Comment on Compston: Pathophysiology of atypical femoral fractures and osteonecrosis of the jaw

2012 ◽  
Vol 23 (12) ◽  
pp. 2901-2902 ◽  
Author(s):  
K. Michaëlsson ◽  
J. Schilcher ◽  
P. Aspenberg
Keyword(s):  
Femoral Fractures ◽  
Osteonecrosis Of The Jaw ◽  
Atypical Femoral Fractures

Medication-Induced Musculoskeletal Changes

2019 ◽  
pp. 322-326
Author(s):  
Winnie A. Mar
Keyword(s):  
Musculoskeletal System ◽  
Gold Standard ◽  
Imaging Modality ◽  
Femoral Fractures ◽  
Osteonecrosis Of The Jaw ◽  
Bisphosphonate Therapy ◽  
Atypical Femoral Fractures ◽  
Osteoblastic Activity ◽  
Induced Changes

Chapter 117 discusses common medication-induced changes of the musculoskeletal system. The effect of corticosteroids on the musculoskeletal system, including osteoporosis and osteonecrosis, is discussed. Corticosteroids decrease osteoblastic activity, stimulate bone resorption, and decrease intestinal absorption of calcium. Complications of bisphosphonate therapy such as atypical femoral fractures and osteonecrosis of the jaw are reviewed. Myopathies and tendon pathologies are briefly discussed, as well as bony changes potentially seen with long-term voriconazole treatment. For osteoporosis, DXA scan is the gold standard, whereas radiography is usually the first imaging modality performed in patients on voriconazole therapy who present with pain.

scholarly journals Comprehensive Study of the Risk Factors for Medication-Related Osteonecrosis of the Jaw Based on the Japanese Adverse Drug Event Report Database

2020 ◽  
Vol 13 (12) ◽  
pp. 467
Author(s):  
Shinya Toriumi ◽  
Akinobu Kobayashi ◽  
Yoshihiro Uesawa
Keyword(s):  
Risk Factors ◽  
Side Effects ◽  
Adverse Drug Event ◽  
Femoral Fractures ◽  
Principal Component ◽  
Osteonecrosis Of The Jaw ◽  
Drug Event ◽  
Event Report ◽  
Atypical Femoral Fractures ◽  
Antiresorptive Agents

Medication-related osteonecrosis of the jaw (MRONJ) is associated with many drugs, including bisphosphonates (BPs). BPs are associated with atypical femoral fractures and osteonecrosis of the external auditory canal. Thus, many drugs are reported to cause adverse effects on bone. This study aimed to investigate the effects of drugs and patient backgrounds regarding osteonecrosis-related side effects, including MRONJ. This study used a large voluntary reporting database, namely, the Japanese Adverse Drug Event Report database. First, we searched for risk factors related to MRONJ using volcano plots and logistic regression analysis. Next, we searched for bone-necrosis-related side effects using principal component and cluster analysis. Factors that were significantly associated with MRONJ included eight types of BPs and denosumab, prednisolone, sunitinib, eldecalcitol, raloxifene, letrozole, doxifluridine, exemestane, radium chloride, medroxyprogesterone, female, elderly, and short stature. Furthermore, antiresorptive agents (i.e., BPs and denosumab) tended to induce MRONJ and atypical femoral fractures by affecting osteoclasts. We believe these findings will help medical personnel manage the side effects of many medications.

scholarly journals Do bisphosphonate-related atypical femoral fractures and osteonecrosis of the jaw affect the same group of patients? A pilot study

2014 ◽  
Vol 6 (1) ◽  
Author(s):  
Haitham Afif ◽  
Sebastian Mukka ◽  
Göran Sjödén ◽  
Arkan S. Sayed-Noor
Keyword(s):  
Clinical Practice ◽  
Pilot Study ◽  
Femoral Fractures ◽  
Osteonecrosis Of The Jaw ◽  
Simultaneous Occurrence ◽  
Limited Sample ◽  
Atypical Femoral Fractures ◽  
Limited Sample Size ◽  
Dental Records

Bisphosphonates (BPs) are commonly used drugs in clinical practice. In this pilot study, we investigated whether bisphosphonate-related atypical femoral fractures (AFF) and osteonecrosis of the jaw (ONJ) occurred simultaneously in the same group of patients. Six ONJ patients were examined by an orthopedic surgeon and 5 AFF patients were examined by a dentist to look for manifestations of simultaneous occurrence of AFF in ONJ patients and <em>vice versa</em>. The required radiological investigations and previous medical and dental records were available. No simultaneous occurrence of AFF and ONJ was found in the examined patients. In this pilot study with limited sample size, no manifestations of simultaneous occurrence of AFF and ONJ were found. This could be an indication that these complications have different pathophysiologies and affect different subgroups of patients on long-term BP treatment.

Osteonecrosis of the Jaw and Atypical Femoral Fractures

Osteoporosis ◽  
2013 ◽  
pp. 1873-1908 ◽  
Author(s):  
Elizabeth Shane ◽  
Sundeep Khosla ◽  
David Burr
Keyword(s):  
Femoral Fractures ◽  
Osteonecrosis Of The Jaw ◽  
Atypical Femoral Fractures

scholarly journals THERAPY OF ENDOCRINE DISEASE: Denosumab vs bisphosphonates for the treatment of postmenopausal osteoporosis

2018 ◽  
Vol 179 (1) ◽  
pp. R31-R45 ◽  
Author(s):  
Athanasios D Anastasilakis ◽  
Stergios A Polyzos ◽  
Polyzois Makras
Keyword(s):  
Fracture Risk ◽  
Femoral Fractures ◽  
Osteonecrosis Of The Jaw ◽  
Mineral Density ◽  
Atypical Femoral Fractures ◽  
Term Administration ◽  
Treatment Naïve ◽  
Fracture Risk Reduction ◽  
Pretreated Patients

The most widely used medications for the treatment of osteoporosis are currently bisphosphonates (BPs) and denosumab (Dmab). Both are antiresorptives, thus targeting the osteoclast and inhibiting bone resorption. Dmab achieves greater suppression of bone turnover and greater increases of bone mineral density (BMD) at all skeletal sites, both in naïve and pretreated patients. No superiority on fracture risk reduction has been documented so far. In long-term administration, BPs reach a plateau in BMD response after 2–3 years, especially at the hip, while BMD increases progressively for as long as Dmab is administered. Both BPs and Dmab are generally considered safe, although they have been correlated to rare adverse events, such as osteonecrosis of the jaw and atypical femoral fractures. Dmab should be preferred in patients with impaired renal function. BPs are embedded in the bone, from which they are slowly released during bone remodeling, therefore continuing to act for years after their discontinuation. In contrast, Dmab discontinuation fully and rapidly reverses its effects on bone markers and BMD and increases the risk for fractures; therefore, Dmab discontinuation should be discouraged, especially in previously treatment-naïve patients, regardless of the conventional fracture risk. In case of discontinuation, other treatment, mainly BPs, should immediately follow, although the optimal sequential treatment strategy is yet to be defined. Combination of teriparatide with Dmab or zoledronic acid, but not alendronate, provides increased BMD gains at all sites. In conclusion, both BPs and Dmab are safe and efficient therapeutic options although their particularities should be carefully considered in an individual basis.

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