Bisphosphonate-induced osteonecrosis of the jaw in patients with bone metastatic, hormone-sensitive prostate cancer. Risk factors and prevention strategies

Bantis, Athanasios; Zissimopoulos, Athanasios; Sountoulides, Petros; Kalaitzis, Christos; Giannakopoulos, Stelios; Deftereos, Savas; Tsakaldimis, Giorgos; Thomaidis, Vasilios; Touloupidis, Stavros

doi:10.1177/030089161109700411

Cited by 10 publications

(7 citation statements)

References 25 publications

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“…There is considerable variability in the reported incidence and prevalence of ONJ occurrence in association with monthly administration of i.v. BPs …”

Section: Resultsmentioning

confidence: 99%

“…The incidence of ONJ in the oncology patient population may be affected by the type of malignancy being treated . Confounding variables also include the use of other drugs that may also impact bone health, such as glucocorticoids, or antiangiogenic drugs, such as bevacizumab.…”

Section: Resultsmentioning

confidence: 99%

“…Recommendations to reduce the risk of ONJ include completion of necessary oral surgery prior to initiation of antiresorptive therapy, the use of antibiotics before and/or after the procedure, antimicrobial mouth rinsing, appropriate closure of the wound following tooth extraction, and maintenance of good oral hygiene …”

Section: Resultsmentioning

confidence: 99%

“…(26,28,29,65,83,85,99,103,(105)(106)(107)109,113,119,122,125,132,139,150,(154)(155)(156)(157)(158)(159)(160)(161) The incidence of ONJ in the oncology patient population may be affected by the type of malignancy being treated. (28,65,85,99,107,119,132,150,(154)(155)(156)159,162) Confounding variables also include the use of other drugs that may also impact bone health, such as glucocorticoids, or antiangiogenic drugs, such as bevacizumab. Christodoulou and colleagues (113) retrospectively evaluated the incidence of ONJ among 116 patients receiving i.v.…”

Section: Incidencementioning

confidence: 99%

“…Recommendations to reduce the risk of ONJ include completion of necessary oral surgery prior to initiation of antiresorptive therapy, (154,219,238,239) the use of antibiotics before and/or after the procedure, (22,25,(239)(240)(241)(242) antimicrobial mouth rinsing, (22,25,241) appropriate closure of the wound following tooth extraction, (240)(241)(242) and maintenance of good oral hygiene. (103,238,240,241,243,244) The etiology of ONJ continues to be further investigated.…”

Section: Can Onj Be Prevented and What Is The Role Of Drug Interruption?mentioning

confidence: 99%

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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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“…There is considerable variability in the reported incidence and prevalence of ONJ occurrence in association with monthly administration of i.v. BPs …”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%