Suspected bisphosphate‐related osteonecrosis of the jaw in a cat being treated with alendronate for idiopathic hypercalcaemia

Rogers-Smith, Emma; Whitley, Nat; Elwood, Clive; Reese, David F.; Wong, Paula

doi:10.1136/vetreccr-2018-000798

Cited by 7 publications

(8 citation statements)

References 19 publications

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“…This condition has also been reported in several animal models, including sheep [63,64], mini-pigs [65], and dogs [66]. Recently, clinical reports showed symptoms compatible with ONJ in cats treated with long-term BPs for idiopathic hypercalcemia [67,68]. An additional serious adverse side effect, AFF, accounts for 1.1% of all femur fracture cases in humans [69].…”

Section: Bisphosphonates' Side Effects: Humans and Animalsmentioning

confidence: 79%

Is the Use of Bisphosphonates Putting Horses at Risk? An Osteoclast Perspective

Vergara-Hernandez

Nielsen

Colbath

2022

Animals

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Osteoclasts are unique and vital bone cells involved in bone turnover. These cells are active throughout the individual’s life and play an intricate role in growth and remodeling. However, extra-label bisphosphonate use may impair osteoclast function, which could result in skeletal microdamage and impaired healing without commonly associated pain, affecting bone remodeling, fracture healing, and growth. These effects could be heightened when administered to growing and exercising animals. Bisphosphonates (BPs) are unevenly distributed in the skeleton; blood supply and bone turnover rate determine BPs uptake in bone. Currently, there is a critical gap in scientific knowledge surrounding the biological impacts of BP use in exercising animals under two years old. This may have significant welfare ramifications for growing and exercising equids. Therefore, future research should investigate the effects of these drugs on skeletally immature horses.

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Section: Bisphosphonates' Side Effects: Humans and Animalsmentioning

confidence: 79%

Is the Use of Bisphosphonates Putting Horses at Risk? An Osteoclast Perspective

Vergara-Hernandez

Nielsen

Colbath

2022

Animals

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“…27,28 The long-term use of oral alendronate has been associated with osteo necrosis of the jaw and increased cortical bone thickness leading to pathological fractures. [29][30][31][32] The long-term use of glucocorticoids can contribute to adverse effects ratio >1.0:1 to reduce the risk of nutritional hyperparathyroidism. Adverse renal effects have been observed in studies where cats were fed high-phosphate diets with Ca:P ratios of <1.0:1.…”

Section: Discussionmentioning

confidence: 99%

“… 27 , 28 The long-term use of oral alendronate has been associated with osteonecrosis of the jaw and increased cortical bone thickness leading to pathological fractures. 29 – 32 The long-term use of glucocorticoids can contribute to adverse effects on bone health and may also increase the risk of the development of diabetes mellitus secondary to insulin antagonism. 33 , 34 …”

Section: Discussionmentioning

confidence: 99%

Ionized hypercalcemia can resolve with nutritional modification in cats with idiopathic hypercalcemia or chronic kidney disease

Ehrlich,

Rudinsky,

Chew

et al. 2024

Journal of Feline Medicine and Surgery

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Case series summary Cats with ionized hypercalcemia that were fed diets with either more than 200 mg calcium per 100 kilocalories (kcal), a calcium:phosphorus (Ca:P) ratio greater than 1.4:1 or both, based on diet history, were included in this case series. Ionized hypercalcemia was documented at least twice in all cats before enrollment. Cats were referred for evaluation of ionized hypercalcemia (n = 5) or were incidentally found to have ionized hypercalcemia (n = 5). After medical workups, cats were diagnosed with either idiopathic hypercalcemia (IHC; n = 7) or chronic kidney disease (n = 3). Cats receiving medications to treat IHC (eg, alendronate, corticosteroids) were excluded. Nutritional recommendations were made to transition the cats to diets with less thn 200 mg calcium per 100 kcal and a Ca:P ratio less than 1.4:1. Ionized calcium (iCa) concentrations were rechecked in all cats, with a median recheck time of 9 weeks (range 3–20). Of the 10 cats, nine (90%) had a decrease in iCa. Of the 10 cats, six (60%) became normocalcemic after the diet change, three (30%) had a partial response and one (10%) did not respond. Of the four cats that did not achieve normocalcemia with a change in diet, two (50%) received chia seeds (1–2 g per day), and at the next recheck, both cats’ iCa concentrations had normalized. Three cats had a long-term follow-up. Ionized normocalcemia was maintained for at least two consecutive follow-up visits over a median follow-up period of 33 weeks (range 12–34). Relevance and novel information Dietary calcium concentrations and the dietary Ca:P ratio appear to be important variables in considering nutritional approaches for hypercalcemic cats.

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“…However, the long-termuse of BP therapy has been associated with bilateral atypical patellar fractures in one cat 7 and jaw osteonecrosis. 9,39 This case report describes atypical fractures sustained in the absence of trauma in a cat prescribed alendronate for the control of IHC. This is only the second reported case of BP-associated fracture in a cat and the first where surgical stabilization and long-term follow-up are reported.…”

Section: Introductionmentioning

confidence: 99%

Management of insufficiency fractures associated with long-term bisphosphonate therapy in a cat

Meneghetti

Perry

2023

Journal of Feline Medicine and Surgery Open Reports

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Case summary A 10-year-old spayed female domestic medium hair cat presented after sustaining atraumatic insufficiency fractures of the right calcaneus and the left tibia approximately 6 weeks apart. Chronic alendronate therapy had been ongoing for 9 years for the management of previously diagnosed idiopathic hypercalcemia. The right calcaneal fracture was managed non-operatively due to minimal functional impairment. The left tibial fracture was managed via open reduction and internal fixation with orthogonal plating. Alendronate therapy was discontinued at the time of the fracture repair with prednisolone being used to manage the hypercalcemia. Despite rapid clinical improvement, the tibial fracture had a protracted healing course, with clinical union only being achieved 22 weeks postoperatively. At 17 months postoperatively, the idiopathic hypercalcemia remained well controlled. Gait assessment, orthopedic examination and orthogonal radiographs performed at this time revealed resolution of left pelvic limb lameness, a normal orthopedic examination of the left pelvic limb and no evidence of implant-associated complications. Monitoring is ongoing but at the time of publication, no further fractures have occurred. Relevance and novel information As reported in humans, this case report gathers evidence of associations between bisphosphonate treatment and the occurrence of insufficiency fractures in cats, and provides evidence that stress reactions may precede their development. If bisphosphonate therapy is utilized in the long term, serial radiographic monitoring for signs of impending fracture may be warranted. Fracture repair can be successful in cats that have received long-term bisphosphonate therapy, but delayed healing should be anticipated and implant choices made accordingly.

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Suspected bisphosphate‐related osteonecrosis of the jaw in a cat being treated with alendronate for idiopathic hypercalcaemia

Cited by 7 publications

References 19 publications

Is the Use of Bisphosphonates Putting Horses at Risk? An Osteoclast Perspective

Is the Use of Bisphosphonates Putting Horses at Risk? An Osteoclast Perspective

Ionized hypercalcemia can resolve with nutritional modification in cats with idiopathic hypercalcemia or chronic kidney disease

Management of insufficiency fractures associated with long-term bisphosphonate therapy in a cat

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