Incidence Of Bisphosphonate-related Osteonecrosis Research Articles

The incidence of Bisphosphonate related Osteonecrosis of the Jaw (BONJ) in patients treated with oral bisphosphonates for osteoporosis

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Systematic Review on the Incidence of Bisphosphonate Related Osteonecrosis of the Jaw in Children Diagnosed with Osteogenesis Imperfecta

ABSTRACTObjectivesTo conduct a systematic review of epidemiological literature to determine the incidence of bisphosphonate related osteonecrosis of the jaw occurring either spontaneously or after dental surgery, in children and adolescents diagnosed with osteogenesis imperfecta.Material and MethodsMEDLINE, HMIC and EMBASE were used to search for English-language articles published from 1946 - 2013. Inclusion criteria consisted of population based studies of children and adolescents (24 years and younger) diagnosed with osteogenesis imperfecta, only studies which included a dental examination, and patients treated with intravenous bisphosphonates were included. Articles were excluded if patients had any other co-morbidity which could affect osteonecrosis of the jaw, and those which treated patients with oral bisphosphonates only.ResultsFive studies consisting of four retrospective cohort studies and one case series were identified. Study populations ranged from 15 to 278 patients and number of subjects with osteogenesis imperfecta ranged from 15 to 221. Mean duration of intravenous bisphosphonate use ranged from 4.5 to 6.8 years. All patients were clinically examined and no patients were found to have osteonecrosis of the jaw.ConclusionsThere is no evidence to support hypothesis of causal relationship between bisphosphonates and osteonecrosis of the jaw in children and adolescents with osteogenesis imperfecta. More prospective studies on bisphosphonate use in osteogenesis imperfecta needs to be carried out.

Editorial

We frequently provide services for patients who present with medical histories that include multiple drug therapies. For example, patients with autoimmune diseases that include lupus erythematosus, psoriasis, progressive inflammatory neuropathy, Sjögren's syndrome, temporal arteritis, ulcerative colitis, and rheumatoid arthritis, which commonly involve long-term glucocorticosteroid (prednisone) therapy. A common side effect of steroid use is glucocorticoid-induced osteoporosis (GIOP) which leads to an increased risk of bone fractures, resorption, and subsequent reduced formation.1–3The American College of Rheumatology (ACR) recently updated guidelines regarding GIOP that include the addition of bisphosphonate drug therapies. Clinicians are aware of the controversy surrounding oral bisphosphonates. Mavrokokki et al found the incidence of bisphosphonate related osteonecrosis of the jaw (BRONJ) in osteoporotic Australian patients, primarily on weekly oral alendronate therapy, is 1 in 2260 to 8470 (0.01% to 0.04%).4 However, if extractions were performed, the incidence was 1 in 296 to 1130 cases (0.09%to 0.34%).Chiu et al noted that when patients have parallel oral bisphosphonate and steroid therapies, osteonecrosis becomes more problematic.5 It was also concluded that: (1) the combination of steroid and bisphosphonate therapy may induce osteonecrosis earlier, (2) osteonecrosis may be more severe, (3) it may respond more slowly to the drug discontinuation, and (4) recovery is less predictable. Glucocorticosteroids promote bone-resorbing osteoclasts and inhibition of bone-modeling osteoblasts.6 Nitrogen containing bisphosphonates (alendronate, risedronate, zoledronate) inhibit osteoclast activity, rendering the osteoclasts unable to release cathepsin-K, which is responsible for bone breakdown and eventual remodeling.7Clinicians must be mindful of the ACR updates. The incidence of BRONJ from oral bisphosphonate therapy appears to be low, but combined with a history of chronic steroid therapy the morbidity becomes BSRONJ, which presents with potentially greater consequences.

Current perspectives in the management of patients with drug-induced osteonecrosis of the maxilla: experience of the school of Naples Federico II

Background Abstract Objective. The use of bisphosphonates (zoledronic acid) in the treatment of metastatic bone disease and osteoporosis has been raised during recent years. The purpose of this treatment is mainly to reduce skeletal-related events, e.g. pain and pathological fractures. Bisphosphonate-related osteonecrosis of the jaw. (BRONJ) adversely affects the quality of life, producing significant morbidity in afflicted patients. BRONJ can develop spontaneously or after minor trauma. In general, these patients seem to have less severe manifestations of necrosis and respond more readily to stage-specific treatment regimens (Table ​(Table1).1). Strategies for the treatment of patients with, or at risk of, BRONJ we reset forth in the American Association of Oral and Maxillofacial Surgeons (AAOMS) Position Paper on Bisphosphonate-Related Osteonecrosis of the Jaws (Position Paper) and approved by the Board of Trusteesin September 2006.1This update contains revisions to the diagnosis and staging and management strategie sand highlights the status of basic science research. We to report the incidence of bisphosphonate-related osteonecrosis of the jaw (ONJ), since the initiation of a routine maxillofacial examination before treatment with bisphosphonates, no ONJ has been seen. Table 1 Staging and treatment strategies Conclusions ONJ is a rare but a very serious complication in relation to treatment with bisphosphonates. To decrease the incidence of ONJ, a maxillofacial examination could be performed in all patients before treatment with bisphosphonates.