Factors Associated with Osteonecrosis of the Jaw among Bisphosphonate Users

Background: Bisphosphonates are widely used for the treatment of bone diseases. Bisphosphonate-associated osteomyelitis of the jaw (BAOMJ) affects 1 per 100,000 patients-treated years for non-cancer bone diseases and ∼ 1 – 2% of cancer patients treated with bisphosphonates. Results: The mechanism of sustaining osteonecrosis of the jaw (ONJ) is unclear, but several predisposing factors have been identified. The dosage, frequency of administration and the duration of bisphosphonate therapy may precipitate BAOMJ. Conclusion: Evidence supports immune and infectious etiology for BAOMJ. Hence, the term BAOMJ seems more appropriate than ONJ or BAON (bisphosphonate-associated ONJ). Bisphosphonates are the mainstay of therapy for osteoporosis. Cancer patients receive 10 – 15 times higher doses of bisphosphonates at a greater frequency per year than osteoporosis patients. This may trigger BAOMJ in such patients. The benefits of bisphosphonate therapy outweigh the incidence and risks of BAOMJ. Bisphosphonates show a...

Insight into bisphosphonate-associated osteomyelitis of the jaw: pathophysiology, mechanisms and clinical management.

Bisphosphonate-induced avascular osteonecrosis of the mandible associated with a common thrombophilic mutation in the prothrombin gene.

The aim of this study was to describe bisphosphonate-related osteonecrosis of the jaw (BRONJ) in the French national pharmacovigilance database. BRONJ was identified with the standardized MedDRA query (SMQ) 'osteonecrosis' among all data from 1985 to 31 December 2014. Because this SMQ was not specific to the jaw localization, selection of cases based on anatomy was performed after data extraction. For each case, demographic and medical information was analysed, as well as data about notification (year of notification, year of occurrence, outcome, seriousness). Known associated factors for BRONJ were also documented: dentoalveolar surgery, glucocorticoids, chemotherapy, anti-angiogenics, denosumab. Among 1404 SMQ notifications, 663 were located in the jaws and 629 were associated with bisphosphonate use. BRONJ reported in the database mainly affected women (n = 443, 71%) with an oncological indication (n = 440, 70%). BRONJ was considered as serious in 91%. Outcome was unfavourable for 92% of cases. Associated factors were identified for 70% of the patients. A peak of notification was noted in 2014 (13% of all cases), but on analysis by year of occurrence instead of by year of notification, this peak disappeared. SMQ 'osteonecrosis' appears to be an adequate tool to analyse BRONJ in a pharmacovigilance database.

Bisphosphonate-related osteonecrosis of the jaw: data from the French national pharmacovigilance database.

L'elevation de l'esperance de vie, et donc des pathologies qui y sont liees, a contribue a accroitre l'utilisation des biphosphonates De par leur action anti-osteoclastique, les biphosphonates font desormais partie des medicaments couramment utilises dans les affections touchant le remodelage osseux, qu'elles soient benignes comme l'osteoporose, ou malignes dans les cas de metastases osseuses ou de myelome multiple Ce moyen therapeutique, maintenant bien connu, l'est aussi pour ses complications, notamment au niveau de la sphere buccale avec l'osteonecrose des maxillaires Cette etude a pour but de mieux connaitre et comprendre la composition, l'action et la necessite de ces medicaments de plus en plus pousses sur le devant de la scene medicale, mais aussi d'analyser et d'anticiper leurs repercussions dans notre domaine de la chirurgie dentaire Apres un rappel sur le remodelage osseux et les biphosphonates, ce travail porte sur leurs effets secondaires, en particulier l'osteonecrose, ainsi que sur la prise en charge therapeutique et chirurgicale des patients touches par cette complication L'implantologie, discipline courante de la chirurgie dentaire, est en rapport etroit avec le milieu osseux Cette etude s'interesse egalement a la possibilite d'envisager cette therapeutique chez des patients traites par bisphosphonates, tout en minimisant le risque d'apparition d'osteonecrose

https://dumas.ccsd.cnrs.fr/dumas-00943562/document

Les patients sous biphosphonates : conduites à tenir en chirurgie buccale

Resume Les osteonecroses de la mâchoire associees aux biphosphonates sont decrites comme des necroses avasculaires. Nous avons realise une synthese bibliographique des cas d’osteonecroses des maxillaires associees aux biphosphonates : 184 cas sont decrits. Plusieurs mecanismes d’action dans la survenue des osteonecroses sont discutes : une modification de l’homeostasie osseuse, une accumulation de microlesions osseuses ou un effet antiangiogenique. D’autres facteurs pourraient favoriser la survenue de ces necroses : cancer, chimiotherapie, corticotherapie, infection et insuffisance renale.

Les ostéonécroses de la mâchoire associées aux biphosphonates : synthèse bibliographique

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Les ostéonécroses de la mâchoire associées aux biphosphonates : synthèse bibliographique