scholarly journals Bisphosphonate-Related Osteonecrosis of the Jaws. A Severe Side Effect of Bisphosphonate Therapy

2012 ◽  
Vol 55 (3) ◽  
pp. 111-115 ◽  
Author(s):  
Zuzana Janovská
Keyword(s):  
High Risk ◽  
Bone Resorption ◽  
Secondary Infection ◽  
Complete Recovery ◽  
Bisphosphonate Therapy ◽  
Severe Side Effect ◽  
Main Role ◽  
Osteonecrosis Of The Jaws ◽  
Oncologic Patients ◽  
High Doses

Bisphosphonates (BP) are potent inhibitors of bone resorption used mainly in the treatment of metastatic bone disease and osteoporosis. By inhibiting bone resorption, they prevent complications as pathological fracture, pain, tumor-induced hypercalcemia. Even though patient’s benefit of BP therapy is huge, various side effects may develop. Bisphosphonate-related osteonecrosis of the jaws (BRONJ) is among the most serious ones. Oncologic patients receiving high doses of BP intravenously are at high risk of BRONJ development. BPs impair bone turnover leading to compromised bone healing which may result in the exposure of necrotic bone in the oral cavity frequently following tooth extraction or trauma of the oral mucosa. Frank bone exposure may be complicated by secondary infection leading to osteomyelitis development with various symptoms and radiological findings. In the management of BRONJ, conservative therapy aiming to reduce the symptoms plays the main role. In patients with extensive bone involvement resective surgery may lead to complete recovery, provided that the procedure is correctly indicated. Since the treatment of BRONJ is difficult, prevention is the main goal. Therefore in high risk patients dental preventive measures should be taken prior to bisphosphonate administration. This requires adequate communication between the prescribing physician, the patient and the dentist.

scholarly journals Submental Perforator Flap for Soft-Tissue Reconstruction in Bisphosphonate-Related Osteonecrosis of the Jaws

2017 ◽  
Vol 10 (4) ◽  
pp. 299-305 ◽  
Author(s):  
Jose-Antonio García-de Marcos ◽  
Juan Rey-Biel
Keyword(s):  
Soft Tissues ◽  
Secondary Infection ◽  
Perforator Flap ◽  
Term Treatment ◽  
Soft Tissue Reconstruction ◽  
Osteonecrosis Of The Jaws ◽  
Long Term Treatment ◽  
Tissue Reconstruction ◽  
High Doses

Bisphosphonate-related osteonecrosis of the jaws (BRONJ) has emerged as an important and increasingly common comorbidity, especially in patients undergoing long-term treatment with high doses of bisphosphonates. The management of BRONJ remains controversial. Surgical treatment is necessary in severe cases. Treatment of the bone requires sequestrectomy or resection. Given the lack of sufficient mucosa to perform the operation and fragility of margins in many patients, local flaps are crucial. We report two cases of stage-3 BRONJ presenting secondary infection with Actinomyces, receiving treatment consisting of marginal resection of the necrotic bone, reinforcement with a reconstruction plate, and reconstruction of soft tissues using a submental perforator artery flap ipsilateral to the lesion. Total cure was achieved in both cases, achieving favorable aesthetic and functional outcomes.

Tooth Extractions in High-Risk Patients Under Bisphosphonate Therapy and Previously Affected With Osteonecrosis of the Jaws

2015 ◽  
Vol 26 (3) ◽  
pp. 696-699 ◽  
Author(s):  
Paolo Vescovi ◽  
Ilaria Giovannacci ◽  
Elisabetta Merigo ◽  
Marco Meleti ◽  
Maddalena Manfredi ◽  
...  
Keyword(s):  
High Risk ◽  
Bisphosphonate Therapy ◽  
High Risk Patients ◽  
Osteonecrosis Of The Jaws ◽  
Risk Patients ◽  
Tooth Extractions

Chemical Features of Bisphosphonates and Histopathological Outcomes in Rat Jaw Treated with Zoledronic Acid Combined with Dexamethasone

2018 ◽  
Vol 69 (7) ◽  
pp. 1802-1807
Author(s):  
Ioana Aurita Albu Stan ◽  
Cecilia Petrovan ◽  
Diana Cerghizan ◽  
Daniel Emil Albu ◽  
Adriana Elena Craciun ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Zoledronic Acid ◽  
Bone Resorption ◽  
Bisphosphonate Therapy ◽  
Inorganic Pyrophosphate ◽  
Osteonecrosis Of The Jaws ◽  
The Past ◽  
Concurrent Use ◽  
Exposed Bone ◽  
First Time

Bisphosphonate related osteonecrosis of the jaws (BRONJ) is a pathological entity described for the first time in 2003; three criteria are mandatory: no radiotion therapy,exposed bone in oral cavities for at least eight weeks with no signs of healing, bisphosphonate therapy in present or in the past,in patients with bisphosphonate therapy in present or in the past. Bisphosphonates (BPs) are stable analogues of natural inorganic pyrophosphate, which inhibit bone resorption. In literature, most patients diagnosed with BRONJ were suffering from multiple myeloma and they had a treatment with nitrogen containing BPs and steroids such as dexamethasone intravenously. With this study we have aimed to achieve a rat model of BRONJ and to evaluate histopathological findings how concurrent use of BPs and steroids can affect emergence of BRONJ in this study.

scholarly journals Neuroleptic malignant syndrome

2011 ◽  
Vol 69 (5) ◽  
pp. 751-755 ◽  
Author(s):  
Mariana Moscovich ◽  
Felipe T.M. Nóvak ◽  
Artur F. Fernandes ◽  
Tatiana Bruch ◽  
Tabita Tomelin ◽  
...  
Keyword(s):  
Adverse Event ◽  
Neuroleptic Malignant Syndrome ◽  
Fatal Outcome ◽  
Signs And Symptoms ◽  
Complete Recovery ◽  
Past Medical History ◽  
History Of ◽  
High Doses ◽  
Symptoms And Signs ◽  
Gathering Data

Neuroleptic malignant syndrome (NMS) is a potentially fatal adverse event associated with the use of antipsychotics (AP). The objective of this study was to investigate the profile of cases of NMS and to compare our findings with those published in similar settings. A series of 18 consecutive patients with an established diagnosis of NMS was analyzed, gathering data on demography, symptoms and signs. Two thirds of all cases involved woman with a past medical history of psychiatric disorder receiving relatively high doses of AP. The signs and symptoms of NMS episodes were similar to those reported in other series and only one case had a fatal outcome, the remaining presenting complete recovery. As expected, more than two thirds of our cases were using classic AP (68%), however the clinical profile of these in comparison with those taking newer agent was similar. Newer AP also carry the potential for NMS.

Different responses of biochemical markers of bone resorption to bisphosphonate therapy in Paget disease

1995 ◽  
Vol 41 (11) ◽  
pp. 1592-1598 ◽  
Author(s):  
A Blumsohn ◽  
K E Naylor ◽  
A M Assiri ◽  
R Eastell
Keyword(s):  
Bone Resorption ◽  
Biochemical Markers ◽  
Type I Collagen ◽  
Bisphosphonate Therapy ◽  
Response To Therapy ◽  
Tartrate Resistant Acid Phosphatase ◽  
Type I ◽  
Paget Disease ◽  
Markers Of Bone Resorption ◽  
Total Alkaline

Abstract We examined the response of different biochemical markers of bone resorption to bisphosphonate therapy (400 mg of etidronate daily for 6 months) in mild Paget disease (n = 14). Urinary markers included hydroxyproline (OHP), total (T) and free (F) pyridinolines (Pyds) determined by HPLC, immunoreactive FPyds, immunoreactive TPyds, and the N- and C-terminal telopeptides of type I collage (NTx, CL). Serum measurements included tartrate-resistant acid phosphatase (TRAcP) and the C-terminal telopeptide of type I collagen (ICTP). ICTP and TRAcP showed a minimal response to therapy (% change at 6 months, -13.1 +/- 6.8 and -6.7 +/- 3.4, respectively). The response was greatest for urinary telopeptides (NTx and CL; % change -75.7 +/- 7.5 and -73.4 +/- 8.9, respectively). The response was somewhat greater for TPyds than for FPyds. We conclude that: (a) ICTP and TRAcP are unreliable indicators of changes in bone turnover; (b) oligopeptide-bound Pyds and telopeptide fragments of type I collagen in urine show a somewhat greater response to therapy than do FPyds and may be more sensitive indicators of bone resorption; and (c) as yet no evidence suggests that these markers are substantially better predictors of the clinical response to therapy than serum total alkaline phosphatase or urinary OHP. There are several problems with the interpretation of these measurements in Paget disease, and the clinical utility of these measurements remains uncertain.

scholarly journals Quantifiable excess of bone resorption in monoclonal gammopathy is an early symptom of malignancy: a prospective study of 87 bone biopsies

Blood ◽  
1996 ◽  
Vol 87 (11) ◽  
pp. 4762-4769 ◽  
Author(s):  
R Bataille ◽  
D Chappard ◽  
MF Basle
Keyword(s):  
High Risk ◽  
Bone Resorption ◽  
Monoclonal Gammopathy ◽  
Plasma Cells ◽  
Bone Biopsy ◽  
Low Risk ◽  
Early Symptom ◽  
Major Interest ◽  
Bone Biopsies

To determine if excessive osteoclastic-mediated bone resorption (BR) is an early tumor-induced event in multiple myeloma (MM), BR was assessed at first presentation on quantitative bone biopsy in 87 individuals evaluated for monoclonal gammopathy of undetermined significance (MGUS) and reinterpreted according to the presenting features and subsequent follow-up evaluation. As a reference population, 48 patients with previously untreated overt MM were evaluated under similar conditions. The median level of BR was significantly higher in 48 overt MM versus 87 MGUS patients (12.2% v 5.1% [normal level, <6%], P <.01). Actually, 93% of overt MM patients had an excessive BR versus 45% of MGUS patients at presentation (P <.01) According to simple presenting parameters (> or <5% plasma cells within the bone marrow, presence or absence of mild anemia/neutropenia), 31 individuals were classified as low-risk MGUS, 32 high-risk MGUS, and 24 indolent MM. An excessive BR was observed in 16% of low-risk MGUS, 46% of high-risk MGUS (P <.01 v low-risk MGUS), 79% of indolent MM (P <.05 v high-risk MGUS), and 93% of overt MM patients. Of major interest, the level of BR in indolent MM (11.2%) was identical to that in overt MM (12.2%) but significantly higher than in both low-risk (4%, P <.01) and high-risk (5.6%, P <.01) MGUS. When considering the follow-up evaluation of MGUS patients, an excessive BR at presentation was observed in 52% of MGUS cases that turned out to be unstable or developed subsequent MM, but in only 4% of stable MGUS (P <.01). More precisely the level of BR of low-risk MGUS that either turned out to be unstable or that developed into MM was significantly higher at presentation than that of subsequent stable MGUS (4.4% v 2.9%, P <.05). The same difference was observed in both high-risk MGUS and indolent MM according to subsequent follow-up studies (8.1% v 3.4% and 11.7% v 6%, respectively, P <.05). Of major interest, the level of BR in 11 stable high-risk MGUS cases actually fulfilling the diagnostic criteria of smoldering MM was very low (3.4%) and similar to that in stable low-risk MGUS (2.9%). We conclude that a quantifiable excess of BR in MGUS is significantly associated with progression and thus is an early symptom of malignancy in these individuals.

scholarly journals EVALUATION OF CEFOPERAZONE/SULBACTAM AND VITAMIN K USE IN PATIENTS WITH BACTERIAL INFECTIONS

2019 ◽  
pp. 191-193 ◽  
Author(s):  
THEERAPONG SEESIN ◽  
PITIPONG PENGSUPSIN ◽  
SARAWUT WEESAPHEN ◽  
PEERAYA SRIPHONG ◽  
UAEPONG LIMPAPANASIT ◽  
...  
Keyword(s):  
Risk Factors ◽  
Chronic Kidney Disease ◽  
High Risk ◽  
Vitamin K ◽  
Bacterial Infections ◽  
Drug Allergy ◽  
High Risk Patient ◽  
General Medicine ◽  
Drug Related Problems ◽  
High Doses

Objective: The objectives of this study were to evaluate the effects of Vitamin K use for bleeding or coagulopathies prevention and to assess theoccurrence of drug-related problems in patients receiving cefoperazone/sulbactam.Methods: The prospective study was conducted between January and April 2018 at 5 general medicine wards in Mahasarakham Hospital, Thailand.Patients above 18 years of age with bacterial infections who received cefoperazone/sulbactam concurrent with Vitamin K were included. Rate ofbleeding, coagulopathies, and drug-related problems were evaluated.Results: Forty-three eligible patients enrolled in this study. Most were women (72.1%), average ages were 64.7 years old and 93.0% had comorbidities(most were diabetes, hypertension, and chronic kidney disease). High doses of cefoperazone/sulbactam have been used in 35 patients (81.4%).Gastrointestinal bleeding occurred in one patient (8.3%), 24 patients had prolonged prothrombin time (55.8%), and 8 patients had prolongedactivated partial thromboplastin time (18.6%). Anticipated risk factors were not associated with bleeding. Drug-related problems were missing ofdose adjustment for cefoperazone/sulbactam in patients with renal impairment (4.7%), drug interactions between warfarin and Vitamin K (4.7%),and drug allergy (2.3%).Conclusion: This study found that cefoperazone/sulbactam aggravated bleeding and coagulopathies despite using Vitamin K for prevention. Wesupport the use of Vitamin K for the prevention of bleeding in high-risk patient such as elderly who receive cefoperazone/sulbactam.

Romosozumab: A first-in-class sclerostin inhibitor for osteoporosis

2020 ◽  
Vol 77 (23) ◽  
pp. 1949-1956
Author(s):  
Caitlin Prather ◽  
Erin Adams ◽  
Whitney Zentgraf
Keyword(s):  
Clinical Trials ◽  
High Risk ◽  
Bone Resorption ◽  
Bone Formation ◽  
English Language ◽  
Safety Concern ◽  
Osteoporotic Fractures ◽  
Mineral Density ◽  
Treatment Of Osteoporosis ◽  
Poster Presentations

Abstract Purpose The purpose of this article is to review the pharmacology, efficacy, and safety of the sclerostin inhibitor romosozumab for the treatment of osteoporosis, including data from clinical trials of the drug. Summary A review of the literature was performed by searching PubMed and MEDLINE for all relevant articles published between January 2014 and February 2020 using the keywords romosozumab, romosozumab-aqqg, osteoporosis, and fracture. All relevant English-language articles evaluating the pharmacology, efficacy, or safety of romosozumab for the treatment of osteoporosis in humans were included; poster presentations were excluded. Romosozumab has been approved by the Food and Drug Administration and is considered both safe and effective for the treatment of osteoporosis in high-risk postmenopausal females. Phase 2 and phase 3 clinical trials have shown a statistically significant decrease in new vertebral fractures and an increase in bone mineral density with romosozumab use, as compared with both placebo use and use of alternative osteoporosis therapies. The primary safety concern is a potential risk of cardiovascular events; additionally, hypocalcemia must be corrected prior to initiation. Romosozumab is the first anabolic medication that both increases bone formation and decreases bone resorption. Data suggest that romosozumab is more effective than oral bisphosphonates in preventing osteoporotic fractures, though cost and safety concerns must be considered. Conclusion Romosozumab is a novel, 12-month treatment option for postmenopausal women at high risk for osteoporotic fracture that both increases bone formation and decreases bone resorption.

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