Presentation
The clinical presentation described in this case series should alert the physician to the possibility of BON. [ncbi.nlm.nih.gov]
H ere we present five cases of osteonecrosis of the jaw associated with bisphosphonate use. [mja.com.au]
A 67-year-old woman (patient 2) with metastatic breast cancer treated with pamidronate and later zoledronate presented with a nonhealing extraction socket. [ajnr.org]
Jaw & Teeth
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Jaw Disease
Osteonecrosis of the Jaw is also known as avascular or aseptic necrosis of the mandible or maxilla, Jaw Death, Dead Jaw Disease or Bisphossy Jaw. [topdentists.com]
A troubling jaw disease that may be related to the use of some of the most commonly used osteoporosis medications has been the subject of many news stories and law firm commercials lately. [uab.edu]
Drug for bones is linked to jaw disease. New York Times June 2, 2006 ;sect A: 1 Tolar J, Teitelbaum SL, Orchard PJ. Osteopetrosis. N Engl J Med 2004 ; 351 : 2839 –49 Reszka AA, Rodan GA. Mechanism of action of bisphosphonates. [ajnr.org]
Treatment
Treatment outcome was poor (33% and 25% responded to treatment in MM group and non-MM group, respectively). Treatment modality did not affect the treatment outcome. [ncbi.nlm.nih.gov]
JAW NECROSIS TREATMENT Treatment for osteonecrosis of the jaw only has a minimal effect on the symptoms and problems caused by the dead jaw condition. [youhavealawyer.com]
[…] any invasive dental treatment while you are taking these treatments. [cancerresearchuk.org]
There is no definitive treatment for BRONJ at this time. [pancreas.imedpub.com]
Prognosis
This decision can be influenced by the general health and cancer prognosis of the patient, a patient quality-of-life evaluation, and the patient’s initial response to cancer therapy. “The earlier the diagnosis, the easier the management,” said Dr. [ascopost.com]
Even though the risk cannot be eliminated, prognosis usually is good for patients with osteonecrosis of the jaw from oral bisphosphonates. [aafp.org]
A more complete understanding of BRONJ will allow clinicians to predict who will benefit most from bisphosphonate therapy and to make more accurate judgments about risk, prognosis, treatment selection, and outcome. References 1. [ncbi.nlm.nih.gov]
The earlier the diagnosis the better the prognosis. Research is ongoing on other non-surgical therapeutic modalities that could alone or in combination with surgery further improve the prognosis and reduce the morbidity of ONj. [dr-jacques-imbeau.com]
Etiology
Bisphosphonate-related osteonecrosis of the jaw (BRONJ) was the initially described entity, but MRONJ is now the preferred term as other medications besides bisphosphonates have been implicated as etiological agents 5,6. [radiopaedia.org]
Data that links the incidence of osteonecrosis of the jaw and its etiologic factors are limited, and the incidence of osteonecrosis of the jaw in the general population (ie, those not taking bisphosphonates) is unknown. [emedicine.medscape.com]
prior trauma, corticosteroid therapy, immune-compromised state predisposing to increased risk of infection, possible vascular insufficiency and an underlying hypercoagulable state secondary to underlying malignancy have been implicated as possible etiologic [druginjurylaw.com]
Treatment The treatment should be tailored to the individual patient according to the etiological factors involved and the severity of the disease process. [dr-jacques-imbeau.com]
Epidemiology
This significant difference in dose in the two types of patient accounts for a good part of the epidemiological differences between osteonecrosis of the jaw in osteoporosis and in oncology, and this must be taken into account in patient information, in [pharmaco-vigilance.eu]
Epidemiology For oral bisphosphonates used to treat osteoporosis, the number of spontaneous reports of ONJ submitted to their manufacturers indicates a reporting rate of less than 1 per 100,000 patient treatment years. [iofbonehealth.org]
Epidemiology Frequency The true incidence of bisphosphonate-related osteonecrosis of the jaw (BRONJ) has yet to be determined. [emedicine.medscape.com]
Pathophysiology
Pathogenesis The underlying pathophysiological mechanisms behind ONJ have yet to be elucidated. [iofbonehealth.org]
Pathophysiology of the disease has not been fully elucidated but theories include: Inhibition of osteoclastic bone resorption and remodeling: Antiresorptive drugs inhibit osteoclast differentiation and function and increase apoptosis, all leading to [pathologyoutlines.com]
The European Medicines Agency’s Committee for Medicinal Products for Human Use (CHMP) reached conclusions on the currently available evidence on four main areas: definition and diagnosis of ONJ related to bisphosphonates; possible underlying pathophysiological [gov.uk]
FRCD(C); Aliya Khan, MD, FRCPC, FACP, FACE; Sotirios Tetradis, DDS, PhD; Edmund Peters, DDS, MSc, FRCD(C) Read the full article (PDF) This work provides a systematic review of the literature from January 2003 to April 2014 pertaining to the incidence, pathophysiology [oasisdiscussions.ca]
Prevention
However, there is no evidence that this helps prevent ONJ in oncology patients. [oncolink.org]
[…] men and women initiating or taking glucocorticoids Zoledronic acid 8 (Reclast ); IV Prevention and treatment of postmenopausal osteoporosis Increase bone mass in men with osteoporosis Prevention and treatment of osteoporosis in men and women expected [ada.org]
The painful exposed jaw bone can persist for years in many cases, and most experts recommend treatment with antibiotic and preventative actions to avoid jaw infection. [youhavealawyer.com]
Preventing or delaying skeletal-related events can preserve quality of life and reduce healthcare costs. [news.cancerconnect.com]
The main goals of preventive dental measures are to remove any oral infection, pathology, or risk factors in order to obtain a stable oral health situation, preventing the necessity for invasive dental procedures in the near or intermediate future.[ 37 [ncbi.nlm.nih.gov]