A study of 225 patients on bisphosphonates presenting to the bisphosphonate clinic at King's College Hospital

Taylor, T.; Bryant, Cathy; Popat, S.

doi:10.1038/sj.bdj.2013.327

Cited by 27 publications

(41 citation statements)

References 18 publications

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“…This was because the previous research presumably involved a wider pool of patients than the current study, which was limited to patients who underwent tooth extraction. In the study of Taylor et al18 in which methods similar to those used in the current study were utilized, 5 (2.5%) out of 202 patients developed BRONJ, showing comparable results. A retrospective study by Sedghizadeh et al19 of 66 patients who were taking alendronate and had undergone extraction reported a higher incidence (6%) of BRONJ development than was found in our study.…”

Section: Discussionsupporting

confidence: 52%

“…Taylor et al18 demonstrated that male patients were significantly more likely to develop BRONJ after tooth extraction than females, but this difference in outcome might have been caused by the intravenous administration of bisphosphonates in 6 of the 7 BRONJ patients suffering from malignant tumors.…”

Section: Discussionmentioning

confidence: 99%

“…The groups were divided at 65 years, as was done in a previous study by Taylor et al,18 in which there was no statistically significant difference according to age; however, the inclusion of patients with malignancies makes a direct comparison with the current study inappropriate. As all 11 patients with BRONJ in this study were over the age of 65 years, age can be considered a significant factor affecting the incidence of BRONJ.…”

Section: Discussionmentioning

confidence: 99%

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Risk factors of osteonecrosis of the jaw after tooth extraction in osteoporotic patients on oral bisphosphonates

et al. 2017

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PurposeThe aim of this study was to investigate the incidence of bisphosphonate-related osteonecrosis of the jaw (BRONJ) after tooth extraction in patients with osteoporosis on oral bisphosphonates in Korea and to evaluate local factors affecting the development of BRONJ.Materials and MethodsThe clinical records of 320 patients who underwent dental extraction while receiving oral bisphosphonates were reviewed. All patients had a healing period of more than 6 months following the extractions. Each patient's clinical record was used to assess the incidence of BRONJ; if BRONJ occurred, a further radiographic investigation was carried out to obtain a more definitive diagnosis. Various local factors including age, gender, extraction site, drug type, duration of administration, and C-terminal telopeptide (CTx) level were retrieved from the patients' clinical records for evaluating their effect on the incidence of BRONJ.ResultsAmong the 320 osteoporotic patients who underwent tooth extraction, 11 developed BRONJ, reflecting an incidence rate of 3.44%. Out of the local factors that may affect the incidence of BRONJ, gender, drug type, and CTx level showed no statistically significant effects, while statistically significant associations were found for age, extraction site, and duration of administration. The incidence of BRONJ increased with age, was greater in the mandible than the maxilla, and was associated with a duration of administration of more than 3 years.ConclusionTooth extraction in patients on oral bisphosphonates requires careful consideration of their age, the extraction site, and the duration of administration, and close postoperative follow-up should be carried out to facilitate effective early management.

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Section: Discussionsupporting

confidence: 52%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Risk factors of osteonecrosis of the jaw after tooth extraction in osteoporotic patients on oral bisphosphonates

et al. 2017

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“…The prevalence of ONJ in patients prescribed oral BPs for the treatment of osteoporosis ranges from 0% to 0.04%, with the majority being below 0.001% . The prevalence of ONJ in those prescribed high dose intravenous (i.v.)…”

Section: Resultsmentioning

confidence: 99%

“…The prevalence of ONJ in patients prescribed oral BPs for the treatment of osteoporosis ranges from 0% to 0.04%, with the majority being below 0.001%. (47)(48)(49)(50)(51)(52)(53)(54)(55)(56)(57) The prevalence of ONJ in those prescribed high dose intravenous (i.v.) BPs is significantly higher than that seen with low dose i.v.…”

Section: Prevalencementioning

confidence: 99%

Diagnosis and Management of Osteonecrosis of the Jaw: A Systematic Review and International Consensus

Khan

Morrison

Hanley

et al. 2014

Journal of Bone and Mineral Research

1,099

1,033

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This work provides a systematic review of the literature from January 2003 to April 2014 pertaining to the incidence, pathophysiology, diagnosis, and treatment of osteonecrosis of the jaw (ONJ), and offers recommendations for its management based on multidisciplinary international consensus. ONJ is associated with oncology-dose parenteral antiresorptive therapy of bisphosphonates (BP) and denosumab (Dmab). The incidence of ONJ is greatest in the oncology patient population (1% to 15%), where high doses of these medications are used at frequent intervals. In the osteoporosis patient population, the incidence of ONJ is estimated at 0.001% to 0.01%, marginally higher than the incidence in the general population (<0.001%). New insights into the pathophysiology of ONJ include antiresorptive effects of BPs and Dmab, effects of BPs on gamma delta T-cells and on monocyte and macrophage function, as well as the role of local bacterial infection, inflammation, and necrosis. Advances in imaging include the use of cone beam computerized tomography assessing cortical and cancellous architecture with lower radiation exposure, magnetic resonance imaging, bone scanning, and positron emission tomography, although plain films often suffice. Other risk factors for ONJ include glucocorticoid use, maxillary or mandibular bone surgery, poor oral hygiene, chronic inflammation, diabetes mellitus, illfitting dentures, as well as other drugs, including antiangiogenic agents. Prevention strategies for ONJ include elimination or stabilization of oral disease prior to initiation of antiresorptive agents, as well as maintenance of good oral hygiene. In those patients at high risk for the development of ONJ, including cancer patients receiving high-dose BP or Dmab therapy, consideration should be given to withholding antiresorptive therapy following extensive oral surgery until the surgical site heals with mature mucosal coverage. Management of ONJ is based on the stage of the disease, size of the lesions, and the presence of contributing drug therapy and comorbidity. Conservative therapy includes topical antibiotic oral rinses and systemic antibiotic therapy. Localized surgical debridement is indicated in advanced nonresponsive disease and has been successful. Early data have suggested enhanced osseous wound healing with teriparatide in those without contraindications for its use. Experimental therapy includes bone marrow stem cell intralesional transplantation, low-level laser therapy, local platelet-derived growth factor application, hyperbaric oxygen, and tissue grafting.

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Concurrent Oral Squamous Cell Carcinoma and Bisphosphonate‐Related Osteonecrosis of the Maxilla: A Case Report and Literature Review

Yoon,

Ramirez,

Yun

et al. 2024

Head & Neck

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IntroductionBisphosphonates (BPs) are widely used for osteoporosis and cancer‐induced bone diseases due to their antiresorptive properties, yet they pose risks such as medication‐related osteonecrosis of the jaw (MRONJ).MethodsWe present a unique case of concurrent oral squamous cell carcinoma (SCC) and MRONJ in a 72‐year‐old female chronically treated with oral ibandronate for osteoporosis. Following a dental extraction, she developed a nonhealing wound in the maxilla. Following conservative treatment, the patient underwent a maxillectomy and extensive tissue reconstructions to control her infection and address suspicions of an underlying malignancy.ResultsHistopathological examinations confirmed simultaneous osteonecrosis and well‐differentiated SCC in the maxillary sinus and surrounding tissues. Despite multiple surgeries, the patient's disease progressed rapidly. Upon examining the literature for patients with a history of BP use diagnosed with MRONJ and/or SCC, a total of 16 cases report a diagnostic dilemma between MRONJ and locoregional SCC. Three of the 16 cases report a final diagnosis of concurrent MRONJ and SCC. This report is the fourth reported case of concurrency to date.ConclusionsThe patient's complex clinical course underscores the diagnostic challenges and therapeutic dilemmas in managing concurrent MRONJ and SCC, highlighting the need for vigilant monitoring and interdisciplinary collaboration in similar cases.

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A study of 225 patients on bisphosphonates presenting to the bisphosphonate clinic at King's College Hospital

Abstract: In our patient cohort the risk of developing a BRONJ following dental extractions was greatest in those patients receiving IV BPs and those on oral BPs with concomitant steroid medication.

Cited by 27 publications

References 18 publications

Risk factors of osteonecrosis of the jaw after tooth extraction in osteoporotic patients on oral bisphosphonates

Risk factors of osteonecrosis of the jaw after tooth extraction in osteoporotic patients on oral bisphosphonates

Diagnosis and Management of Osteonecrosis of the Jaw: A Systematic Review and International Consensus

Concurrent Oral Squamous Cell Carcinoma and Bisphosphonate‐Related Osteonecrosis of the Maxilla: A Case Report and Literature Review

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