Risk Of Medication-related Osteonecrosis Research Articles

Oral health, dental treatment, and medication related osteonecrosis of the jaw in multiple myeloma – a longitudinal cohort study

ObjectiveThe objective of the present study was to investigate oral health status, oral health related quality of life, and identify risk factors associated with invasive dental treatment and medication related osteonecrosis of the jaw in patients with multiple myeloma.Material and methodsPatients newly diagnosed with multiple myeloma (n = 144) referred between January 2015 and September 2022 were retrospectively included. The patients underwent a thorough clinical and radiological oral examination and odontogenic infections were treated before the start of bisphosphonate treatment. The patients were followed annually, including clinical and radiological examinations. The oral health related quality of life was investigated by the OHIP-14 questionnaire.ResultsDental treatment (RR = 7.75), receiving combination antineoplastic therapy≥3 (RR =4.13), periodontitis (RR = 4.21), and reduced number of teeth (RR = 2.87) were associated with an increased risk of medication related osteonecrosis of the jaw. The response rate of the OHIP-14 questionnaire was 70.2%. Oral pain or discomfort in the mouth related to the medical treatment was reported by 30.5%.ConclusionDental screening and treatment planning in patients with Multiple Myeloma may result in fewer oral infections and fewer interruptions of the medical treatment of myeloma.

Evaluation of serum C-terminal telopeptide (CTX) value for the risk of medication related osteonecrosis of the jaws

Evaluation of serum C-terminal telopeptide (CTX) value for the risk of medication related osteonecrosis of the jaws

Surgical removal of torus palatinus in a patient with a history of bisphosphonates

Torus palatinus is a common bony outgrowth of the hard palate. We discuss our surgical approach to managing a torus palatinus in a 61-year-old woman. She had a seven-year history of taking oral bisphosphonates, increasing the risk of medication related osteonecrosis. The torus had been slowly increasing in size over the previous three years. It affected her ability to eat and was associated with frequent food packing. The torus was surgically removed with no postoperative complications.

The presenting dental status of solid tumours with bone metastases requiring bone-targeting agents - part 3: prostate cancer.

Introduction Metastatic prostate cancer (MPC) patients due to receive bone-targeting agents (BTAs) are expected to undertake a dental assessment before commencing. The aim of this study was to determine the dental status of this tumour group and understand the challenges the dental practitioner faces in attempting to achieve 'dental fitness'.Materials and methods Data were retrospectively collected from a dedicated pre-BTA dental assessment clinic and analysed for MPC. Statistical analysis and observational data were used to compare patient and tumour demographics.Results A total of 111 patients were included in this cohort, with the majority of patients presenting with only bone metastases (BM) and no additional metastatic sites. On average, MPC patients presented with 19.3 teeth and were below the threshold for functional dentition. The 75-84-year-old age group had the worst horizontal bone loss score and subsequently lose six teeth over a decade (p = 0.001). In addition, all MPC tumour sub-categories showed favourable survival rates.Conclusion MPC patients have a high dental burden on presentation, likely associated with their age. Favourable survival prospects and the cumulation of BTAs and dental disease would suggest a heightened risk of medication-related osteonecrosis of the jaw in this group compared to many other tumour sites.

The awareness and practice of dentists regarding medication-related osteonecrosis of the jaw and its prevention: a cross-sectional survey

BackgroundAccurate documentation of a patient’s prior medication use and awareness of side effects associated with anti-osteoporotic agents can assist dentists to prevent medication-related osteonecrosis of the jaw. I aimed to determine the awareness of Korean dentists regarding medication-related osteonecrosis of the jaw and the duration of drug holidays they prescribe to patients who need to undergo various dental procedures.MethodsAn online, questionnaire-based survey was conducted among 1000 dentists registered in an online community in Korea. The following were determined: general characteristics; type of practice; recordkeeping regarding patients’ use of bone-modifying agents; requirement of a doctor’s referral letter; advice given regarding drug holidays of bone-modifying agents before dental surgery procedures; and experience with medication-related osteonecrosis of the jaw. Differences between dentists with and without experience in treating patients with medication-related osteonecrosis of the jaw were evaluated using the χ2 test.ResultsAlthough a relatively high proportion (293/1000, 29.3%) of dentists had experienced cases of medication-related osteonecrosis of the jaw, only 650/1000 (65.0%) routinely documented the type of bone-modifying agent used by patients and the duration of its use. Moreover, only 591/1000 (59.1%) dentists routinely requested referral letters from doctors before performing dental surgery on patients. Although the recommended period for a drug holiday differs for each drug, 533/1000 (53.3%) dentists did not make such a distinction. There was a statistically significant difference in the level of detail documented in terms of anti-osteoporotic drug use between dentists who had no experience in medication-related osteonecrosis of the jaw (707/1000) and those who had such experience (P = 0.007). There was a statistically significant difference in the length of drug holidays prescribed between dentists with and without prior experience with the condition (P = 0.001).ConclusionsThese results suggest that dentists do not respond consistently to patients' drug history prior to performing dental procedures. This implies the need for increased cooperation between dentists and physicians, as well as the development of targeted educational interventions for the dental profession, to reduce the risk of medication-related osteonecrosis of the jaw.Trial registrationNot applicable.

Medicaments and oral healthcare. Adverse effects of medicaments: the 'Big Five' of bone healing

the bone can still be present long after patients have stopped taking the medication. Patients are often able to report accurately what disorder(s) they have and certain disorders should cause dentists to be alert. Patients who can be defined as the Big Five users of bone-modulating medicaments are: 1. patients with osteoporosis, 2. patients who have been long-term users of glucocorticoids, 3. patients with solid tumours, 4. patients with multiple myeloma and 5. patients with congenital or hereditary bone disorders. These patient groups have an indication for bone-modulating medicaments. These are anti-resorptive medications (such as bisphosphonates and denosumab) or anti-angiogenic medications. By recognising the correct patient group, dentists can ask appropriate questions about the use of medicaments in the present or in the past. A dentist can recognise patients with a risk of medication-related osteonecrosis by using this method.

Are Solid Organ Transplant Patients the New Unsuspecting Osteonecrosis Victims?

Purpose Bone disease is common in organ transplant recipients. Immunosuppressive regimens with glucocorticoids have shown to improve patient and graft survival rates following transplantation. As survival rates have improved, so has awareness of long-term complications of transplantation. Pre-existing bone disease combined with immunosuppressive agents serve as primary risk factors for osteoporosis and fractures. Recently, supplementation of the traditional medical regimen with bisphosphonates and denosumab has become necessary to counteract the adverse effects of long-term steroid use. Although it does enhance bone mineral density, bisphosphonate therapy has failed to result in a significant decrease in the fracture rate. We propose an individualized approach aimed at managing bone loss and fracture rates in transplant patients. Methods This study, an evidence-based review, aims to provide a better understanding of the risk factors associated with osteoporosis, incorporating the bone effects of glucocorticoids and antiresorptive medications. We first developed several specific research questions, assorted questions by category, devised an approach to identify appropriate sources in the organ transplant literature, and selected a list of possible articles to review. We completed an initial review to limit the set to 55 articles and then conducted a thorough review, including the current guidelines provided by the American College of Rheumatology for management of bone disease, and the American Association of Oral and Maxillofacial Surgeons for prevention and treatment of osteonecrosis of the jaw. Furthermore, we have summarized our findings to synthesize an improved patient-centered protocol to help limit the indiscriminate use of antiresorptive medications, and strategies for appropriate dental management pre- and post-transplantation. Results Bisphosphonates and other antiresorptive medications reduce excessive turnover of bone, resulting in enhanced bone mineral density (BMD). These medications have become part of the typical treatment regimen for patients in the post-transplantation period to counteract the negative effects of high-dose steroids, despite the lack of evidence that preservation in BMD translates to decreased fracture risk. Although the risk of medication-related osteonecrosis of the jaw (MRONJ) is low, the diagnosis and the sequelae can be devastating and difficult to treat in advanced stages. Conclusions The best method of prevention lies in an evidence-based multidisciplinary approach to ensure that the solid organ transplant patients administered these medications do not become the new MRONJ victims. This should include, but not be limited to, evaluation by a dental professional familiar with antiresorptive medications and bisphosphonates and their adverse effects on the craniofacial skeletal tissues, minimizing steroid use, adequate supplementation of vitamin D in patients with vitamin D deficiency, and careful targeted use of bisphosphonates and denosumab only in those patients where it is mandatory. Although the prevalence of MRONJ among transplant recipients remains to be studied, it behooves providers to help protect these patients from unnecessary harm.