Receiving Bisphosphonate Therapy Research Articles

Dental implants in breast cancer patients receiving bisphosphonate therapy

This review article aims to assess the success of dental implants in breast cancer patients receiving bisphosphonate therapy, and to evaluate the risk of developing bisphosphonate related osteonecrosis of the jaw following dental implant surgery.Breast cancer patients undergoing bisphosphonate therapy may receive dental implants. However, the risk of developing BRONJ and implant failure is quite high. Risk factors such as the type of BP received, the route of administration, and the length of treatment prior to surgery should be considered.

HRQoL Evaluation of Pediatric Osteogenesis Imperfecta with Zoledronic Acid Therapy

Background: Zoledronic acid as bisphosphonates could increase bone mineral density (BMD), which in osteogenesis imperfecta will reduce clinical manifestations. Pediatric patients with osteogenesis imperfecta given zoledronic acid therapy should improve their quality of life.Methods: A retrospective analytic study was conducted on 16 pediatric osteogenesis imperfecta patients who had received intravenous zoledronic acid. Interview using PedsQL 4.0 regarding the condition before and after therapy assessed the quality of life. A paired t-test was used to assess the contrast in each aspect of PedsQL 4.0. Results were expressed as an adjusted odds ratio with a 95% confidence interval. P-value <0.05 is considered statistically significant.Results: A significant increase was found in the child report of social performance (+12.083, p=0.023), and proxy report of physical performance, social performance, and total score of the proxy report (+14.844, p=0.006; +10.625, p=0.010; +10.364, p=0.006). An insignificant increase was found in the child report of physical performance, school performance, and total score of the child report (+8.833, p=0.148; +5.000, p=0.359; +7.065, p=0.115), and proxy report of emotional performance and school performance (+2.500, p=0.669; +6.250, p=0.167). An insignificant decrease was found in child reports of emotional performance (-2.500, p=0.669).Conclusion: After receiving bisphosphonate therapy, pediatric patients with osteogenesis imperfecta experienced an increased quality of life in most aspects within every perception. Physical and social aspects experienced the greatest improvement. Emotional is the aspect that experienced the lowest increase in the child's perception and decreased parent perception of the value of quality of life after bisphosphonate therapy.

The Profile of Osteogenesis Imperfecta in Dr. Moewardi General Hospital Year 2020-2021: A Retrospective Study

Osteogenesis imperfecta (OI) is a heritable bone dysplasia characterized by bone fragility and long bone deformities. This study aims to report the profile of osteogenesis imperfecta in Dr. Moewardi General Hospital. The patients were searched from the medical record, registered from January 1, 2020, to December 31, 2021, in Dr. Moewardi General Hospital, a tertiary hospital in Surakarta, Indonesia. The data were recorded and described in tables as age, sex, type of OI according to Sillence, clinic, ward admission, signs and symptoms, bisphosphonate therapy and its discipline, as well as the surgical/non-surgical treatment. The quantity of male patients is higher than that of females, OI type IV is the most common, the most common sign/symptoms are fracture and blue sclera, and the most common bone to be fractured is the femur. More than half of patients received bisphosphonate therapy, but only a quarter received it routinely. More than half of patients have performed surgery as the treatment of fractures. Osteogenesis imperfecta patients require an interdisciplinary and tailored treatment that involves both medical and surgical components.

Bisphosphonate treatment as a safe choice for treating lung metastases of recurrent giant cell tumor of bone

Giant cell tumor (GCT) accounts for 5% of all primary bone tumors and 20% of benign skeletal tumors. This case report presents the case of a 17-year-old female with a recurrent giant cell tumor and lung metastases. The patient received bisphosphonate therapy instead of surgery. The use of zoledronic acid for lung metastases from GCT may have conservatively improved clinical symptoms and radiological assessments can be achieved.

Analysis of Postoperative Distal Radius Fracture Outcomes in the Setting of Osteopenia and Osteoporosis for Patients with Comorbid Conditions

Distal radius fractures (DRFs) are among the most common orthopedic injuries, especially in the elderly. A wide variety of approaches have been advocated as successful treatment modalities; yet, there remains variability in practice patterns of DRF in patients with osteoporosis and osteopenia. Using large data set analysis, we sought to determine the risk profile of operative fixation of DRF in patients with low bone mineral density. A commercially available health care database, PearlDiver, was queried for all patients who underwent open reduction internal fixation of DRFs between 2010 and 2020. The study population was divided into groups based on the presence or absence of osteopenia or osteoporosis and was further classified by patients who were receiving bisphosphonate therapy. Complication rates were calculated, including rates of malunion, surgical site infection, osteomyelitis, hardware failure, and hardware removal. Five-year future fragility fractures were defined in hip, vertebrae, humerus, and wrist fractures. Chi-square analysis and logistic regression were performed to determine an association between these comorbidities and various postoperative complications. A total of 152,926 patients underwent open reduction internal fixation of a DRF during the study period. Chi-square analysis of major complications at 3 months showed a statistically significant increase in malunion in patients with osteopenia (P= .05) and patients with osteoporosis (P= .05) who underwent open reduction internal fixation. Logistic regression analysis at 12 months after surgery demonstrated that osteopenia was associated with an increased risk of hardware failure (P < .0001), hardware removal (P < .0001), surgical site infection (P < .0001), and malunion (P= .004). Osteoporosis was associated with a significantly increased risk of hardware failure (P= .01), surgical site infection (P < .0001), and malunion (P < .0001). We demonstrated, using large data set analysis, that DRF patients with osteopenia and osteoporosis are predicted to be at increased risk of multiple postoperative complications, and thus, bone density should be strongly considered in treatment planning for these patients. Prognostic III.

PSAT157 Efficacy of Bisphosphanate Treatment in Pediatric Patients with Osteoporosis Due to Immobilization

Abstract Introduction Osteoporosis is medical condition commonly associated with immobilization in children, which can lead to a vicious cycle of disability, worsening osteoporosis, and recurrent fractures. Currently, bisphosphonates are widely used as a standard therapy in children with osteoporosis, but there are limited data on efficacy according to its dosage and duration. We aimed to evaluate efficacy of bisphosphonate treatment according to the dosage and duration in pediatric patients with osteoporosis due to immobilization.METHOD: We reviewed medical records of pediatric patients who were diagnosed with osteoporosis due to immobilization rated as Gross Motor Function Classification System (GMFCS) grade V, and who received bisphosphonate therapy with regular check-up for at least 1 year. The dosage and duration of the treatment, biochemical laboratory measurements, data of bone densitometry, and the occurrence of side effects were collected. Results Subjects were 21 children. The average duration of bisphosphonate treatment was 2.0 ± 0.9 years, and mean cumulative dose per body weight of bisphosphonate was 7.7 ± 2.5 (mg/kg/year). After the treatment, mean lumbar spine bone mineral contents (BMC) significantly increased from 14.20 ± 8.58 (g) to 19.38 ± 9.89 (g) (p&amp;lt;0.05), lumbar spine bone mineral density (BMD) significantly increased from 0.40 ± 0.14 (g/cm2) to 0.49 ± 0.14 (g/cm2) (p&amp;lt;0.05), and height-adjusted lumbar spine BMD Z-score also showed improvement from -2.66 ± 1.66 to -1.66 ± 1.38 with statistical significance (p&amp;lt;0.05). The cumulative dose and the duration of treatment were not related to its efficacy, but increasing average dose per body weight in each cycle (mg/kg/cycle) showed significant effects on increasing change in height-adjusted lumbar spine BMD z-score (β = 1.065, p &amp;lt;0.05). Discussion BMC, BMD, and height-adjusted BMD z-score significantly increased after bisphosphonate treatment in pediatric patient with osteoporosis due to immobilization. Independent of cumulative dosage and duration, the efficacy of bisphosphonate treatment increased significantly as average dose per body weight in each cycle increased. Further studies with sufficient number of subjects and long term follow-up observation are needed. Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.

PSAT196 Monostotic Paget's disease of the bone involving the calcaneus

Abstract Introduction Paget's disease of bone (PDB) is a chronic bone disorder that is fairly common in older age. It is characterized by an initial increase in osteoclastic activity followed by excessive osteoblastic activity with disorganized bone architecture. PDB may involve any bone and may be monostotic or polyostotic. Herein, we report the rare occurrence of monostotic Paget's involving the calcaneus. Case Description A 71-year-old white male with PMH of prostate cancer status post radical prostatectomy presented with acute onset severe left heel and ankle pain. Pain was localized to the retrocalcaneal area and heel pad limiting his physical activity. He denied recent trauma. Physical exam was significant for swelling and tenderness of the left heel. Left foot X-rays showed a slightly enlarged calcaneus with very coarse trabeculae consistent with PDB. A total body bone scan done previously because of the prostate cancer showed intense uptake in the left calcaneus but no significant uptake elsewhere. Laboratory workup showed an elevated total serum alkaline phosphatase of 164 U/L (40-129 U/L) and bone specific alkaline phosphatase 65 ug/L (0.0-20 ug/L). He was treated with a single infusion of Zoledronic acid with good clinical response evidenced by improvement in pain and swelling as well as a significant decrease in bone specific alkaline phosphatase to 10 ug/L six months post-infusion. Discussion Monostotic PDB only represents about 20% of PDB cases. The pelvis is the most common location followed by the femur as described by Bachiller-Corral et al (Bone, 2013). In our review of the English literature, we found only nine cases of monostotic PDB involving the calcaneus. The mean age of presentation was 60 years old and most of the cases presented as chronic heel pain not responding to conservative pain alleviating measures. Conventional radiography showed the characteristic features of PDB but the changes observed were difficult to differentiate from that of a malignant process. That led to further imaging in most cases by either CT, MRI scan or SPECT scan. Three out of nine patients were reported to receive bisphosphonate therapy with successful remission with a long duration of disease suppression. Good response to therapy highlights the importance of proper diagnosis. Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.

Osseointegration and Remodeling of Mineralized Bone Graft Are Negatively Impacted by Prior Treatment with Bisphosphonates.

Bisphosphonates limit resorption by inhibiting osteoclast formation and activation. They are removed during preparation of demineralized bone matrix (DBM) particles, but it is not known if osteogenesis and incorporation of mineralized bone allografts from patients treated with oral bisphosphonates are affected in vivo. Human block allografts from 3 bisphosphonate-treated donors and 3 age and sex-matched control donors who had not received bisphosphonates were obtained (Musculoskeletal Transplant Foundation); one-half from each donor was demineralized. In the first study, 3 × 2-mm mineralized and demineralized cylindrical grafts were implanted bilaterally in the femoral metaphysis of 56 rats. In the second study, samples from each group were pooled, prepared as particles, and implanted bilaterally in the femoral marrow canal of 24 rats. Osseointegration, defined as native bone in contact with allograft, was assessed at 10 weeks by micro-computed tomography (CT) and histomorphometry. Micro-CT showed greater bone volume in sites treated with demineralized samples compared with the control mineralized and bisphosphonate-exposed mineralized samples. More new bone was generated along the cortical-endosteal interface compared with mineralized samples. Histology showed significantly less new bone in contact with the mineralized bisphosphonate-exposed allograft (10.4%) compared with mineralized samples that did not receive bisphosphonates (22.8%) and demineralized samples (31.7% and 42.8%). A gap was observed between native bone and allograft in the bisphosphonate-exposed mineralized samples (0.50 mm 2 ). The gap area was significantly greater compared with mineralized samples that did not receive bisphosphonates (0.16 mm 2 ) and demineralized samples (0.10 and 0.03 mm 2 ). Mineralized allografts were osseointegrated, but not remodeled or replaced by living bone, preventing full regeneration of the bone defect. Prior treatment of the donor with bisphosphonates affected osteogenesis, preventing osteointegration and remodeling of the allograft into the regenerating bone. Clinical use of mineralized allografts from patients who had received bisphosphonate therapy needs to be evaluated; in this animal model, such grafts were not integrated into the host bone or remodeled, and full regeneration of the bone defects was prevented.

Hyperbaric oxygen therapy as a conservative approach for osteoradionecrosis of the jaw in an osteoporotic patient receiving oral bisphosphonate therapy: a case report

BackgroundOsteoradionecrosis of the jaw (ORNJ) is a well-known chronic side effect of radiotherapy (RT) for head and neck malignancies. Osteonecrosis of the jaw (ONJ), similar pathology to ORNJ, may be induced by bisphosphonate (BP) therapy and is known as BP-related ONJ (BRONJ). Although differences exist between ORNJ and BRONJ in terms of clinical features and management methods, ONJ in a patient with history of both RT and BP therapy is categorized as ORNJ in the diagnostic criteria, despite the possibility that the ONJ may be affected by BP considering the pharmacology and mechanism of action. To date, management of ORNJ with a history of BP therapy has been scarcely discussed.Case presentationWe report here our experience of serious ORNJ in an 82-year-old osteoporotic woman receiving oral BP therapy. She had undergone partial maxillectomy to treat left maxillary gingival cancer and had received RT of 60 Gy as postoperative treatment. She had a history of osteoporosis, for which she had been administered BP for 8 years and 5 months. A bony sequestrum 45 × 25 mm in size was found at the site of the mandibular ramus, and the clinical diagnosis was ORNJ. We administered hyperbaric oxygen therapy (HBOT), scheduled for 3–5 days per week in 2 courses, 35 times. After HBOT, we performed sequestrectomy avoiding invasive surgery such as mandibulectomy. After the surgical procedure the wound healed completely. Bone regeneration was confirmed by computed tomography postoperatively. There have been no signs of recurrence as of 4 years after the operation.ConclusionsWe undertook a multimodality approach with HBOT and conservative surgery and achieved a satisfactory outcome. HBOT may be worthy of consideration as a conservative approach for ORNJ in patients receiving BP therapy, leading to the possibility of avoiding invasive surgery such as mandibulectomy.

Growth and Pubertal Features in a Cohort of 83 Patients with Osteogenesis Imperfecta.

Osteogenesis imperfecta (OI) is a genetic disease characterized by fragile bones and variable short stature. We performed a retrospective cohort study to evaluate demographic data, clinical findings, growth and pubertal characteristics, and medical treatment of 83 OI patients. 83 (31 female/52 male) patients were enrolled in the study. The median follow-up duration was 4.7 (0.6-17.7) years. 51 out of 83 patients (61.4%) received bisphosphonate therapy. The median Z-score of the bone mineral density improved in patients with OI-I and OI-III with the treatment. During follow-up, height-SDS significantly increased in both OI-I and OI-III on treatment; however, final adult height SDS of patients did not improve. The frequency of overweight and obesity was found to be increased at the last evaluation compared to the admission. The rate of precocious puberty (PP) and early puberty (EP) were 20 and 10% in girls, and they were 15.7 and 47.3% in boys, respectively. Reduced growth, significant weight gain over time due to impaired mobility, and high frequency of PP/EP require effective interventions to improve mobility and functional parameters as early as possible in children with OI.

Time to Benefit of Bisphosphonate Therapy for the Prevention of Fractures Among Postmenopausal Women With Osteoporosis

The clinical decision to initiate bisphosphonate therapy for the treatment of osteoporosis requires balancing shorter-term harms and burdens (eg, gastroesophageal irritation or severe musculoskeletal pain) with longer-term benefits in reducing potential fractures. To assess the time to benefit (TTB) of bisphosphonate therapy for the prevention of nonvertebral and other fractures among postmenopausal women with osteoporosis. Randomized clinical trials (RCTs) were identified from systematic reviews commissioned by the US Preventive Services Task Force (1 review), the Agency for Healthcare Research and Quality (1 review), the Cochrane Library (2 reviews), and the Endocrine Society (1 review). Studies selected were RCTs involving postmenopausal women with a diagnosis of osteoporosis based on existing vertebral fractures or bone mineral density T scores of -2.5 or lower. The selection process was focused on studies of alendronate, risedronate, and zoledronic acid because they are guideline-recommended first-line agents for reducing nonvertebral fractures. Studies were excluded if they did not focus on women with a primary diagnosis of osteoporosis, had no placebo arm, or had a lack of data on time to fracture. Random-effects Weibull survival curves were fitted and Markov chain Monte Carlo methods were used to estimate the absolute risk reduction (ARR) and TTB for each study. These estimates were pooled using a random-effects meta-analysis model. The primary outcome was the time to 3 different ARR thresholds (0.002, 0.005, and 0.010) for the first nonvertebral fracture. Secondary outcomes included the time to 4 ARR thresholds (0.001, 0.002, 0.005, and 0.010) for hip fracture, any clinical fracture, and clinical vertebral fracture. Of 67 full-text articles identified, 10 RCTs comprising 23 384 postmenopausal women with osteoporosis were included either as the original RCT or part of subsequently published pooled analyses. Among the studies, the number of participants ranged from 994 to 7765, with mean (SD) age ranging from 63 (7) years to 74 (3) years and follow-up duration ranging from 12 to 48 months. The pooled meta-analysis found that 12.4 months (95% CI, 6.3-18.4 months) were needed to avoid 1 nonvertebral fracture per 100 postmenopausal women receiving bisphosphonate therapy at an ARR of 0.010. To prevent 1 hip fracture, 200 postmenopausal women with osteoporosis would need to receive bisphosphonate therapy for 20.3 months (95% CI, 11.0-29.7 months) at an ARR of 0.005. In addition, 200 postmenopausal women with osteoporosis would need to receive bisphosphonate therapy for 12.1 months (95% CI, 6.4-17.8 months) to avoid 1 clinical vertebral fracture at an ARR of 0.005. This meta-analysis found that the TTB of bisphosphonate therapy was 12.4 months to prevent 1 nonvertebral fracture per 100 postmenopausal women with osteoporosis. These results suggest that bisphosphonate therapy is most likely to benefit postmenopausal women with osteoporosis who have a life expectancy greater than 12.4 months.

Magnetic Resonance Imaging Signal Changes Mimicking Bone Metastasis in Patients Receiving Bisphosphonate Therapy

Bisphosphonates are inorganic pyrophosphate agents that reduce bone turnover. These agents reduce bone pain and delay skeletal complications, such as fractures in patients with metastatic lytic lesions, malignant-related hypercalcemia, multiple myeloma, Paget’s disease of bone, and osteoporosis. Osteonecrosis, developing in the jaw bones specifically, has been described as a complication associated with the use of bisphosphonates. In this report, we presented osteonecrosis-like magnetic resonance imaging findings that can be confused with bone metastasis in two patients who underwent long-term bisphosphonate treatment and the value of bone scan and 18flor-fluorodeoxyglucose positron emission tomography/computerized tomography in the differential diagnosis.

Abnormalities in Tooth Formation after Early Bisphosphonate Treatment in Children with Osteogenesis Imperfecta

Treatment with intravenous bisphosphonate (BP) in children and adolescents with osteogenesis imperfecta (OI) started in Sweden in 1991. No human studies on the role of BP therapy in development of disturbances in tooth mineralization or tooth morphology have been published. The study cohort comprised 219 individuals who were divided into four groups: group 1, BP treatment onset before 2 years of age (n = 22); group 2, BP treatment onset between 2 and 6 years of age (n = 20); group 3, BP treatment onset between 6 and 10 years of age (n = 13); and a control group of patients with OI who had not received BP therapy (n = 164). The chi-square test was used in between-group comparisons of the prevalence of tooth agenesis. The prevalence of tooth agenesis was significantly higher in children who began BP treatment before the age of 2 years (group 1; 59%,) compared to the controls (10%; p < 0.001) and to children who had begun BP therapy between ages 2 and 6 years (group 2; 10%; p = 0.009) or between ages 6 and 10 years (group 3; 8%; p = 0.003). Different types of disturbances in the enamel formation were seen in 52 premolars, where 51 were seen in those who began BP treatment before the age of 2 years. To conclude, starting BP treatment before the age of 2 years increases the risk of abnormalities in tooth formation manifesting as morphological aberrations, tooth agenesis, and enamel defects.

Bone density, fractures and the associated factors in iranian children and adolescent with Osteogenesis Imperfecta

BackroundOsteogenesis imperfecta(OI) is a frequent bone fragility disorder in children. The purpose of this study was to assess the BMD and Vitamin D level in children with OI in southern Iran.MethodThis case-control study was conducted on 23 children, clinically diagnosed as osteogenesis imperfecta and 23 age- and gender-matched healthy controls. Demographic and anthropometric data, biochemical parameters, puberty, sun exposure and physical activity were assessed. Bone mineral density (BMD) was measured by Dual-energy X-ray absorptiometry (DXA). Data analysis was done by SPSS22.ResultsForty-three point four percent of OI patients and fifty-six point five percent of control group had vitamin D deficiency (P = 0.376). Thirteen OI patients (56%) had low bone mass for chronological age in lumbar area (P < 0.001). Fracture episodes during treatment was significantly influenced by time of Pamidronate start, courses of Pamidronate injection, puberty and sun exposure (P values = 0.015, 0.030, 0.044 and 0.032, respectively). Fracture episodes during treatment had significantly increased in patients who had received Pamidronate more than 3 years compared with those received less than 3 years(P values = 0.047).ConclusionsThis study showed that vitamin D deficiency is prevalent amongst OI children in southern Iran. More than half of the OI children had low bone mass for chronological age in lumbar area, despite receiving bisphosphonate therapy. The present results revealed that early initiation of Pamidronate and number of Pamidronate courses are associated with lower fracture rate. However, treatment period more than 3 years can have adverse effect on fracture rates.

Impact of a Bisphosphonate Drug Holiday on the Bone Mineral Density in Patients with Osteoporosis

ABSTRACT Background: Bisphosphonate therapy has proven efficacy in the management of osteoporosis. Unlike other therapies, bisphosphonates are unique in that they continue inhibiting bone resorption after a discontinuation of therapy. Rare adverse effects related to its prolonged use, specifically osteonecrosis of the jaw and atypical femur fractures, resulted in the concept of a “drug holiday” (DH). Objective: To evaluate the effect of a bisphosphonate DH on bone mineral density (BMD) in the treatment of osteoporosis with zoledronic acid and/or alendronate. Methods: A single-centre retrospective cohort study of 97 patients with osteoporosis who had received bisphosphonate therapy and undertaken a DH between 2000 and 2016 was conducted at a large public academic hospital in Johannesburg, South Africa. Results: A total of 97 patients were included in the study. The median age at the initiation of bisphosphonate therapy was 63 years. The median duration of treatment before the DH was 5 years with the median duration of the DH being 2 years. The overall effect of the DH on BMD assessed as the percentage change from the beginning to the end of the DH showed a decrease in BMD lumbar spine [−3.3%, P = 0.398], radius and ulnar [−16.7%, P = 0.03] and total hip [−8.9%, P = 0.001]. Four patients (4.1%) sustained fractures during the DH. Conclusion: A DH should be cautiously considered with the long-term use of bisphosphonates. An individualised approach based on risk factor assessment, fracture risk, and BMD is key in assessing the duration of the DH, and only low-risk patients should be considered.

Effects of bisphosphonates on long-term kidney transplantation outcomes.

Bisphosphonates are administered to post-transplantation patients with mineral and bone disorders; however, the association between bisphosphonate therapy and long-term renal graft survival remains unclear. This nested case-control study investigated the effects of bisphosphonates on long-term graft outcomes after kidney transplantation. We enrolled 3836 kidney transplant recipients treated from April 1979 to June 2016 and matched patients with graft failure to those without (controls). Annual post-transplant bone mineral density assessments were performed and recipients with osteopenia or osteoporosis received bisphosphonate therapy. The associations between bisphosphonate use and long-term graft outcomes and graft survival were analyzed using conditional logistic regression and landmark analyses, respectively. A landmark analysis demonstrated that death-censored graft survival was significantly higher in bisphosphonate users than in non-users in the entire cohort (log-rank test, P < 0.001). In the nested case-control matched cohort, bisphosphonate users had a significantly reduced risk of graft failure than did non-users (odds ratio = 0.38; 95% confidence interval 0.30-0.48). Bisphosphonate use, increased cumulative duration of bisphosphonate use >1 year and increased cumulative bisphosphonate dose above the first quartile were associated with a reduced risk of graft failure, after adjustments. Bisphosphonates may improve long-term graft survival in kidney transplant recipients.

Dental extractions in patients on oral or intravenous bisphosphonate therapy: A clinical dilemma

Dental extraction has been touted to be a potential trigger for the onset of bisphosphonate-related osteonecrosis of the jaw (BRONJ). In this article, we carry out a comprehensive discussion on the pharmacology of bisphosphonates. This article also aims to assess and outline the pathogenesis of BRONJ, the outcome of dental extractions on patients receiving bisphosphonate therapy and to draw a protocol for its prevention and management.

ПРИМЕНЕНИЕ АУТОЛОГИЧНОЙ ПЛАЗМЫ ПРИ ЛЕЧЕНИИ МЕДИКАМЕНТОЗНО АССОЦИИРОВАННОГО ОСТЕОНЕКРОЗА ЧЕЛЮСТЕЙ

Subject. Drug-associated jaw osteonecrosis is a serious complication that can occur in patients receiving bisphosphonate therapy for bone metastases in malignant neoplasms. The studies are due to the widespread use of bisphosphonates in patients with proven bone metastases, with myeloma, and malignant neoplasms of various locations. Due to the toxic effects of bisphosphonates on soft tissues, the healing process is sluggish, often with a relapse. The task of finding optimal methods of stimulating local regenerative processes is urgent, since the use of general-action drugs can provoke continued growth of the primary tumor. The aim of the study was to develop a method for treating patients with a diagnosis of “drug-associated jaw osteonecrosis” using autologous plasma, which will further reduce the number of relapses and increase the effectiveness of treatment. Methodology. Patients with a diagnosis of “medically associated jaw osteonecrosis” underwent sequestrectomy with boundaries determined by perfusion by laser Doppler flowmetry, an APRF clot was placed on the bottom of the bone wound, and autologous plasma was injected into the wound edges in the postoperative period. Results. The result of applying this technique in the early postoperative period was a partial discrepancy of the edges of the wound, but the absence of sections of the exposed bone in the wound. After 6–8 weeks, we observed complete healing of the postoperative wound. The number of relapses was reduced from 16 to 3 (by 57.56 %). Conclusions. The use of autologous plasma in the treatment of drug-associated osteonecrosis is the most optimal way to stimulate local regenerative processes in the absence of the possibility of using general-action drugs.

The effect of bisphosphonate discontinuation on the incidence of postoperative medication-related osteonecrosis of the jaw after tooth extraction.

ObjectivesThe discontinuation of bisphosphonate (BP) treatment before tooth extraction may induce medication-related osteonecrosis of the jaw (MRONJ). Whether the long-term discontinuation of BP treatment before tooth extraction affects the risk of developing MRONJ after tooth extraction or whether extended drug holidays induce systemic side effects remains unclear. The present study assessed the incidence of MRONJ among patients who underwent tooth extraction and did not discontinue BP therapy prior to the procedure.Materials and MethodsPatients were classified according to whether or not they discontinued BP therapy before tooth extraction. Differences in the incidence of MRONJ after tooth extraction were compared between the two groups using the chi-squared test.ResultsThe BP-continuation (BPC) and BP-discontinuation (BPDC) groups included 179 and 286 patients, respectively. One patient in the BPC group and no patients in the BPDC group developed MRONJ (P=0.385). The patients in the BPDC group stopped receiving BP therapy at a mean of 39.0±35.5 months prior to tooth extraction.ConclusionThe possibility of pre-existing MRONJ in the extraction area must be considered during the extraction procedure. Routine discontinuation of BP medications for several months before the extraction procedure should be carefully considered, as evidence of its efficacy in reducing the development of post-extraction MRONJ is limited.

Assessment the effect of the use of bisphosphonates on dental implant rehabilitation and peri-implant tissues

Background: Long-term use of bisphosphonates (BP) has been associated with the risk of BP-related osteonecrosis of the jaw (BRONJ). The number of post-menopausal women receiving BP therapy for osteoporosis continues to increase as the life expectancy increases. Dental implant rehabilitations have progressed over the years. The purpose of the present study was to evaluate the peri-implant conditions of patients taking oral or intravenous (IV) BPs. Methods: This was a retrospective study using an ORACLE database search by means of a Procedural Language/Structured Query engine. Fifty female patients with dental implant rehabilitations and taking bisphosphonates, and fifty female patients with dental implants but not taking BP were evaluated. Peri-implant health and rehabilitation conditions were collected and statistics analyzed. Results: Data analysis revealed a strong indication (p<0.01; 82.81%) of the use of bisphosphonates and absence of abscesses. Relative risk indicated 25 times more chance of a person that does not use bisphosphonates to develop abscess when compared with people using bisphosphonates. This shows that the use of bisphosphonates may play a protecting role in the patients with dental implants. Alternatively, there was a strong indication (p<0.01) of existence of association between the occurrence of mucositis and the use of bisphosphonates. Most of the cases of mucositis (94.44%) occurred in patients that used bisphosphonates while the majority of the cases where mucositis did not occur (59.76%) referred to the group being treated with bisphosphonates. Conclusion: This study revealed that there was absence of indications of significant associations between doses of bisphosphonates and the occurrence of peri-implant diseases.