Osteonecrosis of the Jaw in Cancer After Treatment With Bisphosphonates: Incidence and Risk Factors

2005 ◽  
Vol 23 (34) ◽  
pp. 8580-8587 ◽  
Author(s):  
Aristotle Bamias ◽  
Efstathios Kastritis ◽  
Christina Bamia ◽  
Lia A. Moulopoulos ◽  
Ioannis Melakopoulos ◽  
...  
Keyword(s):  
Risk Factors ◽  
Zoledronic Acid ◽  
Median Number ◽  
Osteonecrosis Of The Jaw ◽  
Bisphosphonate Treatment ◽  
Cumulative Hazard ◽  
Dental Procedures ◽  
History Of ◽  
Number Of Treatment ◽  
Other Neoplasms

Purpose Osteonecrosis of the jaw (ONJ) has been associated recently with the use of pamidronate and zoledronic acid. We studied the incidence, characteristics, and risk factors for the development of ONJ among patients treated with bisphosphonates for bone metastases. Patients and Methods ONJ was assessed prospectively since July 2003. The first bisphosphonate treatment among patients with ONJ was administered in 1997. Two hundred fifty-two patients who received bisphosphonates since January 1997 were included in this analysis. Results Seventeen patients (6.7%) developed ONJ: 11 of 111 (9.9%) with multiple myeloma, two of 70 (2.9%) with breast cancer, three of 46 (6.5%) with prostate cancer, and one of 25 (4%) with other neoplasms (P = .289). The median number of treatment cycles and time of exposure to bisphosphonates were 35 infusions and 39.3 months for patients with ONJ compared with 15 infusions (P < .001) and 19 months (P = .001), respectively, for patients with no ONJ. The incidence of ONJ increased with time to exposure from 1.5% among patients treated for 4 to 12 months to 7.7% for treatment of 37 to 48 months. The cumulative hazard was significantly higher with zoledronic acid compared with pamidronate alone or pamidronate and zoledronic acid sequentially (P < .001). All but two patients with ONJ had a history of dental procedures within the last year or use of dentures. Conclusion The use of bisphosphonates seems to be associated with the development of ONJ. Length of exposure seems to be the most important risk factor for this complication. The type of bisphosphonate may play a role and previous dental procedures may be a precipitating factor.

Bisphosphonate-induced osteonecrosis of the jaw: Incidence and risk factors in patients with breast cancer and gynecological malignancies

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 1113-1113
Author(s):  
V. Beck ◽  
E. Solomayer ◽  
M. Krimmel ◽  
C. Reinert ◽  
T. Fehm
Keyword(s):  
Breast Cancer ◽  
Risk Factors ◽  
Zoledronic Acid ◽  
Bone Metastases ◽  
Osteonecrosis Of The Jaw ◽  
Bisphosphonate Therapy ◽  
Gynecological Malignancies ◽  
Dental Procedures ◽  
The Mean ◽  
Number Of Treatment

1113 Background: Bisphosphonates are potent inhibitors of osteoclast-mediated bone resorption. They are successfully used in conditions of increased bone turnover such as osteoporosis or bone metastases. Since 2003 multiple cases of bisphosphonate-induced osteonecrosis of the jaw (ONJ) were reported. Our purpose was to describe the incidence and risk factors of ONJ in patients with breast cancer or gynecological malignancies. Patients and Methods: ONJ was assessed retrospectively for all patients with breast cancer or gynecological malignancies treated with bisphosphonates at the Department of Gynecology and Obstetrics, University Hospital Tuebingen during April 1999 until May 2006. Results: 10 of 310 (3%) patients with breast cancer or gynecological malignancies developed ONJ while receiving bisphosphonate therapy. All patients with ONJ were treated for bone metastases. Except one all patients with ONJ had a history of recent dental procedures. All patients had received zoledronic acid as part of their bisphosphonate regimen. In 4 of 10 patients this was the only bisphosphonate given. The remaining 6 patients had received at least one of the other bisphosphonates (alendronate, ibandronate, clodronate or pamidronate) before or after zoledronic acid therapy during their course of disease. Time of exposure to bisphosphonates and the number of treatment cycles were significant risk factors for the development of ONJ (p<0.001). In patients diagnosed with ONJ the mean number of treatment cycles was 27 ±18 cycles (median: 21 cycles, range 6–62 cycles) and the mean duration of bisphosphonate therapy was 29 ±20 months (median: 22 months, range 1–67 months). In contrast, the mean number of treatment cycles in patients without manifestation of ONJ was 11 ±12 cycles (median: 6 cycles, range 1–90 cycles). The mean duration of therapy was 12 months (median: 7 months, range 1–81 months). Conclusion: Osteonecrosis of the jaw is regarded a major side effect of bisphosphonate therapy. Length of exposure to bisphosphonates and the number of treatment cycles seem to be the most important risk factors for the development of ONJ. In addition, recent dental procedures favours the development of an ONJ. No significant financial relationships to disclose.

Bisphosphonates (BP)-related osteonecrosis of the jaw (ONJ): Clinical experience of the “Rete Oncologica di Piemonte e Valle d’Aosta” network

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 18584-18584 ◽  
Author(s):  
V. Fusco ◽  
C. Ortega ◽  
F. Goia ◽  
L. Ciuffreda ◽  
M. Ardine ◽  
...  
Keyword(s):  
Dental Care ◽  
Median Number ◽  
Osteonecrosis Of The Jaw ◽  
X Rays ◽  
Treatment And Prevention ◽  
Dental Procedures ◽  
Network Methods ◽  
History Of ◽  
Previously Treated ◽  
Prospective Trials

18584 Background: ONJ have been recently reported in patients (pts) treated with BP, especially Pamidronate (P) and Zoledronic Acid (Z). Measures of screening, treatment, and prevention have been planned in our regional oncology network. Methods: We evaluated dental history of pts previously treated with BP and/or under treatment in 2005, finding 60 cases of ONJ, but a large number of suspected cases are under investigation/observation. Full details of oncologic and dental history have been collected so far of 43 pts. Results: Pts characteristics: sex: 14/29 M/F; median age 66 years (range 45–81); tumour: 24 breast cancer, 7 prostate cancer; 12 myeloma. BP treatment: 5 P, 14 P changed to Z, 24 Z; median number of infusions: 22 of P (range 12–52), 18 of Z (range 7–43). Site of ONJ: 33 (77%) in mandible, 9 (21%) in maxilla, 1 (2%) in both. Presenting findings included exposed bone or infections (95%), pain, mobile teeth, soft-tissue swelling, nonhealing fistulas . Dental comorbidities were present in all pts and 92 % had precipitating events, as teeth extraction, periodontal surgery, dental implants, or traumatic use of dentures. Conclusions: Our oncology network planned: a) review of all pts treated with BP since 2000, to obtain real estimates of frequency and of possible risk factors; b) screening of all pts under treatment with BP, with panoramic X-rays and maxillofacial surgeon visit (w/o CT or MR scan in selected cases); c) careful evaluation of pts candidate to be treated with BP (as above), with pretherapy dental care if necessary; d) prospective evaluation of incidence in future, after pretherapy dental care policy and avoiding (as possible) surgical dental procedures during BP treatment; e) prospective trials of evaluation of palliative treatment of ONJ and related complications in affected pts (chlorohexidine mouthwashes, antibiotics, metronidazole, hyperbaric oxygen, etc.). No significant financial relationships to disclose.

Osteonecrosis of the jaw associated with intravenous bisphosphonate therapy—A single institution experience

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 18553-18553 ◽  
Author(s):  
E. M. Wallace ◽  
K. I. Quintyne ◽  
B. M. Cantwell ◽  
P. M. Calvert ◽  
G. D. Leonard
Keyword(s):  
Breast Cancer ◽  
Metastatic Breast Cancer ◽  
Zoledronic Acid ◽  
Metastatic Breast ◽  
Median Number ◽  
Osteonecrosis Of The Jaw ◽  
Bisphosphonate Therapy ◽  
Unknown Primary ◽  
Dental Procedures ◽  
Increased Risk

18553 Background: Osteonecrosis of the jaw (ONJ) is a debilitating disease that has been associated with cancer therapy. Recently a link between ONJ and chronic intravenous (IV) bisphosphonates has been suggested. We assessed the incidence of ONJ and its risk factors in patients treated with IV bishosphonates at our institution. Methods: All patients with a cancer diagnosis treated at our institution with at least four cycles of either IV Zoledronic Acid, Pamidronate, or a combination of both, from 2000–2005 were evaluated using outpatient records. Patients with ONJ were identified and their characteristics were compared to all patients receiving bisphosphonate therapy. Results: One hundred and twenty-one patients were evaluated, 36 Male and 85 Female. Median age- 62 (Range 34–85). Seventy-six had metastatic Breast cancer, 25 Prostate, 7 Lung, 3 Colorectal, 3 Renal, 2 unknown primary, 1 each of Penile, Bladder, Seminoma, Lymphoma and Melanoma. Forty patients received Pamidronate infusions alone, 51 Zoledronic Acid alone and 30 a combination of the two. The median number of Pamidronate infusions was 8 (Range 4–10), Zoledronic infusions 10.7 (Range 4–32), and a combination of pamidronate and zoledronic acid was 12 (Range 5–66). Three patients developed ONJ. All 3 patients were female, had a median age of 62 (range 52–74) and had metastatic breast cancer. The median number of bisphosphonate infusions prior to the development of ONJ was 35 (Range 18–47). All patients had chest wall radiotherapy and 1 had chemotherapy and steroids. No patients had dental procedures or prolonged antibacterial therapy. Conclusions: ONJ is a complication associated with IV Bisphosphonate therapy. Our study suggests that female sex, zoledronic acid, and prolonged administration of bisphosphonates, may confer an increased risk for the development of ONJ. Further prospective studies with adequate power are needed to clarify what patients are most at risk for developing ONJ and what measures are needed to prevent its occurrence. No significant financial relationships to disclose.

The Incidence of Osteonecrosis of the Jaw (ONJ) in Patients with Multiple Myeloma Who Receive Biphosphonates Depends on the Type of Biphosphonate.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 637-637 ◽  
Author(s):  
Meletios A. Dimopoulos ◽  
Efstathios Kastritis ◽  
Lia A. Moulopoulos ◽  
Ioannis Melakopoulos ◽  
Athanasios Anagnostopoulos ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Zoledronic Acid ◽  
Median Number ◽  
Osteonecrosis Of The Jaw ◽  
Accurate Estimate ◽  
Dental Extraction ◽  
Bone Lesions ◽  
Cumulative Hazard ◽  
True Incidence ◽  
Sequential Administration

Abstract Purpose: Biphosphonates have been approved for the treatment of bone lesions in patients with multiple myeloma. Although these agents are usually well tolerated, osteonecrosis of the jaw (ONJ) has been recently associated with the use of pamidronate and zoledronic acid. Nevertheless, the true incidence of this complication is not clearly defined. Therefore, we studied the incidence, characteristics and risk factors for the development of ONJ among patients with multiple myeloma treated with biphosphonates in our institution. Patients and Methods: One hundred and thirty-seven patients who received biphosphonates (zoledronic acid: 50 pts, pamidronate: 29 patients, bondronate: 2 pts, pamidronate and zoledronic acid: 50 pts, zoledronic acid and bondronate: 5 pts) since January 1995 and had a minimum exposure of 6 months to the drug were included in this analysis. Since the first reports, which associated ONJ with biphosphonate treatment, we prospectively evaluated this complication (first patient diagnosed in July 2003): all patients complaining of symptoms suggestive of ONJ were referred to a maxillofascial surgeon who confirmed the diagnosis and managed the patients for this complication. The medical records of all patients who were included in the analysis were reviewed in order to exclude symptoms and signs of ONJ, which might have not been formally diagnosed. From this retrospective review, no patient with a highly probable diagnosis of ONJ was identified. Results: Ten patients (6.7%) developed ONJ. The median number of treatment cycles and time of exposure to biphosphonates were 26 infusions and 42 months for patients with ONJ compared to19 infusions (p=0.2) and 27 months (p=0.05) for patients with no ONJ. The cumulative hazard of ONJ increased with time to exposure from 0% for exposure 6–12 months to 13% (95% CI: 3–23) for exposure of 5 years. The use of thalidomide was not associated with the development of ONJ. No case of ONJ was observed among patients treated with pamidronate or pamidronate and ibandronate. In patients who received sequential pamidronate and zoledronic acid, all cases of ONJ occurred during the use of zoledronic acid. The cumulative hazard was significantly higher with zoledronic acid compared to pamidronate alone or sequential administration of pamidronate and zoledronic acid (p=0.022). Among the 10 patients, who developed ONJ, 7 had had dental extraction prior to the development of the complication, 2 had dentures and only one had not had either. In spite of the discontinuation of biphosphonate treatment, only one patient experienced improvement of osteonecrosis, in 7 cases it remained stable and in 2 cases osteonecrosis progressed. Conclusions: The use of biphosphonates in patients with multiple myeloma seems to be associated with the development of ONJ. Our cohort study is the first one which provides a fairly accurate estimate of the incidence of documented ONJ after treatment with biphosphonates. Length of exposure and the type of biphosphonate used appear to be the most important risk factor for this complication. The risk of developing osteonecrosis appears to be higher with zoledronic acid than with pamidronate and may be precipitated by dental extraction.

Osteonecrosis of the Jaw in Multiple Myeloma Patients. Experience of Two Hospitals.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 5086-5086 ◽  
Author(s):  
Carmen Garcia-Garay ◽  
Consuelo Gonzalez-Garcia ◽  
Maria Juliana Majado ◽  
Tomasa Santos ◽  
Domingo Borrego
Keyword(s):  
Multiple Myeloma ◽  
Statistical Analysis ◽  
Zoledronic Acid ◽  
Treatment Duration ◽  
Osteonecrosis Of The Jaw ◽  
Treatment Length ◽  
Length Of Treatment ◽  
Dental Procedures ◽  
History Of ◽  
Patients Experience

Abstract Introduction of bisphsophonates (BPs) treatment has changed the history of bone symptoms in multiple myeloma (MM) patients, as well as in metastasic cancers (MC). However, osteonecrosis of the jaw (ONJ) has been recently described in these patients. No clear mechanism is known, although length of BPs treatment, as well as dental procedures, have been argued as possible causes. We reviewed MM patients treated with BPs from two hospitals, in the last 7 years, with the aim of studying the incidence on ONJ and their correlation with: kind of BPs administered, time of treatment and dental procedures. MC patients treated with BPs were also reviewed in order to establish the influence of the disease in ONJ development. Non-parametric Mann-Whitney U-test was used in statistical analysis. From January 1999 to June 2006 a total of 225 MM patients were diagnosed in our two hospitals, 143 of them received BPs: 49 pamidronate (P) only, 64 zoledronic acid (Z) only, and 30 received P and Z (PZ) sequentially. P was administered at a doses of 90 mg every 4 weeks, and Z at a doses of 4 mgr every 4 weeks. 14 MM patients treated with BPs suffered ONJ: one patient (2%) treated with P, six (9,3%) with Z, and seven (23.3%) in the group receiving PZ. In the same period of time 353 MC patients were treated with BPs, two of them (0.6%) developed ONJ. Length of treatment, expressed in months, is shown in the table (in MC patients, only Z group was analyzed). Months of treatment Diagnosis P Z PZ Total Expressed as median and range. MM without ONJ 22.5 (4–52) 9.5 (1–28) 38 (12–72) 14 (1–52) MM with ONJ 28 12 (7–28) 43.5 (24–59) 28 (7–59) MC 8 (1–41) The longest administration of treatment was in PZ patients compared with P and Z(p&lt;0.02), followed by P group that was longer than Z group (p&lt;0.01). No difference was found between MC and MM groups in Z treatment length, neither between patients with and without ONJ inside each Z and ZP groups. Five ONJ patients suffered from dental procedures along BPs administration. In our series the incidence of ONJ is higher than that described in literature (4–10%), and it is very surprising the elevated incidence reached in patients treated with both BPs (23%). In our opinion, coincidental with other authors, the lasting of treatment might be one, but not the only, important factor, because in patients receiving P treatment duration was longer than Z but, ONJ incidence was lesser. For this reason we think that more potent BPs might have a role in ONJ development. Since MC patients receiving the same schedule of treatment with Z than MM do not develop ONJ so frequently, so it seems that the disease itself might play a role in ONJ incidence.

Optimal use of antihypertensive agents in management of bevacizumab-associated hypertension.

2011 ◽  
Vol 29 (4_suppl) ◽  
pp. 614-614
Author(s):  
M. Suenaga ◽  
H. Imada ◽  
E. Nakamoto ◽  
S. Matsusaka ◽  
T. Watanabe ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Adverse Events ◽  
Total Duration ◽  
Antihypertensive Agents ◽  
Median Number ◽  
Management Protocol ◽  
First Choice ◽  
History Of ◽  
Grade 3 ◽  
Number Of Treatment

614 Background: Hypertension (HT) is the most common toxicity associated with bevacizumab (BV). Angiotensin converting enzyme inhibitors, calcium channel blockers (CCB), beta-blockers or diuretics are frequently chosen to control BV-associated HT. However, optimal use of these antihypertensive (AHT) agents for each grade of HT remains to be determined. Furthermore, the AHT agent to be used must be carefully chosen to avoid increasing risk for BV-associated cardiovascular adverse events. Methods: Seventy-five consecutive patients with metastatic colorectal cancer who received first-line FOLFOX4 plus BV 5 mg/kg were included in the study. Treatment continued until progression of disease or unmanageable toxicity occurred. Blood pressure was measured prior to treatment in each cycle and graded using the NCI–CTC, version 3.0. The management protocol was as follows: 8-12 mg candesartan cilexetil (an angiotensin II receptor antagonist) as the first choice for grade 2 HT; 2.5 mg ≤ additional amlodipine besylate (a CCB) when grade 3 HT occurred; BV was discontinued if HT remained uncontrolled with use of both these agents. Stable blood pressure < 150/100mmHg during treatment was defined as manageable. Results: Twenty patients (26.7%) had a history of HT. Grades 2-3 HT developed in 53 patients (70.7%) and grade 3 in 24 (32%). Median number of treatment cycles until onset of grades 2 and 3 HT was 3 and 4.5, respectively. Comparing patients with a history of HT to those without, the incidence of grade 3 was greater in the former (85 vs. 12.7%, respectively), and the median number of treatment cycles until onset of grade 3 was shorter (4 vs. 12 cycles, respectively); blood pressure was considered manageable in both groups (90 vs. 91%, respectively), and no difference in total duration of chemotherapy was observed. No AHT approach-related severe adverse events were observed. Conclusions: Grade 3 HT was manageable during BV treatment, regardless of prior hypertensive history. However, to ensure improved survival, especially in patients with a history of HT, appropriate management is needed in BV-associated grade 3 HT. These data suggest that use of AHT agents is an effective and safe strategy in the management of BV-associated HT. No significant financial relationships to disclose.

Osteonecrosis of the jaw (ONJ) in radium 223 (Ra223)-treated metastatic castration-resistant prostate cancer (mCRPC) patients (pts) with exposure to zoledronic acid and/or denosumab.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 5575-5575
Author(s):  
Yen Thi Kim Hong Cao ◽  
Janson Trieu ◽  
Vanessa Rojas ◽  
Michael Elias ◽  
Michael J. Anderson ◽  
...  
Keyword(s):  
Zoledronic Acid ◽  
Bone Metastases ◽  
Data Entry ◽  
Sequential Therapy ◽  
Median Number ◽  
Osteonecrosis Of The Jaw ◽  
Sequential Treatment ◽  
Castration Resistant Prostate Cancer ◽  
Radium 223 ◽  
Sequential Group

5575 Background: Bone health agents (BHA) including denosumab, a monoclonal antibody, and Zoledronic acid (ZA), a bisphosphonate, are recommended for men with CRPC and bone metastases to prevent skeletal-related complications. ONJ occurs in about 5% of patients (pts) on BHA. The incidence of ONJ in pts treated with Ra223 and BHA remains unknown, particularly in those who receive sequential treatment of BHAs. Here we describe the rate of ONJ in a real-world setting in mCRPC pts treated with Ra223 in 3 groups: 1) denosumab alone, 2) ZA alone, and 3) sequential ZA /denosumab or vice versa. Methods: A retrospective analysis of a cohort of mCRPC pts with bone metastases who received Ra223. Follow-up was until date of death or last data entry. Chart inclusion criteria included patients who received Ra223 between November 2010 to August 2018 with documentations of data points. Results: A total of 177 pts received Ra223 between 11/2010 and 8/2018. Median age 73 at 1st Ra223 (range 40-93); Median PSA 15.8- at 1st Ra223 (range 0.1-1952); Demographics-AA-10, C-130, Asian-9, unspecified-28; Median Alk Phos 95 at 1st Ra233 (range 25-1515). 93 % (164/177) received BHA. Of the 164 who received BHA, 45% (73/164) received denosumab only, 37% (61/164) received ZA only, and 18% (30/164) received sequential treatment. ONJ developed in 9.7% (16/164) of all patients on BHA. Denosumab alone caused ONJ in 7 of 73 pts (9.6%). ZA alone caused ONJ in 6 of 61 pts (9.8%). ONJ occurred in 3 of 30 pts (10%) in the sequential group. The median number of doses of BHA before development of ONJ was 10 with denosumab, 20 with ZA, and 19.5 (denosumab) and 22 (ZA) in the sequential group. Conclusions: In patients treated with Ra223 and a BHA, the rate of ONJ is 9.7%. The rate of ONJ was similar in groups treated with denosumab alone, ZA alone, and sequential treatment of ZA and denosumab However, ONJ developed more quickly in patients on denosumab. We conclude that the risk of ONJ is increased in patients treated with Ra223 and BHA. ZA or sequential therapy appears to delay time to onset of ONJ compared to denosumab. Clinicians should be mindful of the toxic synergy between Ra223 and BHA. ZA may be the preferred BHA partner with Ra223.

scholarly journals Cancer Patients at Risk for Medication-Related Osteonecrosis of the Jaw. A Case and Control Study Analyzing Predictors of MRONJ Onset

2021 ◽  
Vol 10 (20) ◽  
pp. 4762
Author(s):  
Antonia Marcianò ◽  
Ylenia Ingrasciotta ◽  
Valentina Isgrò ◽  
Luca L’Abbate ◽  
Saveria Serena Foti ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Assessment ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Zoledronic Acid ◽  
Cancer Patients ◽  
Logistic Regression Analysis ◽  
Osteonecrosis Of The Jaw ◽  
P Value ◽  
Multiple Variables

The goal of this investigation was to identify potential risk factors to predict the onset of medication-related osteonecrosis of the jaw (MRONJ). Through the identification of the multiple variables positively associated to MRONJ, we aim to write a paradigm for integrated MRONJ risk assessment built on the combined analysis of systemic and local risk factors. The characteristics of a cohort of cancer patients treated with zoledronic acid and/or denosumab were investigated; beyond the set of proven risk factors a new potential one, the intake of new molecules for cancer therapy, was addressed. Registered data were included in univariate and multivariate logistic regression analysis in order to individuate significant independent predictors of MRONJ; a propensity score-matching method was performed adjusting by age and sex. Univariate logistic regression analysis showed a significant effect of the parameters number of doses of zoledronic acid and/or denosumab (OR = 1.03; 95% CI = 1.01–1.05; p = 0.008) and chemotherapy (OR = 0.35; 95% CI = 0.17–0.71; p = 0.008). The multiple logistic regression model showed that breast, multiple myeloma, and prostate cancer involved a significantly higher risk compared to lung cancer; a significant effect of the combined variables number of doses of zoledronic acid and/or denosumab (OR = 1.03; 95% CI = 1.01–1.06); p-value = 0.03) and exposure to novel molecule treatment (OR = 34.74; 95% CI = 1.39–868.11; p-value = 0.03) was observed. The results suggest that a risk assessment paradigm is needed for personalized prevention strategies in the light of patient-centered care.

scholarly journals 1075. A Retrospective Comparison of Native Valve Endocarditis and Prosthetic Valve Endocarditis in a Large Tertiary Care Teaching Hospital From 2007 to 2015

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S322-S322
Author(s):  
Hoi Yee Annie Lo ◽  
Anahita Mostaghim ◽  
Nancy Khardori
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Aortic Valve ◽  
Teaching Hospital ◽  
Prosthetic Valve ◽  
Prosthetic Valve Endocarditis ◽  
Native Valve ◽  
Prosthetic Valves ◽  
Dental Procedures ◽  
History Of

Abstract Background Studies comparing native valve and prosthetic valve endocarditis (NVE and PVE) have mixed findings on the risk factors and outcomes between the two cohorts. This retrospective review of infective endocarditis (IE) at a teaching hospital in the United States aims to compare the clinical and microbiological features between NVE and PVE. Methods Patients were retrospectively identified from 2007 to 2015 using appropriate IE-related ICD-9 codes. Cases that met definite Modified Duke Criteria for IE were further classified as either PVE or NVE, and were reviewed for epidemiology, causative organism(s), affected valves and associations, risk factors, dental procedures in the past 6 months, and 30-day mortality. Results A total of 363 admissions met criteria for definite endocarditis, with 261 NVE cases and 59 PVE cases. Forty-three cases that were either associated with an infection involving both native and prosthetic valves or intracardiac devices were omitted from this study. Most risk factors, such as hemodialysis and intravenous drug use, did not show any significant difference amongst the two groups. IE involving the aortic valve as well as a previous history of IE were more likely to be seen in PVE (both P &lt; 0.0001). Dental procedures done in the preceding 6 months before IE admission were more likely to be associated with PVE than NVE (P = 0.0043). PVE showed a higher likelihood of 30-day mortality compared with NVE (P = 0.067). The causative organisms of PVE were more likely to be caused by common gut pathogens such as Klebsiella and Enterobacter species. Conclusion PVE cases had a significantly higher chance of involving the aortic valve as well as having a history of IE. PVE cases were also significantly more likely to be associated with a dental procedure done in the preceding 6 months than with the NVE cases. This implies that patients with prosthetic valves, who are currently covered under the 2007 AHA guidelines to receive prophylaxis prior to dental procedures, are still at a high risk of developing PVE. It may be prudent to reconsider adding a post-procedure dose of antibiotics, instead of a single preprocedure dose, to extend the protection of this high-risk population with prosthetic valves. Furthermore, PVE cases showed higher rates of 30-day mortality compared with NVE with near significance, which is likely multifactorial. Disclosures All authors: No reported disclosures.

Antibiotic Prophylaxis Before Dental Procedures Can Reduce ONJ Incidence.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 3613-3613 ◽  
Author(s):  
Vittorio Montefusco ◽  
Francesca Gay ◽  
Francesco Spina ◽  
Maria Teresa Ambrosini ◽  
Massimo Maniezzo ◽  
...  
Keyword(s):  
Risk Factors ◽  
Zoledronic Acid ◽  
High Risk ◽  
Antibiotic Prophylaxis ◽  
Low Risk ◽  
Dental Procedure ◽  
Dental Procedures ◽  
Significant Difference ◽  
Group A ◽  
Group B

Abstract Osteonecrosis of the jaw (ONJ) is a frequent complication in bisphosphonate-treated multiple myeloma (MM) patients. The pathogenesis is unclear, and major risk factors are duration of bisphosphonate treatment and dental procedures. The histology of osteonecrotic bone shows osteomyelitis and inflammatory infiltrates, and, in most cases, presence of Actynomycetes. Since dental procedures are a major risk factor for ONJ development and oral microflora can be involved in the pathogenesis of the disease, we conducted a retrospective observational trial comparing ONJ occurrence and related risk factors in two groups of MM patients, who received zoledronic acid treatment at two Italian hematological centres. In one centre all patients systematically received as antibiotic prophylaxis amoxicillin-clavulanate 1 gm bid or levofloxacin 500 mg once a day starting from one day before to 3 days after any dental procedure (group A, 52 patients), while in the other centre patients did not receive any prophylaxis (group B, 61 patients). Dental procedures were categorized according to their invasivity and their supposed probability to cause ONJ. Extractions, implants, and professional cleanings were considered at high risk, while fillings were considered low risk procedures. Thirty-three group A patients (63%) and 32 group B patients (52%) received high risk procedures; 4 group A patients (8%) and 5 group B patients (8%) received low risk procedures, while 15 (29%) and 24 (39%) patients, respectively, had a denture. The duration of zoledronic acid exposure differed significantly between the two groups, with a median of 26 months for A patients and 12 months for B patients (p&lt;0.0001). In group A no cases of ONJ were observed, while in group B 8 cases (13%) of ONJ were diagnosed, with a significant difference between the two groups (p=0.007). There was a temporal correlation between dental procedure and ONJ, with a median time of 60 days (range 37–990). The relative risk of ONJ after a dental procedure was 4.8 (p=0.01). The pooled analysis of the two groups showed that age, sex, transplant procedure, and thalidomide therapy did not correlate with ONJ. In both groups the presence of dentures was not associated with ONJ. While in group B incidence of ONJ is consistent with data reported in the literature, which range between 7% and 11%, group A patients had an unexpected low occurrence of this complication, despite a significantly longer exposure to zoledronic acid. This finding suggests a possible role of antibiotic prophylaxis in protecting from ONJ after dental procedures. Further, our observation, along with the correlation between dental procedures and ONJ development, can contribute to the proposal of a comprehensive model of ONJ pathogenesis: trauma of the alveolar bone modified by bisphosphonates induces a bacterial translocation with a subsequent induction of infection, inflammation and necrosis. In this perspective, since antibiotic prophylaxis is a simple and low cost precaution, it’s reasonable to propose it as part of standard care to zoledronic acid treated MM patients before any dental procedure.

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