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1.
Quintessence Int ; 51(3): 220-228, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32020132

RESUMO

OBJECTIVES: Tooth extractions are suspected to be a major trigger for the development of bisphosphonate-related osteonecrosis of the jaw (BRONJ). Preventive measures like perioperative antibiotic therapy and primary wound closure have been found to be effective in preventing the development of BRONJ following tooth extraction. The aim of this study was to present long-term results of a treatment protocol for patients under bisphosphonate therapy requiring tooth extraction. METHOD AND MATERIALS: Between January 2008 and December 2012, 232 tooth extractions were performed in 84 patients under current or previous bisphosphonate treatment. Extractions were performed applying an atraumatic technique under prolonged intravenous antibiotic therapy. The bony edges were rounded off meticulously and the extraction sockets were covered with a mucoperiosteal flap. RESULTS: Out of 84 patients, two developed osteonecrosis of the jaw (ONJ), resulting in an incidence-rate of 2.4%. Both ONJ patients had received radiation therapy to the head and neck region following tooth extraction. The remaining 82 patients had uneventful healing and did not present any signs or symptoms of BRONJ during the follow-up period of 41.5 months. CONCLUSION: Tooth extractions, if performed under certain circumstances, would not seem to constitute a major risk factor for the development of BRONJ. The treatment protocol presented in this article seems to be highly effective in preventing development of ONJ after tooth extraction in patients under current or previous bisphosphonate therapy.


Assuntos
Osteonecrose da Arcada Osseodentária Associada a Difosfonatos , Conservadores da Densidade Óssea , Antibacterianos , Difosfonatos , Humanos , Extração Dentária , Cicatrização
2.
Rev Med Suisse ; 16(676-7): 78-80, 2020 Jan 15.
Artigo em Francês | MEDLINE | ID: mdl-31961090

RESUMO

Except for bisphosphonates, the duration of anti-osteoporotic treatment is not limited to 3 to 5 years. T-score between - 2.0 and - 1.5 DS might be the BMD target to reach before considering discontinuing anti-osteoporosis treatment. A rebound of bone remodeling can occur in some patients despite receiving zoledronate after denosumab discontinuation, and the monitoring of CTX is required. There is no benefit of vitamin D supplementation on musculoskeletal health in the general population, but vitamin D remains indicated in patients with vitamin D deficiency or receiving osteoporosis treatment. A sequential treatment with romosozumab during one year, a bone anabolic anti-sclerostin antibody, followed by two years of denosumab, decreases vertebral and non-vertebral fractures with rapid and substantial BMD gains after 3 years.


Assuntos
Conservadores da Densidade Óssea , Remodelação Óssea , Osteoporose Pós-Menopausa , Osteoporose , Densidade Óssea , Conservadores da Densidade Óssea/uso terapêutico , Osso e Ossos , Denosumab , Difosfonatos , Humanos , Osteoporose/tratamento farmacológico , Osteoporose Pós-Menopausa/tratamento farmacológico
3.
Int J Oral Maxillofac Surg ; 49(2): 183-191, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31447218

RESUMO

Knowledge of bisphosphonate-related osteonecrosis of the jaw (BRONJ) is mostly based on adult cases, however bisphosphonates are also currently recommended for different paediatric diseases resulting in osteoporosis. The aim of this study was to review the literature on the risk of developing BRONJ in children and adolescents. The PubMed, LILACS, Web of Science, Scopus, and Cochrane databases were searched using the key words "bisphosphonates", "osteonecrosis", "jaw", and "children". Literature reviews, case reports, abstracts, theses, textbooks, and book chapters were excluded. Studies involving children and young adults (younger than 24 years of age) were included. A total of 56 publications were identified. After applying the eligibility criteria, only seven articles remained. Although no cases of osteonecrosis were identified, all studies had weaknesses such as a limited sample size or the absence of risk factors for the development of osteonecrosis. There is general consensus that this subject should be of concern and that further studies should be conducted before any definitive opinion is reached. It is believed that patients with secondary osteoporosis who use bisphosphonates continuously should be followed up during adulthood, since bone turnover decreases over the years.


Assuntos
Osteonecrose da Arcada Osseodentária Associada a Difosfonatos , Conservadores da Densidade Óssea , Osteonecrose , Osteoporose , Adolescente , Adulto , Criança , Difosfonatos , Humanos , Fatores de Risco , Adulto Jovem
4.
Med Oral Patol Oral Cir Bucal ; 25(1): e71-e83, 2020 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-31880288

RESUMO

BACKGROUND: Medication-related osteonecrosis of the jaw (MRONJ) is a rare, but serious adverse effect of certain drugs, of which bisphosphonates are the most widely known. This pathology is also associated with other medications such as the biologic antiresorptive agent, denosumab and some antiangiogenics such as sunitinib, bevacizumab or aflibercept. Very recently, new medications have also been associated with osteonecrosis of the jaw (ONJ). The objectives were to update the list of medications associated with ONJ, to analyze the fundamental aspects of this list and to describe the level of evidence available. MATERIAL AND METHODS: A narrative bibliographic review was made, using the PubMed-MedLine, DOAJ and SCIELO databases. Additional information was obtained through the online Medication Information Centre of the Spanish Agency of Medicines and Medical Devices (AEMPS - CIMA), the websites of the US Food & Drugs Administration (Drugs@FDA) and the European Medicines Agency (EMA). RESULTS: The latest drugs identified as potential facilitators of this pathology include a number of anti-VEGF based antiangiogenic drugs and anti-TKI and different types of immunomodulators. Neither the level of evidence in this association nor the risk are equal for all these drugs. On the other hand, over the coming years, new drugs will be marketed with similar action mechanisms to those that are recognized as having this adverse effect. CONCLUSIONS: No effective therapy is currently known for the treatment of ONJ. Therefore, in order to prevent new cases of MRONJ, it is essential for all oral healthcare professionals to be fully up-to-date with the etiopathogenic aspects of this pathology and to be aware of those drugs considered to be a risk.


Assuntos
Osteonecrose da Arcada Osseodentária Associada a Difosfonatos , Conservadores da Densidade Óssea , Osteonecrose , Preparações Farmacêuticas , Denosumab , Difosfonatos , Humanos
5.
Magy Onkol ; 63(4): 320-329, 2019 Dec 09.
Artigo em Húngaro | MEDLINE | ID: mdl-31821387

RESUMO

Oncogenic mutation of RAS occurs in 20-25% of all malignancies. Our research group have examined inhibition of RAS prenylation on RAS wild type and RAS mutated melanoma, colorectal cancer and lung adenocarcinoma cell lines. Effects of clinically approved bisphosphonate (zoledronic acid) and its lipophilic derivate (BPH1222) on cell viability and cell signaling were determined. In models of melanoma and colorectal cancer we found no relevant difference in sensitivity to the drugs in light of RAS mutation presence. In case of lung adenocarcinoma bisphosphonate treatment inhibited both wild-type and mutated K-RAS, although tumor cells carrying mutated K-RAS seemed to be more sensitive to the bisphosphonate treatment. In summary, further investigations are warranted to identify tumor subgroups where bisphosphonates could have an effective therapeutic potential.


Assuntos
Mutação , Neoplasias/genética , Proteínas ras/genética , Linhagem Celular Tumoral , Sobrevivência Celular , Difosfonatos , Humanos , Prenilação , Transdução de Sinais , Ácido Zoledrônico
6.
J Craniomaxillofac Surg ; 47(12): 1922-1928, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31810841

RESUMO

Non-surgical therapy has proved to be effective in chronic diffuse sclerosing osteomyelitis (DSO) of the mandible in children. Therefore we aimed to investigate the effect of non-surgical therapy in adult DSO patients. We included consecutive patients with DSO who received non-surgical therapy in our center. They all received occlusal splint therapy, counselling about the disease, and/or physiotherapy by a specialised team. The use of analgesics, preferably nonsteroidal anti-inflammatory drugs, was advised for symptomatic control during periods of exacerbation. Sixteen patients (11/5 female/male) aged 39.9 ± 15.0 years with DSO of the mandible were included. The mean duration of symptoms was 39.7 ± 26.3 months before referral to our center. Patients were treated with a broad range of treatments before referral. All patients underwent non-surgical treatment. In 12 patients this led to remission. Four patients still had complaints after 12 months of non-surgical therapy and started with intravenous bisphosphonate therapy. In our center, DSO of the mandible was successfully treated with non-surgical therapy, despite a long duration before referral and extensive pre-treatment. Considering this high success rate, we recommend this non-surgical approach as the first treatment option for DSO of the mandible. In case of persistence, alternative treatments such as bisphosphonates should be explored.


Assuntos
Conservadores da Densidade Óssea/uso terapêutico , Tratamento Conservador/métodos , Difosfonatos/uso terapêutico , Doenças Mandibulares/terapia , Placas Oclusais , Osteomielite/terapia , Dor/tratamento farmacológico , Periostite/terapia , Adulto , Criança , Doença Crônica , Feminino , Humanos , Masculino , Mandíbula/patologia , Doenças Mandibulares/complicações , Pessoa de Meia-Idade , Osteomielite/complicações , Dor/etiologia , Periostite/complicações , Resultado do Tratamento , Adulto Jovem
7.
J Am Dent Assoc ; 150(11): 902-903, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31668168
8.
J Am Dent Assoc ; 150(11): 902, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31668169
9.
Oral Maxillofac Surg ; 23(4): 473-479, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31686251

RESUMO

OBJECTIVES: To evaluate the mandible and tibia of rats treated with bisphosphonates (BPs) by imaging and histomorphometric analysis. STUDY DESIGN: Thirty-four rat specimens (Rattus norvegicus, Wistar strain) were distributed into 3 groups: (1) 12 rats treated with zoledronic acid; (2) 12 rats treated with clodronate; and (3) the control group, containing 10 rats that received saline. All bones were exposed to cone beam computed tomography (CBCT). The images were analyzed to determine bone density (BD), using the software OsiriX 7.0. Histological slides were prepared from the specimens and the proportion of bone volume (BV) was quantified using the software Adobe Photoshop CC. RESULTS: There was no statistically significant difference in BD either between the drug groups or between mandible and tibia. BV between BPs and control group did not show a significant difference. However, comparing the two bones, the mandibles in the control group displayed higher BV than did the tibiae in the same group. CONCLUSION: According to our results, we conclude that (1) BD was not altered by bone type or by type of BP administered, and (2) treatment with zoledronic acid or clodronate did not affect BV in the mandible or tibia of test groups.


Assuntos
Conservadores da Densidade Óssea , Difosfonatos , Animais , Mandíbula , Ratos , Ratos Wistar , Tíbia
10.
Bone Joint J ; 101-B(11): 1402-1407, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31674239

RESUMO

AIMS: Bone health assessment and the prescription of medication for secondary fracture prevention have become an integral part of the acute management of patients with hip fracture. However, there is little evidence regarding compliance with prescription guidelines and subsequent adherence to medication in this patient group. PATIENTS AND METHODS: The World Hip Trauma Evaluation (WHiTE) is a multicentre, prospective cohort of hip fracture patients in NHS hospitals in England and Wales. Patients aged 60 years and older who received operative treatment for a hip fracture were eligible for inclusion in WHiTE. The prescription of bone protection medications was recorded from participants' discharge summaries, and participant-reported use of bone protection medications was recorded at 120 days following surgery. RESULTS: Of 5456 recruited patients with baseline data, 2853 patients (52%) were prescribed bone protection medication at discharge, of which oral bisphosphonates were the most common, 4109 patients (75%) were prescribed vitamin D or calcium, and 606 patients (11%) were not prescribed anything. Of those prescribed a bone protection medication, only 932 patients (33%) reported still taking their medication 120 days later. CONCLUSION: These data provide a reference for current prescription and adherence rates. Adherence with oral medication remains poor in patients with hip fracture. Cite this article: Bone Joint J 2019;101-B:1402-1407.


Assuntos
Conservadores da Densidade Óssea/uso terapêutico , Fraturas do Quadril/cirurgia , Idoso , Cálcio/uso terapêutico , Estudos de Coortes , Denosumab/uso terapêutico , Difosfonatos/uso terapêutico , Humanos , Hidroxicolecalciferóis/uso terapêutico , Adesão à Medicação , Pessoa de Meia-Idade , Cuidados Pós-Operatórios/métodos , Complicações Pós-Operatórias/prevenção & controle , Estudos Prospectivos , Teriparatida/uso terapêutico , Reino Unido , Vitamina D/uso terapêutico
11.
Arch Esp Urol ; 72(9): 948-954, 2019 Nov.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-31697256

RESUMO

OBJECTIVE: To examine the predictive value of osteocalcin (OC) and C-terminal telopeptide (CTX) levels for jaw osteonecrosis in high-risk prostate cancer (PCa) patients taking bisphosphonates (BPs). METHODS: Twenty-four patients were prospectively recruited in this study and followed from 2011 to 2015. All patients were diagnosed with metastatic PCa with secondary bone deposits and were on androgen deprivation therapy (ADT). All participants were started on 4mg of zoledronic acid intravenously every 4 weeks for two years. The patients were reviewed every three months with full blood count, blood biochemistry, PSA and measurement of OC and CTX. Patients also underwent dental/oral examination. OC and CTX levels in serum were calculated using the ELISA method. RESULTS: A significant decrease in PSA levels was found (ß=-0.06, SE=0.02, p=0.006). The levels of OC (ß=-0.46, SE=0.14, p=0.001) and CTX (ß=-0.01, SE=0.004, p=0.007) also decreased significantly during the two years of follow up. Osteonecrosis of the jaw was identified in three patients at two years. Patients with osteonecrosis also showed a decrease in OC and CTX levels. The mean OC reduction was 77.3% for patients with osteonecrosis and 12.6% for patients without osteonecrosis. The mean CTX reduction was 44.1% for patients with osteonecrosis and 9.62% for patients without osteonecrosis. CONCLUSION: Our study demonstrated no clear association between the levels of serum OC and CTX and bisphosphonate-related osteonecrosis of the jaw (BRONJ). To date, there is no clinically useful biomarker for the prediction of jaw osteonecrosis. More studies are needed using different bone turnover markers in order to identify patients at risk for BRONJ.


Assuntos
Osteonecrose da Arcada Osseodentária Associada a Difosfonatos , Conservadores da Densidade Óssea , Osteocalcina , Peptídeos , Neoplasias da Próstata , Antagonistas de Androgênios , Osteonecrose da Arcada Osseodentária Associada a Difosfonatos/diagnóstico , Conservadores da Densidade Óssea/uso terapêutico , Colágeno Tipo I , Difosfonatos , Humanos , Masculino , Osteocalcina/sangue , Peptídeos/sangue , Valor Preditivo dos Testes , Estudos Prospectivos , Neoplasias da Próstata/tratamento farmacológico
12.
Medicine (Baltimore) ; 98(48): e18161, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31770261

RESUMO

RATIONALE: Epithelioid hemangioma (EH) of bone is an intermediate vascular tumor that can be locally aggressive. The optimum management of multifocal EH of bone is not well delineated. We described our experience treating one patient with multifocal EH of bone in an effort to document the effect of bisphosphonates in bone EH. PATIENT CONCERNS: In this report, a 53-year old male patient presented with back pain which was initially been diagnosed of multiple bone metastatic carcinoma by 18F-FDG PET/CT scan and bone scintigraphy. DIAGNOSIS: CT-guided bone biopsy of ilium indicated that puncture tissue had irregular hyperplasia of thick and thin-walled blood vessels, immunohistochemistry revealed positive staining for CD31 and CD34, negative for CAMTA-1, PCK and EMA, which confirmed the diagnosis of multiple EH. INTERVENTIONS: The patient was treated with 4 times of intravenous Zometa (zoledronate, 4 mg each time) with average three-month interval. Bone metabolic markers including serum bone specific alkaline phosphatase (BALP) and type I collagen cross-linked C-terminal telopeptide (CTX) levels were closely monitored before and after use of bisphosphonates each time. OUTCOME: BALP and CTX were significantly lowered following intravenous Zometa and the back pain improved with integrated therapy including bone graft fusion internal fixation surgery and vertebroplasty. CONCLUSIONS: EH of multiple bones responded favorably to intravenous Zometa with improvement of bone metabolic markers. After 1 year on follow-up, the patient was doing well with no significant pain. We suggest that bisphosphonates should be considered in the treatment of multifocal osteolytic EH of bone.


Assuntos
Neoplasias Ósseas , Osso e Ossos , Hemangioendotelioma Epitelioide , Imuno-Histoquímica/métodos , Metástase Neoplásica/diagnóstico , Procedimentos Ortopédicos/métodos , Ácido Zoledrônico/administração & dosagem , Biópsia/métodos , Conservadores da Densidade Óssea/administração & dosagem , Neoplasias Ósseas/diagnóstico , Neoplasias Ósseas/metabolismo , Neoplasias Ósseas/patologia , Neoplasias Ósseas/terapia , Remodelação Óssea/efeitos dos fármacos , Osso e Ossos/diagnóstico por imagem , Osso e Ossos/metabolismo , Osso e Ossos/patologia , Terapia Combinada , Diagnóstico Diferencial , Difosfonatos/administração & dosagem , Monitoramento de Medicamentos/métodos , Hemangioendotelioma Epitelioide/diagnóstico , Hemangioendotelioma Epitelioide/metabolismo , Hemangioendotelioma Epitelioide/patologia , Hemangioendotelioma Epitelioide/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
13.
Z Rheumatol ; 78(10): 904-909, 2019 Dec.
Artigo em Alemão | MEDLINE | ID: mdl-31654138

RESUMO

The occurrence of multiple vertebral fractures after discontinuation of denosumab in the treatment of osteoporosis has reopened the debate on the optimal treatment duration and drug holidays.In principle, there is a difference in this regard between the discontinuation of medications such as bisphosphonates and substances without bone retention such as selective estrogen receptor modulators (SERMs), denosumab or teriparatide. Even after the end of application bisphosphonates have a very long half-life in the bones. After cessation of drug intake there is a slow, slight increase of bone turnover markers. Even after cessation of the SERM raloxifene, a decline in bone density can be observed, as with the termination of teriparatide. In contrast to these osteoporosis medications, after cessation of denosumab, a steep and rapid increase in markers of bone resorption above baseline levels ("rebound") and a reduction in bone mineral density to initial values can be observed.Osteoporosis is a disease that carries an increased risk of fracture, which is reduced for the duration of osteoporosis treatment. In certain situations, the fracture risk is only temporarily raised. In these situations, cessation of the osteoporosis treatment is possible. Beyond these special clinical situations, however, osteoporosis needs to be addressed as a chronic disease with a permanently increased fracture risk and the indication for therapy should be evaluated according to the extent of the risk of fracture.What happens after discontinuation of anti-osteoporosis drugs? The various effects on bone turnover markers, bone mineral density and fracture incidence of the individual drug groups are presented in detail, as are the resulting recommendations of the task forces of the American Society of Bone and Mineral Research (ASBMR) and the European Calcified Tissue Society (ECTS).


Assuntos
Conservadores da Densidade Óssea , Osteoporose , Densidade Óssea , Conservadores da Densidade Óssea/uso terapêutico , Denosumab , Difosfonatos , Humanos , Osteoporose/tratamento farmacológico
14.
J Biol Regul Homeost Agents ; 33(5): 1315-1320, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31591875

RESUMO

Osteoarthritis (OA) is a chronic rheumatic disease characterized by joint cartilage wear and loss of normal function. Clodronate (CLO) is a first-generation non-nitrogen-containing bisphosphonate that exerts anti-inflammatory and analgesic and modulatory effects on bone and cartilage metabolism. To date, few clinical studies have evaluated the effect of CLO in OA. Current evidence suggests that CLO may represent a new type of analgesic drug as it reduces pain in bone diseases characterized by edema such as Complex Regional Pain Syndrone type-1 and vertebral fractures. Thanks to its anti-inflammatory and analgesic effects, CLO has been shown to afford benefit in knee OA, erosive OA of the hand, painful knee hip prosthesis and veterinary practice. Transforming growth factor ß1 has also been found to play an important role in the pathogenesis of OA. The present review article examines recent evidence on the potential use of CLO in the treatment of OA.


Assuntos
Ácido Clodrônico/uso terapêutico , Difosfonatos/uso terapêutico , Osteoartrite/tratamento farmacológico , Cartilagem Articular/patologia , Humanos
15.
Bone Joint J ; 101-B(10): 1285-1291, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31564154

RESUMO

AIMS: Currently, periprosthetic fractures are excluded from the American Society for Bone and Mineral Research (ASBMR) definition of atypical femoral fracture (AFFs). This study aims to report on a series of periprosthetic femoral fractures (PFFs) that otherwise meet the criteria for AFFs. Secondary aims were to identify predictors of periprosthetic atypical femoral fractures (PAFFs) and quantify the complications of treatment. PATIENTS AND METHODS: This was a retrospective case control study of consecutive patients with periprosthetic femoral fractures between 2007 and 2017. Two observers identified 16 PAFF cases (mean age 73.9 years (44 to 88), 14 female patients) and 17 typical periprosthetic fractures in patients on bisphosphonate therapy as controls (mean age 80.7 years (60 to 86, 13 female patients). Univariate and multivariate analysis was performed to identify predictors of PAFF. Management and complications were recorded. RESULTS: Interobserver agreement for the PAFF classification was excellent (kappa = 0.944; p < 0.001). On univariate analysis compared with controls, patients with PAFFs had higher mean body mass indices (28.6 kg/m2 (sd 8.9) vs 21.5 kg/m2 (sd 3.3); p = 0.009), longer durations of bisphosphonate therapy (median 5.5 years (IQR 3.2 to 10.6) vs 2.4 years (IQR 1.0 to 6.4); p = 0.04), and were less likely to be on alendronate (50% vs 94%; p = 0.02) with an indication of secondary osteoporosis (19% vs 0%; p = 0.049). Duration of bisphosphonate therapy was an independent predictor of PAFF on multivariate analysis (R2 = 0.733; p = 0.05). Following primary fracture management, complication rates were higher in PAFFs (9/16, 56%) than controls (5/17, 29%; p = 0.178) with a relative risk of any complication following PAFF of 1.71 (95% confidence interval (CI) 0.77 to 3.8) and of reoperation 2.56 (95% CI 1.3 to 5.2). CONCLUSION: AFFs do occur in association with prostheses. Longer duration of bisphosphonate therapy is an independent predictor of PAFF. Complication rates are higher following PAFFs compared with typical PFFs, particularly of reoperation and infection. Cite this article: Bone Joint J 2019;101-B:1285-1291.


Assuntos
Artroplastia de Quadril/efeitos adversos , Difosfonatos/efeitos adversos , Osteoporose/tratamento farmacológico , Fraturas Periprotéticas/induzido quimicamente , Fraturas Periprotéticas/cirurgia , Idoso , Idoso de 80 Anos ou mais , Artroplastia de Quadril/métodos , Estudos de Casos e Controles , Intervalos de Confiança , Difosfonatos/uso terapêutico , Relação Dose-Resposta a Droga , Feminino , Fraturas do Fêmur/induzido quimicamente , Fraturas do Fêmur/cirurgia , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Variações Dependentes do Observador , Osteoporose/complicações , Fraturas Periprotéticas/diagnóstico por imagem , Estudos Retrospectivos , Medição de Risco , Fatores de Tempo , Estados Unidos
16.
Medicine (Baltimore) ; 98(38): e17256, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31567998

RESUMO

RATIONALE: Cardiac amyloidosis, considered for the last years to be a rare disease, is one of the determinants of HFpEF. The non-specific clinical presentation and the difficulties related to endomyocardial biopsy have made cardiac amyloidosis an underdiagnosed clinical entity. Improvement of non-invasive diagnostic techniques and the development of new therapies increased clinical awareness for this form of restrictive cardiomyopathy. We here summarize echocardiography and Tc-HDP scintigraphy findings in 6 cases of cardiac amyloidosis and review the literature data of this progressive and fatal cardiomyopathy. PATIENTS CONCERNS: The main clinical manifestations were fatigue, low exercise tolerance and edemas. The right heart failure symptoms usually dominated the clinical picture. DIAGNOSES: All cases were evaluated by echocardiography; 3 cases were further examined by bone scintigraphy and 4 cases a peripheral biopsy was performed. Electrocardiography showed low-voltage QRS complexes and "pseudo-infarct" pattern in the precordial leads, contrary to the echocardiographic aspect, which revealed thickening of ventricle walls. Biatrial dilation and diastolic disfunction were observed. Impaired systolic function was detected in advanced stages of the disease. Tc-HDP scintigraphy revealed cardiac uptake of radiopharmaceutical and managed to confirm the diagnosis in 1 case of cardiac amyloidosis in which salivary gland biopsy was negative. INTERVENTIONS: The treatment was based on managing fluid balance, with the mainstream therapy represented by diuretics. Neurohormonal agents, usually used in heart failure treatment were avoided, due to poor tolerance and worsening of disease course. The management of these 6 cases was challenging due to the refractory manifestation of congestive heart failure. OUTCOMES: During follow-up, 4 of the 6 patients from the current study died in the first year after the final diagnosis was established. LESSONS: Nuclear imaging of cardiac amyloidosis has a revolutionary development nowadays. Bone scintigraphy presents promising results for identifying patients at early stages of disease and to differentiate between cardiac amyloidosis types. Further studies are necessary for the standardization of imaging protocol and development of non-invasive diagnostic tools, especially in assessing the response to treatment and disease progression, for which little is known.


Assuntos
Amiloidose/diagnóstico por imagem , Ecocardiografia , Cardiopatias/diagnóstico por imagem , Cintilografia/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Amiloidose/diagnóstico , Amiloidose/patologia , Difosfonatos , Feminino , Coração/diagnóstico por imagem , Cardiopatias/diagnóstico , Cardiopatias/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Miocárdio/patologia , Compostos de Organotecnécio
17.
J Assoc Physicians India ; 67(9): 87-90, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31561698

RESUMO

Pachydermoperiostosis is a rare genetic disorder which commonly presents with clubbing, bone pains and skin changes. The treatment is mostly unsatisfactory. We tried bisphosphonates in our case with encouraging results. We suggest that parenteral bisphosphonates should be tried early in treatment of Pachydermoperiostosis.


Assuntos
Difosfonatos/uso terapêutico , Osteoartropatia Hipertrófica Primária/tratamento farmacológico , Humanos , Pele
18.
J Am Dent Assoc ; 150(10): 830-838, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31561759

RESUMO

BACKGROUND: In this study, the authors assessed the knowledge and opinions of patients regarding osteoporosis and the associations among osteoporosis, osteoporosis treatments, and oral health care use. METHODS: Outpatients with osteopenia or osteoporosis completed a questionnaire, including sociodemographic data, internet use, osteoporosis status, oral health care use status, and knowledge regarding the effect of osteoporosis pharmacotherapy on dental procedures. RESULTS: Among 258 patients (mean [standard deviation] age, 68.5 [9.3] years; 93% female), 83.9% had osteoporosis, one-third had previous osteoporotic fracture, and 74.4% took osteoporosis medication, mostly antiresorptive agents. In addition, 66.3% had more than 12 years of education, and 53.9% used the internet daily. A total of 79.9% visited a dentist during the past year, and 29.0% had undergone an invasive procedure. Yet 46.5% estimated that their dentist did not know that they had osteoporosis. Approximately one-half of the participants responded that they did not know the answers to knowledge questions regarding associations between osteoporosis, its pharmacotherapy, and oral health care. Of the patients who answered questions about associations between osteoporosis and oral health care, 70% incorrectly believed osteoporosis increased gingival disease, and 30% incorrectly thought medications should be discontinued before caries restoration. CONCLUSIONS: Outpatients with osteoporosis or osteopenia who responded to a questionnaire had limited knowledge about associations among osteoporosis, osteoporotic treatment, and oral health care. PRACTICE IMPLICATIONS: Dentists should review previous and current medical treatments with their patients, including osteoporosis diagnoses. The medical community should make more efforts to provide balanced, accurate information to help patients prioritize health care treatment and avoid unnecessary interruptions in osteoporosis treatment.


Assuntos
Conservadores da Densidade Óssea , Osteoporose , Assistência Odontológica , Odontólogos , Difosfonatos , Feminino , Humanos , Masculino , Saúde Bucal
19.
J Biol Regul Homeost Agents ; 33(3 Suppl. 1): 43-50, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31538449

RESUMO

Customization of post-and-cores using computer-aided-design and computer-aided-manufacturing (CAD-CAM) requires the scanning of a pattern and the subsequent digital design. This case report describes the production of a CAD-CAM customized post-and-core designed from an intraoral scan and milled from a metal block. The use of an intraoral scanner (IOS) for post-endodontic rehabilitation could lead to a faster and more efficient CAD-CAM customized post-and-core realization. The use of a high resistance material such as metal is paramount in cases with high loss of coronal structure. The patient has been treated with bisphosphonate (BP) for years. The risk of osteonecrosis of the jaw after extraction was high.


Assuntos
Projeto Auxiliado por Computador , Implantes Dentários , Fluxo de Trabalho , Osteonecrose da Arcada Osseodentária Associada a Difosfonatos , Implantação Dentária Endo-Óssea Endodôntica , Difosfonatos/efeitos adversos , Difosfonatos/uso terapêutico , Humanos , Metais
20.
Lakartidningen ; 1162019 Sep 16.
Artigo em Sueco | MEDLINE | ID: mdl-31529420

RESUMO

Atypical fracture of the femur is a well-documented adverse reaction to antiresorptive treatment with bisphosphonates. Although there has been significant gain of knowledge during the past decade, the pathogenesis of this type of fracture is still poorly understood. We present an update on the evidence in regard to epidemiology, pathophysiology, and management of atypical fractures.


Assuntos
Conservadores da Densidade Óssea/efeitos adversos , Difosfonatos/efeitos adversos , Fraturas do Fêmur/induzido quimicamente , Idoso , Difosfonatos/uso terapêutico , Medicina Baseada em Evidências , Feminino , Fraturas do Fêmur/diagnóstico por imagem , Fraturas do Fêmur/fisiopatologia , Fraturas do Fêmur/prevenção & controle , Humanos , Masculino , Radiografia , Fatores de Risco
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