Skeletal complications of bisphosphonate use: What the radiologist should know

Department of Radiology, University Hospital Aintree, Liverpool, UK.
The British journal of radiology (Impact Factor: 2.03). 10/2012; 85(1018):1333-42. DOI: 10.1259/bjr/99102700
Source: PubMed

ABSTRACT Bisphosphonates are widely used for prevention of fractures in patients at risk, mainly in the presence of osteoporosis and bone metastases. A number of adverse effects of prolonged bisphosphonate treatment have emerged. We would like to highlight the skeletal complications from which a radiologist may be the first healthcare professional to recognise the association with bisphosphonate therapy. We illustrate these complications (namely osteonecrosis of the jaw and less well-known atypical femoral shaft fractures), presenting radiological findings in our patients. Recommendations for safer use of bisphosphonates are included in the conclusion of our review.

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    • "The cumulative incidence of BRONJ in patients taking intravenous bisphosphonates is significantly greater than in patients using oral bisphosphonates and varies from 0.8% to 12%. The estimated risk of BRONJ for oral bisphosphonate users remains uncertain but the occurrence appears to range from 1 in 10 000 to 1 in 100 000 patient-years [2–4]. "
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    ABSTRACT: Objectives. This paper offers a critical review of published information on the imaging strategies used for diagnosing bisphosphonate-associated osteonecrosis of the jaw (BRONJ) in patients taking intravenous bisphosphonates, pointing at the different methodologies and results of existing literature. Methods. Electronic literature search was performed in order to identify as many quantitative studies that discussed the imaging findings of BRONJ up to February 2014. Initially, the search for articles was based on the following four types of imaging modalities for evaluating BRONJ: computed tomography, plain film radiographs, magnetic resonance imaging, and nuclear bone scanning. Results. Eleven out of the 79 initially selected articles met the inclusion criteria. Most of the selected articles were cross-sectional studies. Regarding the selected studies, 54.5% have used plain films radiographs and 54.5% were based on computed tomography findings. All of the selected studies showed a small number of patients and none of the selected studies have tested the accuracy of the imaging examination for evaluating BRONJ. Conclusions. This critical review showed a scarcity of quantitative studies that analyzed the typical imaging findings related to BRONJ. Further studies are necessary in order to analyze the role of different imaging techniques in the assessment of BRONJ.
    International Journal of Dentistry 06/2014; 2014:784348. DOI:10.1155/2014/784348
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    • "In 1975, 99mTc bone imaging agents were found to be a useful diagnostic method [58,59]. Today, 99mTc diphosphonates are used with 18 F fluorodeoxyglucose in metastatic cancer diagnosis because 99mTc has an affinity for sites where bone is actively remolded, while 18 F fluorodeoxyglucose is taken up by tumor cells [60,61]. "
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    ABSTRACT: It is now 40 years since bisphosphonates (BPs) were first used in the clinic. So, it is timely to provide a brief review of what we have learned about these agents in bone disease. BPs are bone-specific and have been classified into two major groups on the basis of their distinct molecular modes of action: amino-BPs and non-amino-BPs. The amino-BPs are more potent and they inhibit farnesyl pyrophosphate synthase (FPPS), a key enzyme of the mavalonate/cholesterol biosynthetic pathway, while the non-amino-BPs inhibit osteoclast activity, by incorporation into non-hydrolyzable analogs of ATP. Both amino-BPs and non-amino-BPs can protect osteoblasts and osteocytes against apoptosis. The BPs are widely used in the clinic to treat various diseases characterized by excessive bone resorption, including osteoporosis, myeloma, bone metastasis, Legg-Perthes disease, malignant hyperparathyroidism, and other conditions featuring bone fragility. This review provides insights into some of the adverse effects of BPs, such as gastric irritation, osteonecrosis of the jaw, atypical femoral fractures, esophageal cancer, atrial fibrillation, and ocular inflammation. In conclusion, this review covers the biochemical and molecular mechanisms of action of BPs in bone, particularly the discovery that BPs have direct anti-apoptotic effects on osteoblasts and osteocytes, and the current situation of BP use in the clinic.
    Journal of Translational Medicine 12/2013; 11(1):303. DOI:10.1186/1479-5876-11-303 · 3.93 Impact Factor
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    ABSTRACT: The bisphosphonates are synthetic drugs used for treatment of neoplasms and bone, Paget’s disease and more reason for excitement in cases of postmenopausal osteoporosis. These drugs present some known side effects, however, a new complication with oral manifestation was recently identified, called Osteonecrosis. When this necrosis of the bone bases is associated to the use of Bisphosphonates, it is named Osteonecrosis by Bisphosphonates. The type of bisphosphonate, route of administration, and duration of treatment with these drugs seem to have direct relation with the incidence of osteonecrosis associated with bisphosphonates. The aim of this work was to present a review of the last five years about the use of bisphosphonates, the available bisphosphonate groups in the Brazilian market emphasizing those used in the treatment of Osteonecrosis, and exploring possible diagnostic aspects of the disease from image Diagnostics. It is concluded the impact of current world life stimulates new research areas focusing on important illnesses, their manifestations, and on searching for better treatment protocols and faster diagnosis protocols, aiming reduce possible treatment unwanted side effects.
    06/2013; 16(2):13-20. DOI:10.14295/bds.2013.v16i2.892
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