Relevance of surgical management of patients affected by bisphosphonate-associated osteonecrosis of the jaws. A prospective clinical and radiological study

Lesclous, Philippe; Grabar, Sophie; Najm, Semaan Abi; Carrel, Jean-Pierre; Lombardi, Tommaso; Saffar, Jean‐Louis; Samson, Jacky

doi:10.1007/s00784-013-0979-2

Cited by 24 publications

(24 citation statements)

References 33 publications

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“…Based on these findings and considering life expectancy of osteoporotic patients, surgical therapy should be the first choice for all MRONJ stages with the aim of complete healing. In addition, better outcomes are achieved compared to cancer patients 31,32 . Some authors reported relatively good effect of the conservative therapy of MRONJ in osteoporotic patients, but particularly early stages were included 33 .…”

Section: Discussionmentioning

confidence: 99%

Surgical therapy for medication-related osteonecrosis of the jaw in osteoporotic patients treated with antiresorptive agents

Hauer

Jambura

Hrušák

et al. 2020

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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Background. Medication -related osteonecrosis of the jaw (MRONJ) is a rare but serious complication of antiresorptive and/or antiangiogenic therapy. It mainly affects oncological patients, however, it can occur in patients with metabolic bone diseases, although this is less frequent. These lesions not only significantly impair the quality of life but can also have impact on the treatment of any underlying disease. In some rare cases MRONJ can be life-threatening. There is still no ideal consensus for treatment, though surgical therapy has been mostly preferred in recent years. Materials and Methods. A monocentric retrospective evaluation of surgical therapy of MRONJ in osteoporotic patients, treated in the time period 3/2014-3/2018 using the uniform department-specific protocol. Results. 26 osteoporotic patients with 32 MRONJ lesions of stage 1 (9%), stage 2 (75%) and stage 3 (16%) were treated surgically. The maxilla: mandibula ratio was 1:2.2, in 19% of patients there was multiple jaw involvement. 69.2% of patients had received bisphosphonates, 15.4% denosumab and 15.4% had a history of both types of antiresorptive treatment. Complete healing was observed in all patients, in 9% of cases by secondary intention in the mean period of 6 weeks. The mean follow-up was 20.5 months. Conclusion. The presented protocol for surgical therapy was effective in the management of all MRONJ stages in the osteoporotic patients described here. The surgery is indicated as an early treatment to prevent complications and the progression of the lesions. It leads to improvement in quality of life and option to resume antiresorptive therapy if interrupted.

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Section: Discussionmentioning

confidence: 99%

Surgical therapy for medication-related osteonecrosis of the jaw in osteoporotic patients treated with antiresorptive agents

Hauer

Jambura

Hrušák

et al. 2020

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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“…Il n'existe cependant aucun consensus international. Toutefois, plusieurs articles récents montrent des taux plus élevés de « guérison » des ostéonécroses après traitement chirurgical qu'après traitement conservateur, même dans les stades précoces de déve-loppement pour lesquels les thérapeutiques interventionnistes ont été longtemps déconseillées [19][20][21][22]. Certains auteurs évoquent des traitements complémentaires comme l'oxygéno-thérapie hyperbare [23] mais son efficacité n'est pas prouvée.…”

Section: Discussionunclassified

Ostéonécrose des maxillaires : quand l’ancien traitement avec bisphosphonates est méconnu

Renoux

Folliguet

Nguyen

et al. 2014

Med Buccale Chir Buccale

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Résumé -Introduction :La personne âgée est atteinte de polypathologies et polymédiquée. Les prescriptions sont faites par plusieurs médecins qui s'ignorent réciproquement, ce qui augmente le risque d'effets adverses. Observation : Le cas d'une patiente de 91 ans vivant dans un établissement d'hébergement pour personnes âgées dépendantes est rapporté. Quatre mois après une perfusion de zolédronate suite à une chute avec tassement vertébral, elle a consulté pour une gêne maxillaire gauche, ce qui a permis de découvrir un foyer d'ostéonécrose spontanée maxillaire. Un deuxième foyer d'ostéonécrose, mandibulaire, a été diagnostiqué trois semaines plus tard. Considérant l'âge de la patiente et l'absence de troubles fonctionnels, seul un débridement chirurgical superficiel a été réalisé. Discussion : L'apparition d'ostéonécroses spontanées bimaxillaires quatre mois après une perfusion unique de zolédronate étant peu probable, la recherche approfondie des antécédents de la patiente a permis de retrouver une prise de trois bisphosphonates oraux pendant sept ans sans aucun examen et suivi bucco-dentaire. L'interrogatoire médical des patients âgés atteints de troubles cognitifs étant difficile, la recherche de tous les médecins prescripteurs est nécessaire. Conclusion : La prise en charge de l'ostéonécrose associée aux bisphosphonates étant complexe, le chirurgien-dentiste joue un rôle important dans la prévention de cette pathologie.Abstract -Osteonecrosis of the jaws: when past bisphosphonates therapy is unknown. Introduction: Older people have multiple morbidities and are polymedicated. The medicines are prescribed by several doctors who are unaware of each other, hence the increased risk of adverse effects. Observation: We report the case of an institutionalized 91-year-old female patient. Following a fall resulting in a vertebral compression fracture, she received an infusion of zoledronic acid. Four months after this treatment, she consulted for left maxillary discomfort. A voluminous bone sequestrum revealed a maxillary osteonecrosis area. Right mandibular osteonecrosis was diagnosed three weeks later. Considering the patient's age and the lack of functional impairment, surgical debridement was the only procedure performed. Discussion: The emergence of spontaneous maxillary osteonecrosis four months after a single infusion of bisphosphonate being implausible, we searched her medical records for the physicians who treated the patient before her institutionalization. We found three oral bisphosphonate medications during seven years. No oral examination was performed during this therapy. The diagnosis of jaw osteonecrosis should lead the oral surgeon to look for past bisphosphonate therapy among other possible etiologies of this pathology. Indeed, this treatment is often forgotten by patients suffering from cognitive impairment. Conclusion: As the management of bisphosphonate-related osteonecrosis of the jaws is difficult, the oral surgeon has an important role in the prevention of this pathology. Mots clés :bisphospho...

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“…When required, surgical therapy consists of a surgical debridement and/or resection covered by a full-thickness mucoperiosteal flap. Indeed, surgery provides pain control and infection control, relieves soft tissue irritations, and decreases osteolysis [ 7 , 66 ]. Beside these approaches, several treatments have been developed and used to treat MRONJ: Teriparatide : as we previously mentioned, Teriparatide is a recombinant human parathyroid hormone, which has stimulatory effects on osteoblasts and osteoclasts and leads to an increase in bone turnover and bone formation, as an osteoanabolic agent [ 67 ].…”

Section: Recent Advances In Mronj Treatmentsmentioning

confidence: 99%

Medication‐Related Osteonecrosis of the Jaw: New Insights into Molecular Mechanisms and Cellular Therapeutic Approaches

Lombard

Neirinckx

Rogister

et al. 2016

Stem Cells International

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In recent years, medication-related osteonecrosis of the jaw (MRONJ) became an arising disease due to the important antiresorptive drug prescriptions to treat oncologic and osteoporotic patients, as well as the use of new antiangiogenic drugs such as VEGF antagonist. So far, MRONJ physiopathogenesis still remains unclear. Aiming to better understand MRONJ physiopathology, the first objective of this review would be to highlight major molecular mechanisms that are known to be involved in bone formation and remodeling. Recent development in MRONJ pharmacological treatments showed good results; however, those treatments are not curative and could have major side effects. In parallel to pharmacological treatments, MSC grafts appeared to be beneficial in the treatment of MRONJ, in multiple aspects: (1) recruitment and stimulation of local or regional endogenous cells to differentiate into osteoblasts and thus bone formation, (2) beneficial impact on bone remodeling, and (3) immune-modulatory properties that decrease inflammation. In this context, the second objective of this manuscript would be to summarize the molecular regulatory events controlling osteogenic differentiation, bone remodeling, and osteoimmunology and potential beneficial effects of MSC related to those aspects, in order to apprehend MRONJ and to develop new therapeutic approaches.

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Relevance of surgical management of patients affected by bisphosphonate-associated osteonecrosis of the jaws. A prospective clinical and radiological study

Abstract: These results deserve further investigations involving a larger cohort. However, they strongly suggest that the guidelines of management of patients with ONJ related to NBPs have to be reconsidered.

Cited by 24 publications

References 33 publications

Surgical therapy for medication-related osteonecrosis of the jaw in osteoporotic patients treated with antiresorptive agents

Surgical therapy for medication-related osteonecrosis of the jaw in osteoporotic patients treated with antiresorptive agents

Ostéonécrose des maxillaires : quand l’ancien traitement avec bisphosphonates est méconnu

Medication‐Related Osteonecrosis of the Jaw: New Insights into Molecular Mechanisms and Cellular Therapeutic Approaches

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