scholarly journals Surgical therapy for medication-related osteonecrosis of the jaw in osteoporotic patients treated with antiresorptive agents

2020 ◽  
Vol 164 (1) ◽  
pp. 100-107 ◽  
Author(s):  
Lukas Hauer ◽  
Jan Jambura ◽  
Daniel Hrusak ◽  
Miroslava Chalupova ◽  
Petr Posta ◽  
...  
Keyword(s):  
Surgical Therapy ◽  
Osteonecrosis Of The Jaw ◽  
Antiresorptive Agents

scholarly journals Platelet Rich Plasma in the Treatment of Bisphosphonate-Related Osteonecrosis of the Jaw: Personal Experience and Review of the Literature

2014 ◽  
Vol 2014 ◽  
pp. 1-7 ◽  
Author(s):  
F. Longo ◽  
A. Guida ◽  
C. Aversa ◽  
E. Pavone ◽  
G. Di Costanzo ◽  
...  
Keyword(s):  
Surgical Therapy ◽  
Personal Experience ◽  
Platelet Rich Plasma ◽  
Osteonecrosis Of The Jaw ◽  
Bone Diseases ◽  
Definitive Evidence ◽  
Synthetic Drugs ◽  
Antiresorptive Agents ◽  
Nonsurgical Therapy ◽  
Prp Gel

Bisphosphonates (BPs) are a class of synthetic drugs commonly used to treat bone metastasis and various bone diseases that cause osseous fragility (such as osteoporosis). Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a common complication in patients who received BPs, especially intravenously. Recently, osteonecrosis of the jaw (ONJ) caused by chemotherapeutic not belonging to BPs drug class has been reported. For this reason, it has been proposed recently to rename BRONJ in antiresorptive agents related osteonecrosis of the jaw (ARONJ), to include a wider spectrum of drugs that may cause osteonecrosis of the jaw. The most debated topic about ARONJ/BRONJ is therapy. The most adequate procedure is far from being standardized and prevention seems to play a pivotal role. In our study, we considered 72 patients with BRONJ with nonsurgical therapy, surgical therapy, and surgical therapy with platelet rich plasma (PRP) gel to evaluate its therapeutic effect in promoting ONJ wounds healing. Good results showed by PRP in improving wound healing give away to case-control randomized studies that could give definitive evidence of its effectiveness.

Development of Antiresorptive Agent-Related Osteonecrosis of the Jaw After Dental Implant Removal: A Case Report

2018 ◽  
Vol 44 (5) ◽  
pp. 359-364
Author(s):  
Shinsuke Yamamoto ◽  
Keigo Maeda ◽  
Izumi Kouchi ◽  
Yuzo Hirai ◽  
Naoki Taniike ◽  
...  
Keyword(s):  
Dental Implants ◽  
Dental Implant ◽  
Osteonecrosis Of The Jaw ◽  
Japanese Woman ◽  
Implant Removal ◽  
Antiresorptive Agent ◽  
Oral Bisphosphonate ◽  
Antiresorptive Agents ◽  
The Right ◽  
Implant Treatment

Dental implant treatment is a highly predictable therapy, but when potentially lethal symptoms or complications occur, dentists must remove the implant fixture. Recently, reports on antiresorptive agent-related osteonecrosis of the jaw have increased in the field of dental implants, although the relationship between dental implant treatment and antiresorptive agents remains unclear. Here, we report a case of antiresorptive agent-related osteonecrosis of the jaw that developed after dental implant removal. A 67-year-old Japanese woman with a medical history of osteoporosis and 7 years of oral bisphosphonate treatment was referred to our hospital with a chief complaint of painful right mandibular bone exposure. A family dentist removed the dental implants from the right mandible using a trephine drill without flap elevation in August 2016. However, the healing was impaired; she was referred to our hospital 3 months after the procedure. We performed a sequestrectomy of the mandible under general anesthesia. In conclusion, this patient's course has two important implications: First, the removal of dental implants from patients who are prescribed oral bisphosphonates for long durations can cause antiresorptive agent-related osteonecrosis of the jaw. Second, meticulous procedures are required to prevent and treat the development of antiresorptive agent-related osteonecrosis of the jaw after dental implant removal.

Bisphosphonate-associated osteonecrosis of the jaw (ONJ): staging and surgical therapy

2007 ◽  
Vol 36 (11) ◽  
pp. 1043
Author(s):  
M.H. Abu-Id ◽  
M.H. Abu-Id ◽  
P.H. Warnke ◽  
J. Wiltfang ◽  
T. Kreusch
Keyword(s):  
Surgical Therapy ◽  
Osteonecrosis Of The Jaw

scholarly journals Drug-induced osteonecrosis of the jaw: the state of the art

Reumatismo ◽  
2017 ◽  
Vol 69 (1) ◽  
pp. 9 ◽  
Author(s):  
A. Fassio ◽  
F. Bertoldo ◽  
L. Idolazzi ◽  
O. Viapiana ◽  
M. Rossini ◽  
...  
Keyword(s):  
Adverse Event ◽  
Oral Surgery ◽  
Absolute Risk ◽  
Rare Condition ◽  
Osteonecrosis Of The Jaw ◽  
Large Majority ◽  
Drug Induced ◽  
Antiresorptive Agents ◽  
Oncologic Patients ◽  
Antiresorptive Drugs

Osteonecrosis of the jaw (ONJ) is a rare adverse event of antiresorptive drugs such as bisphosphonates (BP) and denosumab (DMAb). The diagnosis of ONJ is considered in cases where exposed bone in the maxillofacial region does not heal within 8 weeks in a patient previously treated with an antiresorptive agent. In patients with osteoporosis, ONJ is reported as a very rare adverse event while in oncologic patients with bone metastases or malignant hypercalcemia the incidence is significantly higher (up to the 1-10% of the patients). The pathophysiology of ONJ is still not completely understood but it is multi-factorial. ONJ is a condition associated with poor oral health, oral surgery, and use of antiresorptive agents. Prevention is of paramount importance especially in cancer patients, in whom the large majority of cases of ONJ (>90%) are reported, but it should also be considered in osteoporotic patients, especially during dental surgical procedure. Some simple prevention procedures are effective in reducing the risk of its appearance. When ONJ unfortunately occurs, the large majority of patients can be managed conservatively. In conclusion, ONJ is a rare condition associated with antiresorptive drugs. Both osteoporotic and oncologic patients should be well informed about its low absolute risk and regarding the fact that the benefits of antiresorptive therapy far outweigh this potential risk of ONJ.

scholarly journals Effectiveness of surgery and hyperbaric oxygen for antiresorptive agent-related osteonecrosis of the jaw: A subgroup analysis by disease stage

PLoS ONE ◽  
2021 ◽  
Vol 16 (1) ◽  
pp. e0244859
Author(s):  
Takuma Watanabe ◽  
Keita Asai ◽  
Shizuko Fukuhara ◽  
Ryuji Uozumi ◽  
Kazuhisa Bessho
Keyword(s):  
Therapeutic Effect ◽  
Hyperbaric Oxygen ◽  
Subgroup Analysis ◽  
Multivariable Analysis ◽  
Osteonecrosis Of The Jaw ◽  
Disease Stage ◽  
Antiresorptive Agent ◽  
Antiresorptive Agents ◽  
Before And After ◽  
Extensive Surgery

Antiresorptive agent-related osteonecrosis of the jaw (ARONJ) is an adverse event induced by antiresorptive agents (ARAs). The purpose of this study was to evaluate variables, mainly surgery and hyperbaric oxygen (HBO) therapy, associated with treatment outcomes in patients with a diagnosis of ARONJ at a single center. We enrolled consecutive patients who presented to our hospital for the management of stage 2 or 3 ARONJ between January 2003 and December 2019. The relationship between potentially predictive factors and outcome variables was examined using statistical analyses, along with a subgroup analysis based on disease stage. Of 252 patients included in this study, 206 had stage 2 ARONJ and 46 had stage 3 ARONJ. There were 119 patients with osteoporosis and 133 with malignant disease. In total, 139 patients were healed, and the healing rate of patients with stage 3 ARONJ was lower than that of patients with stage 2 ARONJ. With regard to the combination of surgery and HBO therapy, most patients underwent HBO before and after surgery. In the univariable analysis, surgery showed a therapeutic effect in both stage 2 and 3 ARONJ, whereas HBO showed a therapeutic effect in stage 2 ARONJ. In the multivariable analysis for stage 2 ARONJ, extensive surgery showed a stronger association with healing than conservative surgery, whereas ≥46 sessions of HBO therapy was less associated with healing than was non-HBO therapy. Our findings suggest that extensive surgery is highly effective against ARONJ regardless of disease stage if there is a sequestrum separation and systemic tolerance, whereas HBO therapy before and after surgical approach can be effective. Further studies are needed to identify treatment strategies for patients with treatment-refractory ARONJ who may be forced to undergo long-term HBO therapy with the expectation of sequestrum separation.

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.

Osteonecrosis of the jaw: BRONJ and ARONJ

2014 ◽  
Vol 5 (2) ◽  
pp. 90-93 ◽  
Author(s):  
Salvatore Ruggiero
Keyword(s):  
Quality Of Life ◽  
Bone Resorption ◽  
Osteonecrosis Of The Jaw ◽  
Small Subset ◽  
Antiresorptive Agents ◽  
Osteoclast Function

Bisphosphonates and other more recent antiresorptive agents are potent inhibitors of osteoclast function and osteoclast-mediated bone resorption. As such, they have been effectively utilised to reduce skeletally related events and improve the quality of life of patients with osteoporosis and malignant osteolytic disease. Despite these benefits, osteonecrosis of the jaw continues to be a worrisome complication in a small subset of patients receiving these drugs.

Primary Surgical Therapy for Osteonecrosis of the Jaw Secondary to Bisphosphonate Therapy

2006 ◽  
Vol 81 (8) ◽  
pp. 1100-1103 ◽  
Author(s):  
Deepak Kademani ◽  
Sreenivas Koka ◽  
Martha Q. Lacy ◽  
S. Vincent Rajkumar
Keyword(s):  
Surgical Therapy ◽  
Osteonecrosis Of The Jaw ◽  
Bisphosphonate Therapy

scholarly journals Concentration of Penicillin G in Jawbone Affected by Antiresorptive Agent-Related Osteonecrosis Following a Single Preoperative Dose

Antibiotics ◽  
2020 ◽  
Vol 10 (1) ◽  
pp. 17
Author(s):  
Philipp Poxleitner ◽  
Michael Andreas Ermer ◽  
Rainer Trittler ◽  
Carolin Lena Feuerstein ◽  
Jörg-Elard Otten ◽  
...  
Keyword(s):  
Antibiotic Therapy ◽  
High Performance ◽  
Limit Of Detection ◽  
Cost Effective ◽  
Osteonecrosis Of The Jaw ◽  
Penicillin G ◽  
Serum Samples ◽  
Median Concentration ◽  
Antiresorptive Agent ◽  
Antiresorptive Agents

The aim of this study was to evaluate the concentration of penicillin G in bone affected by antiresorptive agent-related osteonecrosis of the jaw (ARONJ) following a single preoperative dose of 10 million international units (6000 mg). ARONJ is a major concern in patients administered antiresorptive agents for conditions associated with pathologically increased bone resorption. Antibiotic therapy is a key component of most treatment approaches for ARONJ and penicillin based regimens, providing a cost effective therapy option with a favorable side effect profile, are administered most frequently. In this study, high performance liquid chromatography with tandem mass spectrometry (HPLC-MS/MS) was applied to evaluate penicillin G concentration in serum and bone samples of 19 patients suffering from ARONJ and undergoing surgical treatment under perioperative intravenous (IV) antibiotic therapy. Penicillin G bone concentrations were above the limit of detection (0.1 μg/g bone tissue) in 16 out of 19 samples, with a median concentration of 2.7 μg/g (range 0.1–8.8 μg/g). Penicillin G concentrations in intraoperative serum samples were above the limit of detection in all serum samples, with a median concentration of 116 μg/mL (range 1–232 μg/mL). Thus, considering bacteria frequently found in ARONJ lesions, penicillin G at levels providing adequate antimicrobial activity was detected in the serum and 16 out of 19 osteonecrotic lesions of patients suffering from ARONJ.

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