Article

An Evidence-Based Review of Risk-Reductive Strategies for Osteonecrosis of the Jaws Among Cancer Patients

Department of Otolaryngology Head & Neck Surgery Faculty of Medicine Aristotle University of Thessaloniki, Thessaloniki Greece. .
Current clinical pharmacology 10/2012; 8(2). DOI: 10.2174/1574884711308020005
Source: PubMed

ABSTRACT Purpose: Bone antiresorptive treatment is associated with osteonecrosis of the jaws. Interventions used to treat this complication are diverse, controversial, and largely empirical but certain risk factors could help in its avoidance. The aim of this evidence-based review is to elucidate any interventions that are effective in reducing the risk for development of ONJ in cancer patients receiving bone antiresorptive therapy and to quantify the effectiveness of such interventions. Materials & Methods: We searched MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), and other trial registries through January 2012. We selected randomized controlled trials (RCTs). Cohort studies were included only as long as there are no RCTs on the same modality. Results: Twelve studies were included in the systematic review while nine studies contributed to the various comparisons. Prescribing denosumab (DSB) instead of zoledronic acid(ZA) may not be expected to reduce risk ONJ (RR:0.71 [99%CI: 0.41-1.24], I2=0%). Prescribing clodronate (RR:10.15 [99%CI: 2.43-42.35], I2=0%) or pamidronate (RR:4.41 [99%CI: 1.90-10.24], I2=16%) instead of ZA may reduce risk for ONJ. Dental extractions remain the most potent risk factor for ONJ (RR:14.04, [99%CI: 10.36-19.03],I2=0%) and their avoidance can be considered an effective risk-reductive intervention. ONJ risk can be reduced by dental prophylactic measures (RR:0.45, [99%CI: 0.23-0.85], I2=7%). Conclusions: DSB and ZA might cause ONJ more frequently compared with chlodornate or pamidronate. Prescription pamidronate and clodronate helps avoid the complication. Reducing the administered dose for denosumab and zoledronic acid might reduce risk for ONJ as well. More randomized clinical trials comparing reduced doses of these regimens against those currently approved are needed.

Download full-text

Full-text

Available from: Athanassios Kyrgidis, Sep 04, 2014
2 Followers
 · 
133 Views
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: This study sought to quantify in vitro antiproliferative effects of pamidronate in feline cancer cells and assess feasibility of use of pamidronate in cats by assessing short-term toxicity and dosing schedule in cats with bone-invasive cancer. A retrospective pilot study included eight cats with bone invasive cancer treated with intravenous pamidronate. In vitro, pamidronate reduced proliferation in feline cancer cells (P < 0.05). One cat treated with pamidronate in combination with chemotherapy and two cats treated with pamidronate as a single agent after failing prior therapy had subjective clinically stable disease; median progression free interval in these cats from initial pamidronate treatment was 81 days. Three cats developed azotemia while undergoing various treatment modalities including nonsteroidal anti-inflammatory drugs and pamidronate. Median overall survival was 116.5 days for all cats and 170 days for cats with oral squamous cell carcinoma. Median progression free survival was 55 days for all cats and 71 days for cats with oral squamous cell carcinoma. Pamidronate therapy appears feasible for administration in cancer bearing cats with aggressive bone lesions in the dose range of 1-2 mg/kg every 21-28 days for multiple treatments. No acute or short-term toxicity was directly attributable to pamidronate.
    06/2014; 2014:675172. DOI:10.1155/2014/675172
  • [Show abstract] [Hide abstract]
    ABSTRACT: This article provides readers with an overview of available evidence in relation to providing care to patients in different medical circumstances within oral surgery. There is evidence available to support discussions with patients taking particular medications (such as bisphosphonates, anticoagulants and corticosteroids) and also to try to prevent certain complications (such as 'dry socket'). In order to reduce the risks of potential morbidities, either perioperatively or postoperatively, operators must use high-quality, reliable and informed protocols, management techniques, advice and interventions to provide patients with the best care. These are used both preoperatively and postoperatively and patients should be consented appropriately, in a manner tailored to their own individual circumstances, but also using available evidence to explain the benefits and harms of any given procedure. In this short series we will outline and discuss common pre- and postoperative management techniques, protocols and instructions, and the evidence available to support these.
    British dental journal 03/2015; 218(5):273-278. DOI:10.1038/sj.bdj.2015.144 · 1.08 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: It remains unclear whether dental implants are a risk factor for the development of bisphosphonate-related osteonecrosis of the jaw (BRONJ). We retrospectively evaluated the status of dental implants in patients given intravenous bisphosphonates (BPs) in a breast cancer cohort to elucidate the risk for BRONJ at the implant site. We established a BRONJ oral monitoring program for 247 breast cancer patients given intravenous BP in our institution. The 3-year cumulative incidence rate was determined. The systemic and local risk factors of 44 patients who completed comprehensive oral examinations were evaluated by logistic regression analysis. The 3-year cumulative incidence rate of the 247 patients was 0.074 % (8/247, 95 % CI 0.0081-0.014). In the 44 orally examined patients, 6 (13.6 %: 6/44) had dental implants. Of these 6 patients, 1 developed BRONJ at the implant site. There were no significant differences in the age, total BP treatment period, number of residual teeth, time of regular oral monitoring, oral hygiene level, or dental implant insertion. Although a case of ONJ was identified, dental implants which were inserted before intravenous BP administration were not a risk factor for the development of ONJ in breast cancer patients.
    Odontology 05/2015; DOI:10.1007/s10266-015-0207-4 · 1.35 Impact Factor

Similar Publications