Bisphosphonate-related osteonecrosis of the jaw in randomized clinical trials

Kyrgidis, Athanassios

doi:10.1007/s10549-009-0466-2

Cited by 7 publications

(3 citation statements)

References 5 publications

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“…As acknowledged by the authors, the case report forms for these three clinical trials did not include detailed assessment of oral health and were limited to the NCI CTCAE 3.0 toxicity assessments. The limitations of assessing ONJ using data from pharmacovigilance reporting and the contrasts between pharmacovigilance data and prospective epidemiologic research have been highlighted in the recent literature [11, 12]. Rare toxicities are likely to be underreported using techniques similar to those used by Guarneri et al, given that the clinical trials analyzed were not specifically designed to address these events.…”

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confidence: 99%

Osteonecrosis of the jaw and bevacizumab therapy

Poznak

2010

Breast Cancer Res Treat

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Osteonecrosis of the jaw (ONJ) initially came to attention through case reporting. It appears to occur in 1-18% of patients with metastatic bone disease treated with bisphosphonate therapy [1,2] and is seen less frequently in patients treated with bisphosphonates for osteoporosis or Paget's Disease of Bone [3]. ONJ is seen uncommonly in patients with early stage breast cancer treated with bisphosphonates as was demonstrated in the recent metaanalysis of breast cancer adjuvant bisphosphonate studies where the incidence of ONJ was 0.24% [4]. ONJ may be uncommon, but it is clinically significant to the patient, medical, and dental communities [5]. Risk factors for developing ONJ appear to be bisphosphonate exposure, cancer and its therapies (possibly including antiangiogenesis therapies), bone invasive dental procedures, lifestyle, and behaviors [6,7]. There are many potential mechanisms of ONJ (Table 1). The etiology of ONJ is presently unknown.Osteonecrosis of the jaw appears to occur most frequently in patients cancer treated with high potency nitrogen-containing bisphosphonates [6], and many of the leading hypotheses for the mechanism behind ONJ relate to potential affects of the bisphosphonates. The main effect of bisphosphonate therapy is osteoclast inhibition, and over suppression of bone metabolism has been proposed as a mechanism involved in the development of ONJ [6]. There are evolving data demonstrating that the bisphosphonates may have additional affects including altering cell migration, invasion, adhesion, apoptosis, and synergizing with antitumor cytotoxic drugs, as well as decreasing angiogenesis [8]. The antiangiogenic effects of bisphosphonates are of particular interest in regard to ONJ due to the importance of neo-vascularization in wound healing. Dental extraction is a risk factor for ONJ, and healing after bone invasive surgeries or mucosal trauma requires revascularization. It is possible that interrupting the normal healing process increases the risk for ONJ. In line with the hypothesis that ONJ is of vascular origin is that avascular necrosis of the hip and osteoradionecrosis are both conditions of necrotic bone associated with vascular disruption [9]. Angiogenesis and ONJ have been linked by the case reports of ONJ occurring in patients treated with antitumor therapies targeting vascular endothelial growth factor. Guarneri et al. [10] provide an excellent presentation of the ONJ case reports involving patients treated with bevacizumab or sunitinib and the rationale for performing their analysis of bevacizumab in patients with locally recurrent or metastatic breast cancer (LR/MBC).Guarneri et al. investigated the databases of three clinical trials, AVADO, RIBBON-1, and ATHENA, where bevacizumab was studied in LR/MBC. Analysis was performed comparing the incidence of ONJ in patients receiving bevacizumab versus placebo and in patients with and without bisphosphonate exposure. A thorough analysis was performed of the data available; however, there are limitations to the research. As acknowle...

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Osteonecrosis of the jaw and bevacizumab therapy

Poznak

2010

Breast Cancer Res Treat

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“…100 Cautions should be exercised during rubber dam placement to prevent soft tissue injury which could increase the risk of BRONJ. [101][102][103] Infection resulting from debris extrusion through the apical foramen during root canal treatment may also lead to the development of BRONJ. 104 To reduce oral bacterial load before initiating treatment, patient may be advised to rinse their mouth with chlorhexidine for 1 min.…”

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confidence: 99%

Expert consensus on endodontic therapy for patients with systemic conditions

Xu,

Zheng,

Lin

et al. 2024

Int J Oral Sci

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The overall health condition of patients significantly affects the diagnosis, treatment, and prognosis of endodontic diseases. A systemic consideration of the patient’s overall health along with oral conditions holds the utmost importance in determining the necessity and feasibility of endodontic therapy, as well as selecting appropriate therapeutic approaches. This expert consensus is a collaborative effort by specialists from endodontics and clinical physicians across the nation based on the current clinical evidence, aiming to provide general guidance on clinical procedures, improve patient safety and enhance clinical outcomes of endodontic therapy in patients with compromised overall health.

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“… Several studies (Kyrgidis Kyrgidis Kyrgidis & Andreadis ) pointed out the possible role of soft tissue damage in the initiation of BRONJ and insist on the fact that one should try to be as cautious and atraumatic as possible when placing a rubber dam clamp. This was emphasized by Gallego et al .…”

Section: Reviewmentioning

confidence: 99%

Bisphosphonates and their clinical implications in endodontic therapy

et al. 2012

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This review gives an overview of the factors that may play a role in the development of osteonecrosis of the jaw in patients treated with bisphosphonates (BPs) and undergoing nonsurgical endodontic treatment as well as some recommendations for its prevention. BPs are a widely prescribed group of drugs for diverse bone diseases. The occasional but devastating adverse effect of these drugs has been described as bisphosphonate-related osteonecrosis of the jaw (BRONJ). As this condition is debilitating and difficult to treat, all efforts should be made to prevent its occurence in patients at risk. The main triggering event is considered to be dental extraction. Even though nonsurgical endodontic treatment appears to be a relatively safe procedure, care remains essential. After an overview of this class of drugs, the clinical presentation, epidemiology and pathogenesis of BRONJ, as well as the possible risk factors associated with its development after nonsurgical endodontic treatment will be described. Finally, several strategies will be proposed for the prevention of BRONJ during nonsurgical endodontic treatment.

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Bisphosphonate-related osteonecrosis of the jaw in randomized clinical trials

Cited by 7 publications

References 5 publications

Osteonecrosis of the jaw and bevacizumab therapy

Osteonecrosis of the jaw and bevacizumab therapy

Expert consensus on endodontic therapy for patients with systemic conditions

Bisphosphonates and their clinical implications in endodontic therapy

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