scholarly journals Keeping an Eye on Bisphosphonate Therapy in Myeloma: A Case Report of Ocular Inflammation Postzoledronic Acid Infusion

2021 ◽  
Vol 2021 ◽  
pp. 1-4
Author(s):  
Rehman Faryal ◽  
Amjad Hayat
Keyword(s):  
Management Strategies ◽  
Complete Recovery ◽  
Osteonecrosis Of The Jaw ◽  
Bisphosphonate Therapy ◽  
Acid Infusion ◽  
Orbital Inflammation ◽  
The Past ◽  
Methyl Prednisolone ◽  
Skeletal Related Events ◽  
Acute Phase Reactions

Bisphosphonates have evolved over the past decades from oral to more potent intravenous preparations. Along with significant paradigm shift in the management of myeloma over the past years, stronger nitrogen-containing bisphosphonates, due to their antiresorptive action on the bones, have found their way as a key and integral part in the management of bone disease in myeloma. Multiple randomized controlled trials have established efficacy of bisphosphonates in reducing skeletal-related events in myeloma. Some well-documented adverse events include acute-phase reactions, esophageal irritation, and osteonecrosis of the jaw. Across all clinical indications, the incidence of inflammatory eye reactions after bisphosphonate infusion ranges from 0.046% to 1%. However, data from myeloma patients are extrapolated from few reported cases in literature with varying management strategies including discontinuation, switching to different forms, and rechallenging with steroid cover. Inflammatory eye reactions can vary from self-limiting conjunctivitis and episcleritis to serious uveitis and vision-threatening orbital inflammation. We present a similar case of a patient with IgG kappa myeloma who developed flu-like symptoms followed by severe orbital inflammation within 48–72 hours after receiving zoledronic acid infusion. The patient was successfully managed with intravenous methyl prednisolone followed by oral tapering dose of steroids and discontinuation of further bisphosphonate therapy. A complete recovery was noted in a week’s time.

ACUTE PHASE REACTIONS AFTER ZOLEDRONIC ACID INFUSION: PROTECTIVE ROLE OF 25-HYDROXYVITAMIN D AND PREVIOUS ORAL BISPHOSPHONATE THERAPY

2018 ◽  
Vol 24 (5) ◽  
pp. 405-410 ◽  
Author(s):  
Chiara Crotti ◽  
Nelson B. Watts ◽  
Maria De Santis ◽  
Angela Ceribelli ◽  
Gianluigi Fabbriciani ◽  
...  
Keyword(s):  
Zoledronic Acid ◽  
Acute Phase ◽  
Protective Role ◽  
Bisphosphonate Therapy ◽  
Acid Infusion ◽  
Hydroxyvitamin D ◽  
Oral Bisphosphonate ◽  
25 Hydroxyvitamin D ◽  
Acute Phase Reactions

scholarly journals Implantes dentários em pacientes usuários de bifosfonatos: o risco de osteonecrose e perda dos implantes é real? Relato de três casos clínicos Dental implants in patients under bisphosphonate therapy: is the risk of osteonecrosis of the jaw and implant loss real? Report of three clinical cases

RSBO ◽  
2018 ◽  
Vol 1 (1) ◽  
pp. 50
Author(s):  
Roberta Targa Stramandinoli-Zanicotti ◽  
Tatiana Miranda Deliberador ◽  
Bruno Candido ◽  
Marcio Vinícius Hurczulack ◽  
Juliana Lucena Schussel ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Oral Health ◽  
Dental Implants ◽  
Risk Group ◽  
Osteonecrosis Of The Jaw ◽  
Bisphosphonate Therapy ◽  
The Past ◽  
Dental Procedures ◽  
Dental Rehabilitation

Introdução: A osteonecrose induzida por medicamentos (ONIM) é uma grave complicação da terapia com drogas antirreabsortivas, como os bifosfonatos (BFs). Embora ocorra com mais frequência em pacientes oncológicos, os quais utilizam BFs endovenosos, pacientes usuários de BFs orais para tratamento de osteoporose também se encontram no grupo de risco, principalmente quando procedimentos odontológicos cirúrgicos como exodontias e implantes dentários são realizados. Objetivo: Relatar três casos de pacientes que fizeram usode BFs no passado ou ainda utilizavam a medicação durante cirurgia para instalação de implantes dentários, abordando os principais fatores de risco para o desenvolvimento da ONIM. Conclusão: O conhecimento prévio pelo implantodontista dos efeitos adversos da terapia com drogas antirreabsortivas em pacientes que necessitam de reabilitação dentária é de extrema importância no manejo desses pacientes, uma vez que elas podem prejudicar a longevidade das reabilitações com implantes e induzir à osteonecrose dos maxilares,comprometendo não somente a saúde bucal como também interferindo negativamente na qualidade de vida dos pacientes.Introduction: Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a serious complication of therapies with anti-resorptive drugs, such as bisphosphonates (BFs). Although it occurs more often in oncology patients who use intravenous BFs, patients who use oral BFs for osteoporosis are also in the risk group, especially when surgical dental procedures such as dental extraction or dental implants are performed. Objective: To report three cases of patients who were submitted to BF therapy in the past or were still using the medication during dental implants surgery and developed BRONJ and lost the implants. Conclusion: It is extremely important that the dentists are aware of the adverse effects of BF therapy in patients that require dental rehabilitation for the management thereof, since they can reduce the longevity of dental implants and induce osteonecrosis of the jaw, compromising not only their oral health but also these patients’ quality of life.

Bisphosphonate Complications Including Osteonecrosis of the Jaw

Hematology ◽  
2006 ◽  
Vol 2006 (1) ◽  
pp. 356-360 ◽  
Author(s):  
Bhoomi Mehrotra ◽  
Salvatore Ruggiero
Keyword(s):  
Risk Factors ◽  
Osteonecrosis Of The Jaw ◽  
Bisphosphonate Therapy ◽  
Myeloma Patient ◽  
Prevention Strategies ◽  
Standard Management ◽  
Chronic Therapy ◽  
Post Marketing ◽  
Skeletal Related Events ◽  
Supportive Management

Abstract Bisphosphonate therapy has been incorporated in the standard management of patients with multiple myeloma–related bony disease. Although their efficacy in reducing skeletal related events is important in the supportive management of the myeloma patient, post-marketing experience with this class of agents, particularly the more potent intravenous agents pamidronate and zoledronic acid, have raised cautionary notes regarding the potential side effects of these agents. The focus of this session is to review the risk factors, incidence, prevention strategies and management of bisphosphonate-related osteonecrosis of the jaw. In addition, pathophysiology, incidence and monitoring for renal dysfunction during chronic therapy with these agents are reviewed.

scholarly journals Thalassaemia: The Dental Implications of Bisphosphonate Therapy

2014 ◽  
Vol 4 (3) ◽  
pp. 57-59
Author(s):  
Navdeep Kumar
Keyword(s):  
Risk Reduction ◽  
Bone Remodelling ◽  
Management Strategies ◽  
Osteonecrosis Of The Jaw ◽  
Bisphosphonate Therapy ◽  
Reduction Strategies ◽  
Risk Reduction Strategies

Bisphosphonates (BP) are commonly used in individuals with thalassaemia to stabilise bone remodelling. However, in recent years, evidence has emerged that bisphosphonate related osteonecrosis of the jaw (BONJ) may occur. Cases of BONJ have recently been confirmed in individuals with thalassaemia. The aim of the presentation is to detail the prevalence of BONJ, outline the presentation (exposed vs. non-exposed), describe the management strategies that have been proposed, and discuss some risk reduction strategies.

scholarly journals Trauma-Induced Coagulopathy: Overview of an Emerging Medical Problem from Pathophysiology to Outcomes

Medicines ◽  
2021 ◽  
Vol 8 (4) ◽  
pp. 16
Author(s):  
Gabriele Savioli ◽  
Iride Francesca Ceresa ◽  
Luca Caneva ◽  
Sebastiano Gerosa ◽  
Giovanni Ricevuti
Keyword(s):  
Major Trauma ◽  
Management Strategies ◽  
Medical Problem ◽  
Current Evidence ◽  
Potential Drug ◽  
The Past ◽  
Trauma Induced Coagulopathy ◽  
Threatening Condition ◽  
Life Threatening ◽  
Trauma Mortality

Coagulopathy induced by major trauma is common, affecting approximately one-third of patients after trauma. It develops independently of iatrogenic, hypothermic, and dilutive causes (such as iatrogenic cause in case of fluid administration), which instead have a pejorative aspect on coagulopathy. Notwithstanding the continuous research conducted over the past decade on Trauma-Induced Coagulopathy (TIC), it remains a life-threatening condition with a significant impact on trauma mortality. We reviewed the current evidence regarding TIC diagnosis and pathophysiological mechanisms and summarized the different iterations of optimal TIC management strategies among which product resuscitation, potential drug administrations, and hemostatis-focused approaches. We have identified areas of ongoing investigation and controversy in TIC management.

scholarly journals Duration of Bisphosphonate Drug Holidays in Osteoporosis Patients: A Narrative Review of the Evidence and Considerations for Decision-Making

2021 ◽  
Vol 10 (5) ◽  
pp. 1140
Author(s):  
Kaleen N. Hayes ◽  
Elizabeth M. Winter ◽  
Suzanne M. Cadarette ◽  
Andrea M. Burden
Keyword(s):  
Surrogate Marker ◽  
Femoral Fractures ◽  
Osteonecrosis Of The Jaw ◽  
Bisphosphonate Therapy ◽  
Narrative Review ◽  
Drug Holiday ◽  
Future Research ◽  
Mineral Density ◽  
First Line Therapy

Bisphosphonates are first-line therapy for osteoporosis, with alendronate, risedronate, and zoledronate as the main treatments used globally. After one year of therapy, bisphosphonates are retained in bone for extended periods with extended anti-fracture effects after discontinuation. Due to this continued fracture protection and the potential for rare adverse events associated with long-term use (atypical femoral fractures and osteonecrosis of the jaw), a drug holiday of two to three years is recommended for most patients after long-term bisphosphonate therapy. The recommendation for a drug holiday up to three years is derived primarily from extensions of pivotal trials with alendronate and zoledronate and select surrogate marker studies. However, certain factors may modify the duration of bisphosphonate effects on a drug holiday and warrant consideration when determining an appropriate time off-therapy. In this narrative review, we recall what is currently known about drug holidays and discuss what we believe to be the primary considerations and areas for future research regarding drug holiday duration: total bisphosphonate exposure, type of bisphosphonate used, bone mineral density and falls risk, and patient sex and body weight.

Safety and efficacy of bone-modifying agents among multiple myeloma patients: A retrospective cohort study

2021 ◽  
pp. 107815522199603
Author(s):  
Christina Billias ◽  
Megan Langer ◽  
Sorana Ursu ◽  
Rebecca Schorr
Keyword(s):  
Multiple Myeloma ◽  
Cohort Study ◽  
Zoledronic Acid ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Osteonecrosis Of The Jaw ◽  
Safety And Efficacy ◽  
Modifying Agent ◽  
Skeletal Related Events ◽  
Agent Group

Objective To determine the incidence of skeletal-related events among multiple myeloma patients who received chemotherapy without a bone-modifying agent (zoledronic acid and denosumab) versus those who received chemotherapy with a bone-modifying agent. The secondary objective was to determine the incidence of skeletal-related events in patients without any prior history of skeletal-related events and who were treated with zoledronic acid every four weeks versus those who received zoledronic acid at an extended interval of every twelve weeks. Additional secondary objectives included the incidence of nephrotoxicity, hypocalcemia and osteonecrosis of the jaw in all patients. Methods This institutional review board-approved, retrospective cohort study included patients 18 to 89 years old with a diagnosis of multiple myeloma, who were being treated with chemotherapy between July 1, 2016 and October 31, 2019. Safety and efficacy were assessed through analysis of pertinent data collected: patient demographics, baseline skeletal-related events, development of new skeletal-related events, number and type of bone-modifying agent doses administered, and drug-related toxicities such as nephrotoxicity, hypocalcemia, and osteonecrosis of the jaw. Results A total of 73 patients were included. New skeletal-related events occurred in 12 patients (27%) in the chemotherapy without a bone-modifying agent group and in 5 patients (17%) in the chemotherapy with a bone-modifying agent group (OR = 0.56, 95% CI [0.172–1.8]; P = 0.32). The incidence of skeletal-related events was similar among patients receiving zoledronic acid every four weeks versus every twelve weeks in patients without a prior skeletal-related event (N = 0 vs. N = 2 respectively; P = 0.47). There were no statistically significant differences observed in each of the three secondary safety endpoints: incidence of hypocalcemia, nephrotoxicity and osteonecrosis of the jaw. Conclusion Multiple myeloma patients receiving chemotherapy without a bone-modifying agent had higher rates of skeletal-related events compared to those being treated with chemotherapy and a bonemodifying agent. Our results highlight the benefit of utilizing bonemodifying agents for the prevention of skeletal-related events in all multiple myeloma patients being treated with chemotherapy.

Understanding the decay of stone-built cultural heritage

2008 ◽  
Vol 32 (4) ◽  
pp. 439-461 ◽  
Author(s):  
B.J. Smith ◽  
M. Gomez-Heras ◽  
S. McCabe
Keyword(s):  
Climate Change ◽  
Natural Environment ◽  
Management Strategies ◽  
Building Stone ◽  
Stone Decay ◽  
Building Stones ◽  
The Public ◽  
The Past ◽  
Built Heritage ◽  
Common Misconceptions

The problem of the decay and conservation of stone-built heritage is a complex one, requiring input across many disciplines to identify appropriate remedial steps and management strategies. Over the past few decades, earth scientists have brought a unique perspective to this challenging area, drawing on traditions and knowledge obtained from research into landscape development and the natural environment. This paper reviews the crucial themes that have arisen particularly, although not exclusively, from the work of physical geographers — themes that have sought to correct common misconceptions held by the public, as well as those directly engaged in construction and conservation, regarding the nature, causes and controls of building stone decay. It also looks to the future, suggesting how the behaviour of building stones (and hence the work of stone decay scientists) might alter in response to the looming challenge of climate change.

scholarly journals How Effective Are Existing Phosphorus Management Strategies in Mitigating Surface Water Quality Problems in the U.S.?

2021 ◽  
Vol 13 (12) ◽  
pp. 6565
Author(s):  
Shama E. Haque
Keyword(s):  
Water Quality ◽  
Surface Water ◽  
Management Strategies ◽  
Surface Water Quality ◽  
Land Application ◽  
Water Soluble ◽  
Phosphorus Recovery ◽  
Water Bodies ◽  
The Past ◽  
The U.S

Phosphorus is an essential component of modern agriculture. Long-term land application of phosphorous-enriched fertilizers and animal manure leads to phosphorus accumulation in soil that may become susceptible to mobilization via erosion, surface runoff and subsurface leaching. Globally, highly water-soluble phosphorus fertilizers used in agriculture have contributed to eutrophication and hypoxia in surface waters. This paper provides an overview of the literature relevant to the advances in phosphorous management strategies and surface water quality problems in the U.S. Over the past several decades, significant advances have been made to control phosphorus discharge into surface water bodies of the U.S. However, the current use of phosphorus remains inefficient at various stages of its life cycle, and phosphorus continues to remain a widespread problem in many water bodies, including the Gulf of Mexico and Lake Erie. In particular, the Midwestern Corn Belt region of the U.S. is a hotspot of phosphorous fertilization that has resulted in a net positive soil phosphorous balance. The runoff of phosphorous has resulted in dense blooms of toxic, odor-causing phytoplankton that deteriorate water quality. In the past, considerable attention was focused on improving the water quality of freshwater bodies and estuaries by reducing inputs of phosphorus alone. However, new research suggests that strategies controlling the two main nutrients, phosphorus and nitrogen, are more effective in the management of eutrophication. There is no specific solution to solving phosphorus pollution of water resources; however, sustainable management of phosphorus requires an integrated approach combining at least a reduction in consumption levels, source management, more specific regime-based nutrient criteria, routine soil fertility evaluation and recommendations, transport management, as well as the development of extensive phosphorus recovery and recycling programs.

Sign in / Sign up

Export Citation Format

Share Document