28 januari 2020:

Een recente Japanse studie belicht de problemen met het kaakbot bij gebruik van bisfosfonaten die mensen kunnen ondervinden: Novel insight into the management of bisphosphonate-related osteonecrosis of the jaw (BRONJ)

Summary

Bisphosphonate-related osteonecrosis of the jaw (BRONJ), characterized by refractory bone exposure, has recently emerged as a serious side effect of bisphosphonate (BPs) treatment. We discuss novel insights that may help to improve the efficacy of BRONJ treatment and prevention. Our report highlights the following: (1) The presence of exposed bone in patients taking BPs does not necessarily reflect BRONJ, and diagnoses of oral ulceration with bone sequestration and malignancy must be excluded. (2) Osteonecrosis type of BRONJ is difficult to avoid using preventive dental measures alone. However, as with osteomyelitis type of BRONJ, preventive dental measures are indispensable for reducing the risk of secondary infection and disease progression. (3) The importance of tooth extraction as a risk factor for BRONJ among patients taking BPs has been overstated, particularly when they are administered at low doses. Delaying tooth extraction may increase the risk for the onset and progression of osteomyelitic BRONJ. (4) In patients taking low doses of BPs, dental implant surgery is not necessarily contraindicated if there are no other risk factors, such as combined use of corticosteroids or concomitant diabetes. However, the risk of BRONJ due to peri-implantitis must be explained when obtaining patient consent.

25 februari 2011:bron: Medscape

Twee recente studies tonen aan dat bisfosfonaten botproblemen kunnen veroorzaken in de kaak. En dit geldt voor alle vormen van bisfosfonaten, zowel welke intraveneus worden gegeven , zoals Zometa - Zoledronic Acid en APD - Pamidronate, maar ook voor de oraal ingenomen bisfosfonaten. Medscape beschrijft uitvoerig de studie, klik daarvoor hier. En dit is een uitleg van de resultaten uit het abstract:

This larger of the 2 studies, led by Andrei Barasch, DMD, MDSc, FAAHD, from the University of Alabama School of Dentistry, Birmingham, investigated 191 ONJ cases (154 [80%] in cancer patients) and 573 matched control subjects from 119 dental practices in the United States.

This team found that bisphosphonate use was strongly associated with ONJ, with an odds ratio of 299.5 for intravenous drugs and of 12.2 for oral drugs.

They also calculated that using bisphosphonates for less than 2 years was associated with a 10-fold risk for ONJ; use for more than 2 years nearly quadrupled that risk.

"This case–control study, conducted in a broad cross-section of dental practices, confirms an elevated risk for ONJ among patients treated with bisphosphonates, with a large effect in the range suggestive of a causal link," the team concludes.

All formulations of bisphosphonates were associated with ONJ, with the exception of oral etidronate — but this drug was used by only 3 participants in the study, the researchers note.

A majority (83%) of the people with ONJ had used bisphosphonates: 48% used intravenous zolendronic acid, 23% used intravenous pamidronate, 38% used oral alendronate, 5% used oral ibandronate, and 8% used oral risedronate.

The risk of developing ONJ was higher for the more potent bisphosphonates, such as intravenous zolendronic acid and pamidronate (both indicated for use in cancer patients), but the risk was also there for weaker oral formulations, such as alendronate (which are used for osteoporosis).

This significant association between the less potent bisphosphonates and ONJ confirms previous reports, and "has significant clinical implications, since millions have been treated with these drugs," the researchers note. Read more>>>>>


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