Bisfosfonaten vergroten risico op breuk in dijbeen, maar dit kleine risico weegt niet op tegen voordeel van bisfosfonaten.

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.

5 mei 2011: het is algemeen bekend dat het gebruik van bisfosfonaten de botdichtheid kan aantasten. Nu blijkt uit een groot Zweeds onderzoek dat het risico op botbreuken in het dijbeen voor gebruikers van bisfosfonaten nogal meevalt. Het risico was wel iets groter bij gebruiksters van bisfosfonaten in vergelijking met niet gebruikers, maar het verschil was klein. En het risico weegt niet op tegen het grote voordeel van het gebruik van bisfosfonaten, aldus de onderzoekers. Wel lijkt het zinnig om na 5 jaar een pauze in te lassen voor de bisfosfonaten. Of misschien zelfs wel eerder regelmatig enkele maanden daarmee te stoppen. Maar overleg dat aub met uw arts of dat zinnig is. Hier het abstract van de studie.

Bisphosphonate Use and Atypical Fractures of the Femoral Shaft

Jörg Schilcher, M.D., Karl Michaëlsson, M.D., Ph.D., and Per Aspenberg, M.D., Ph.D.

N Engl J Med 2011; 364:1728-1737May 5, 2011

Background

Studies show conflicting results regarding the possible excess risk of atypical fractures of the femoral shaft associated with bisphosphonate use.

Methods

In Sweden, 12,777 women 55 years of age or older sustained a fracture of the femur in 2008. We reviewed radiographs of 1234 of the 1271 women who had a subtrochanteric or shaft fracture and identified 59 patients with atypical fractures. Data on medications and coexisting conditions were obtained from national registries. The relative and absolute risk of atypical fractures associated with bisphosphonate use was estimated by means of a nationwide cohort analysis. The 59 case patients were also compared with 263 control patients who had ordinary subtrochanteric or shaft fractures.

Results

The age-adjusted relative risk of atypical fracture was 47.3 (95% confidence interval , 25.6 to 87.3) in the cohort analysis. The increase in absolute risk was 5 cases per 10,000 patient-years (95% CI, 4 to 7). A total of 78% of the case patients and 10% of the controls had received bisphosphonates, corresponding to a multivariable-adjusted odds ratio of 33.3 (95% CI, 14.3 to 77.8). The risk was independent of coexisting conditions and of concurrent use of other drugs with known effects on bone. The duration of use influenced the risk (odds ratio per 100 daily doses, 1.3; 95% CI, 1.1 to 1.6). After drug withdrawal, the risk diminished by 70% per year since the last use (odds ratio, 0.28; 95% CI, 0.21 to 0.38).

Conclusions

These population-based nationwide analyses may be reassuring for patients who receive bisphosphonates. Although there was a high prevalence of current bisphosphonate use among patients with atypical fractures, the absolute risk was small. (Funded by the Swedish Research Council.)

Dr. Aspenberg reports receiving consulting fees from Eli Lilly and Amgen and grant support to his institution, Linköping University, from Eli Lilly and Amgen, as well as holding stock in AddBIO, a company trying to commercialize a method for bisphosphonate coating of implants to be inserted in bone, and holding a patent for this method. No other potential conflict of interest relevant to this article was reported.

Disclosure forms provided by the authors are available with the full text of this article at NEJM.org.

Drs. Schilcher and Michaëlsson contributed equally to this article.

Source Information

From the Department of Experimental and Clinical Medicine, Faculty of Health Science, Linköping University, Linköping (J.S., P.A.); and the Department of Surgical Sciences, Section of Orthopedics, and Uppsala Clinical Research Center, Uppsala University, Uppsala (K.M.) — both in Sweden.

Address reprint requests to Dr. Aspenberg at the Department of Experimental and Clinical Medicine, Faculty of Health Sciences, Linköping University, SE-581 85 Linköping, Sweden, or at per.aspenberg@liu.se.

botbreuken, APD, Zometa, bisfosfonaten