osteopenia, can compromise subsequent reconstruction. Similarly, care must be taken to avoid additional bone loss during implant removal. Various techniques are available on both the femoral and acetabular sides that can facilitate the procedure. Recent developments in instrumentation can prove helpful. In this article the techniques are reviewed. In addition, the importance of pre-operative planning and exposure is discussed. The techniques used to remove both cemented and uncemented implants are detailed with examples, illustrations and practical tips. The overall aim of the article is to make this potentially complicated procedure less challenging for the surgeon, but more importantly, to reduce complication rates in implant removal, improving clinical outcomes for patients.

Stability of Treated Angular and Horizontal Bony Defects: A Retrospective Radiographic Evaluation in a Private Periodontal Practice

This retrospective radiographic evaluation provided a comparative assessment of long-term alterations of alveolar bone levels at sites with angular and horizontal bony defects that underwent open-flap debridement and did not undergo resective or regenerative periodontal therapy. The investigation included 50 patients (27 met inclusion criteria) who had periodontal surgery and periodontal maintenance every 3 to 6 months and who presented with sites demonstrating radiographic angular defects and sites on adjacent or contralateral teeth that demonstrated horizontal bone loss. Subsequent to surgical therapy, alterations in bone levels at the alveolar crest of horizontal defects and at the base of angular defects were evaluated by comparing radiographs from the initial examination to those obtained after a period of periodontal maintenance (6 to 16 years; mean: 8.83 years). After periodontal therapy, sites with angular and horizontal alveolar bone loss had additional bone loss of 5.56% and 3.88%, respectively. Based on a defining criterion of 10%, the angular and horizontal sites were clinically equivalent with respect to the magnitude of osseous resorption that occurred after periodontal surgery and maintenance.