Bisphosphonate-related osteonecrosis of the jaw: from the <i>sine qua non</i> condition of bone exposure to a non-exposed BRONJ entity

Koth, Valesca Sander; Figueiredo, Maria Antonia Zancanaro de; Salum, Fernanda Gonçalves; Cherubini, Karen

doi:10.1259/dmfr.20160049

Cited by 29 publications

(35 citation statements)

References 66 publications

(165 reference statements)

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“…Neither method provides a reliable benefit and patients often must undergo major mandibular resections and free tissue transfer reconstruction despite being cancer free. Furthermore, bisphosphonates may actually be harmful in the setting of mandibular inflammation leading to bisphosphonate‐related osteonecrosis of the jaw . Thus, an osteoanabolic therapy, such as the Scl‐Ab, would be ideal for mandibular ORN treatment, as well as for the treatment of Down syndrome.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, bisphosphonates may actually be harmful in the setting of mandibular inflammation leading to bisphosphonate-related osteonecrosis of the jaw. 26,29 Thus, an osteoanabolic therapy, such as the Scl-Ab, would be ideal for mandibular ORN treatment, as well as for the treatment of Down syndrome. The encouraging results of this proof of principle study motivate additional research to identify a dose that would be optimal in a clinical context.…”

Section: Discussionmentioning

confidence: 99%

“…Antiresorptive bisphosphonates are the most common therapy used to treat bone loss in the axial skeleton. However, they provide little benefit to the mandibular bone and, in some cases, can be harmful and lead to bisphosphonate‐related osteonecrosis of the jaw . A targeted osteoanabolic agent, such as Scl‐Ab, could provide a novel therapeutic option for diseases with mandibular bone insufficiency, such as mandibular ORN and Down syndrome.…”

Section: Introductionmentioning

confidence: 99%

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Treatment with anti‐Sclerostin antibody to stimulate mandibular bone formation

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Treatment with anti‐Sclerostin antibody to stimulate mandibular bone formation

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“…On radiographic analysis, whether panoramic or periapical, from a certain stage of maxillary osteonecrosis, less radiopaque areas can be observed, with some radiopaque sequestration of necrotic bone tissue and little evidence of healing [41]. The radiographic image of asymptomatic patients shows a radiopaque lesion corresponding to an empty socket [42].…”

Section: Discussionmentioning

confidence: 99%

Calcium Phosphate Ceramics Can Prevent Bisphosphonate-Related Osteonecrosis of the Jaw

et al. 2020

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Bisphosphonate-associated osteonecrosis of the jaw (BRONJ), a post-surgical non-healing wound condition, is one of the most common side effects in patients treated with nitrogen-containing bisphosphonates. Its physiopathology has been related with suppression of bone turnover, of soft tissue healing and infection. Biphasic calcium phosphates (BCP) are used as a drug delivery vehicle and as a bone substitute in surgical wounds. Due to their capacity to adsorb zoledronate, it was hypothesized these compounds might have a protective effect on the soft tissues in BRONJ wounds. To address this hypothesis, a reproducible in vivo model of BRONJ in Wistar rats was used. This model directly relates chronic bisphosphonate administration with the development of osteonecrosis of the jaw after tooth extraction. BCP granules were placed in the alveolus immediately after tooth extraction in the test group. The animals were evaluated through nuclear medicine, radiology, macroscopic observation, and histologic analysis. Encouragingly, calcium phosphate ceramics were able to limit zoledronate toxicity in vivo and to favor healing, which was evidenced by medical imaging (nuclear medicine and radiology), macroscopically, and through histology. The studied therapeutic option presented itself as a potential solution to prevent the development of maxillary osteonecrosis.

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“…Bisphosphonates are inhibitors of osteoclastic bone resorption. They are effective in treating osteoporosis and other metabolic bone diseases, and prevent skeletal events associated with metastatic neoplasms [ 1 – 5 ]. Although bisphosphonates are effective, they are also implicated in the development of medication-related osteonecrosis of the jaw (MRONJ) [ 6 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

Characteristic Multimodal Imaging of Medication- Related Osteonecrosis of the Jaw: Comparison Between Oral and Parenteral Routes of Medication Administration

et al. 2018

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SummaryBackgroundTo assess multimodal imaging features of medication-related osteonecrosis of the jaw (MRONJ) and to analyze the differences between oral and parenteral routes of medication administration. We retrospectively reviewed panoramic radiographs, CT, MRI, and bone scintigraphy of patients with MRONJ.Material/MethodsA retrospective study was conducted in 16 patients with MRONJ who underwent panoramic radiography, CT, MRI, and bone scintigraphy. Statistical analysis for the comparison between routes of medication administration and multimodal imaging features was performed with the Pearson’s χ2 test.ResultsThe percentage of cases with sequestrum separation was 25.0% (4/16 cases) on panoramic radiography and 81.3% (13/16 cases) on CT. The percentage of cases with periosteal bone proliferation on CT was 41.7% (5/12 cases) in the oral route of administration vs. 100% (4/4 cases) in the parenteral route of administration (p=0.042). The percentage of cases with spread of soft tissue inflammation to buccal and other spaces on CT and MRI was 33.3% (4/12 cases) in the oral route of administration vs. 100% (4/4 cases) in the parenteral route of administration (p=0.021).ConclusionsThe sequestrum separation on panoramic radiography in patients with MRONJ was unclear in comparison to CT. Furthermore, characteristic CT findings of patients with MRONJ in the parenteral administration group were periosteal bone proliferation and spread of soft tissue inflammation to buccal and other spaces.

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Bisphosphonate-related osteonecrosis of the jaw: from the sine qua non condition of bone exposure to a non-exposed BRONJ entity

Cited by 29 publications

References 66 publications

Treatment with anti‐Sclerostin antibody to stimulate mandibular bone formation

Treatment with anti‐Sclerostin antibody to stimulate mandibular bone formation

Calcium Phosphate Ceramics Can Prevent Bisphosphonate-Related Osteonecrosis of the Jaw

Characteristic Multimodal Imaging of Medication- Related Osteonecrosis of the Jaw: Comparison Between Oral and Parenteral Routes of Medication Administration

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