Osteonecrosis of the jaw and bisphosphonate treatment for osteoporosis

Rizzoli, René; Burlet, Nansa; Cahall, David; Delmas, Pierre D.; Eriksen, Erik Fink; Felsenberg, Dieter; Grbic, John T.; Jontell, Mats; Landesberg, Regina; Laslop, Andrea; Wollenhaupt, Martina; Papapoulos, Socrates E.; Sezer, Orhan; Sprafka, Michael; Reginster, Jean‐Yves

doi:10.1016/j.bone.2008.01.003

Cited by 197 publications

(137 citation statements)

References 50 publications

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“…Of the adverse effects of BPs, BRONJ has also been recognized in non-cancer patients affected by osteometabolic diseases [22,23,29,36,42,44,47,49], but always impacting less than expected in cancer patients. The real risk for patients in therapy with BPs for osteometabolic diseases developing BRONJ is not really known, in part due to the paucity of crucial information, such as the exact total number of patients exposed to BP, and to the precise interplay of the high number of suspected risk factors implicated (Table 5).…”

Section: Discussionmentioning

confidence: 99%

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Osteonecrosis of the jaws in patients assuming oral bisphosphonates for osteoporosis: A retrospective multi-hospital-based study of 87 Italian cases

Fede

Fusco

Matranga

et al. 2013

European Journal of Internal Medicine

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Section: Discussionmentioning

confidence: 99%

“…The estimated prevalence of BRONJ in non-cancer (mainly osteoporotic) patients may range from 0.02% to 11% [22][23][24]29,33,36,42,44,47,49].…”

Section: European Journal Of Internal Medicine 24 (2013) 784-790mentioning

confidence: 99%

Osteonecrosis of the jaws in patients assuming oral bisphosphonates for osteoporosis: A retrospective multi-hospital-based study of 87 Italian cases

Fede

Fusco

Matranga

et al. 2013

European Journal of Internal Medicine

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“…As there is currently no consensus on its underlying mechanism, ONJ task forces have called for more clinical and basic research [3,7,19,20]. The aim of the present study was to examine clinical and histopathological features of patients with ONJ in an attempt to better understand the pathogenesis of this disorder.…”

Section: Introductionmentioning

confidence: 99%

“…High repeated doses of NBPs administered intravenously to cancer patients, are most frequently associated with ONJ [4][5][6]. In contrast, patients receiving oral NBPs for osteoporosis are less prone to ONJ [7].…”

Section: Introductionmentioning

confidence: 99%

Bisphosphonate-associated osteonecrosis of the jaw: A key role of inflammation?

Lesclous

Najm

Carrel

et al. 2009

Bone

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194

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Osteonecrosis of the jaw (ONJ) can be associated with nitrogen-containing bisphosphonates (NBPs) therapy. Various mechanisms of NBP-associated ONJ have been proposed and there is currently no consensus of the underlying pathogenesis. The detailed medical and dental histories of 30 ONJ patients treated with NBPs for malignant diseases (24) or osteoporosis (6) were analyzed. The necrotic bone was resected and analyzed histologically after demineralization. In 10 patients the perinecrotic bone was also resected and processed without demineralization. Alveolar bone samples from 5 healthy patients were used as controls. In 14 ONJ patients, serial technetium-99m-methylene diphosphonate scintigraphic scans were also available and confronted to the other data. Strong radionuclide uptake was detected in some patients several months before clinical diagnosis of ONJ. The medullary spaces of the necrotic bone were filled with bacterial aggregates. In the perinecrotic bone, the bacteria-free bone marrow characteristically showed an inflammatory reaction. The number of medullary inflammatory cells taken as an index of inflammation allowed us to discriminate two inflammation grades in the ONJ samples. Low-grade inflammation, characterized by marrow fibrosis and low inflammatory cells infiltration, increased numbers of TRAP + monoand multineacleated cells was seen in patients with bone exposure b 2 cm 2 . High-grade inflammation, associated with larger lesions, showed amounts of tartrate-resistant acid phosphatase + /calcitonin receptor − mono-and multinucleated cells, osteocyte apoptosis, hypervascularization and high inflammatory cell infiltration. The clinical extent of ONJ was statistically linked to the numbers of inflammatory cell. Taken together these data suggest that bone necrosis precedes clinical onset and is an inflammation-associated process. We hypothesize that from an initial focus, bone damage spreads centrifugally, both deeper into the jaw and towards the mucosa before the oral bone exposure and the clinical diagnosis of ONJ.

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“…Furthermore, the underlying risk of developing ONJ may be increased in osteoporotic patients by comorbid diseases. 50 Owing to the reported incidence of rhabdomyolysis, defined as the combination of muscle pain and creatine kinase (CK) elevation 10 times the upper limit of normal, associated with statin therapy and following the publication of the CK monitoring recommendations, 51 an exploratory study was conducted to characterise the CK profile in postmenopausal women treated with ibandronate [Data on file, previously unpublished]. This study included healthy volunteers (n = 260) and assessed the levels of CK during 12 weeks of treatment with monthly oral ibandronate (150 mg), weekly risedronate (35 mg; control group) and monthly placebo.…”

Section: Safetymentioning

confidence: 99%

Ibandronate in the Management of Postmenopausal Osteoporosis

Reginster

Hiligsmann

Rabenda

et al. 2009

Clinical Medicine. Therapeutics

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Oral daily and weekly bisphosphonates were considered, for several years, as the mainstay for the treatment of postmenopausal osteoporosis. However, the inconvenience of frequent dosing is known to negatively affect adherence to therapy in the long-term, hence outcomes. This has prompted the development of convenient oral bisphosphonate regimens that feature simple, less frequent dosing schedules. Ibandronate is a potent, nitrogen-containing bisphosphonate which, uniquely, can be administered either orally, monthly, or as an intravenous injection, every 3 months. A positive impact for adherence has been observed with a reduction in the bisphosphonate dosing frequency. Anti-fracture efficacy of the various currently available regimens of ibandronate is documented in randomized controlled clinical trials, non-inferiority studies, meta-analyses and real-life settings studies. The present paper summarizes the pharmacology, efficacy and tolerability of oral and intravenous ibandronate, when administered with extended dosing intervals, in postmenopausal osteoporosis.

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Osteonecrosis of the jaw and bisphosphonate treatment for osteoporosis

Cited by 197 publications

References 50 publications

Osteonecrosis of the jaws in patients assuming oral bisphosphonates for osteoporosis: A retrospective multi-hospital-based study of 87 Italian cases

Osteonecrosis of the jaws in patients assuming oral bisphosphonates for osteoporosis: A retrospective multi-hospital-based study of 87 Italian cases

Bisphosphonate-associated osteonecrosis of the jaw: A key role of inflammation?

Ibandronate in the Management of Postmenopausal Osteoporosis

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