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1.
Acta Biomed ; 93(S1): e2022257, 2022 Sep 21.
Artigo em Inglês | MEDLINE | ID: mdl-36129726

RESUMO

BACKGROUND AND AIM: Number of hip prosthesis implants in arthritis, number of patients treated with bisphosphonates to prevent fragility fractures and, together, number of atypical femoral fracture's cases are increasing. CASE SERIES: This article describes two cases of hip arthritis, treated with hip replacement, in patients using bisphosphonates for a long time; in both cases an incomplete atypical femoral fracture was misdiagnosed before the surgery. Authors describe the importance to carry out a complete osteometabolic and radiographic pre-operative examination of patients in treatment with bisphosphonates going to hip replacement, to check the possible presence of incomplete atypical femoral fracture and to optimize surgical and pharmacological treatment. CONCLUSIONS: In hip prosthesis surgery, prior diagnosis of incomplete atypical femoral fractures can indicate the choice of a different kind of prosthesis stem to optimize surgical results. This can also positively impact to rehabilitation in term of duration and daily activities recovery.


Assuntos
Artrite , Artroplastia de Quadril , Fraturas do Fêmur , Fraturas do Quadril , Prótese de Quadril , Artrite/induzido quimicamente , Artrite/tratamento farmacológico , Artrite/cirurgia , Artroplastia de Quadril/efeitos adversos , Artroplastia de Quadril/métodos , Difosfonatos/efeitos adversos , Fraturas do Fêmur/diagnóstico por imagem , Fraturas do Fêmur/etiologia , Fraturas do Fêmur/cirurgia , Fraturas do Quadril/cirurgia , Prótese de Quadril/efeitos adversos , Humanos , Estudos Retrospectivos
2.
J Coll Physicians Surg Pak ; 32(9): 1165-1169, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-36089714

RESUMO

OBJECTIVE: To evaluate the efficacy and safety of zoledronic acid in children with osteogenesis imperfecta (OI). STUDY DESIGN: Descriptive Study. PLACE AND DURATION OF STUDY: National Institute of Child Health, Department of Endocrine and Diabetes, Karachi, Pakistan, from January 2011 to December 2020. METHODOLOGY: Children, with OI registered for the treatment, were included. Zoledronic acid was given to them by intravenous infusion over 30 minutes with a dose of 0.05 mg/Kg/day for a median duration of 60 (24-96) months. To ensure safety, patients were kept for 24 hours after dose administration to monitor any short-term side effects. The patients were assessed after every 3-6 months for frequency of fracture, bone pain, and BMD. RESULT: Out of 82 children [40 females (48.8%) and 42 males (51.2%)], 11 patients (13.4%) had fever and 2 patients (2.4%) had flu-like illness. No other side effects were observed. The annual fracture rate decreased overall from 2.8±1.5 to 0.2±0.5 (˂0.001) in both males (2.6±1.3 to 0.1±0.4) and females (3.1±1.7 to 0.2±0.6). Z-score on DEXA scan showed improvement in BMD overall (-3.9±2.0 to 2.2 ±1.7), in males (-3.7±1.9 to -2.1±1.7) and in females (4.1±2.1 to -2.3±1.8). There were no other long-term side effects like ocular problems, osteonecrosis of the jaw, and delayed healing of the fractures. CONCLUSION: Zoledronate use in children is associated with minimal short-term and long-term side effects with a significant improvement in BMD and decline in fracture rate. KEY WORDS: Osteogenesis imperfecta (OI), Bisphosphonates (BPs), DEXA scan, Bone mineral density (BMD).


Assuntos
Conservadores da Densidade Óssea , Fraturas Ósseas , Osteogênese Imperfeita , Conservadores da Densidade Óssea/efeitos adversos , Criança , Difosfonatos/efeitos adversos , Feminino , Humanos , Masculino , Osteogênese Imperfeita/complicações , Osteogênese Imperfeita/tratamento farmacológico , Resultado do Tratamento , Ácido Zoledrônico/uso terapêutico
3.
Artigo em Inglês | MEDLINE | ID: mdl-36078614

RESUMO

In patients with osteoporosis receiving antiresorptive agents (ARs), it has been widely practiced to withdraw ARs for several months before tooth extraction and during treatment if medication-related osteonecrosis of the jaw (MRONJ) develops. This study examined the effects of drug holidays on recovery from osteoclast suppression and the treatment outcomes. The relationship between the period of the drug holidays and treatment outcomes was examined retrospectively in 166 osteoporosis patients with MRONJ who received ARs. Histological examinations using hematoxylin and eosin staining and cathepsin K stains were performed to observe the recovery from osteoclast suppression in 43 patients in whom living bone was observed in the resection margins of the surgical specimens. Three-month AR drug holidays were not significantly correlated with the treatment outcomes of the 139 patients who underwent surgical treatment and the 27 who underwent conservative treatment. Of the 43 patients who underwent histological investigations, 16 had drug holidays from 7 to 678 days. Osteoclast suppression was observed in almost all patients, except in one without a drug holiday and one with a 261-day drug holiday. These findings suggest that AR drug holidays for approximately 3 months neither recover osteoclast suppression nor affect treatment outcomes.


Assuntos
Osteonecrose da Arcada Osseodentária Associada a Difosfonatos , Conservadores da Densidade Óssea , Osteoporose , Osteonecrose da Arcada Osseodentária Associada a Difosfonatos/tratamento farmacológico , Conservadores da Densidade Óssea/uso terapêutico , Difosfonatos/efeitos adversos , Humanos , Osteoclastos , Osteoporose/tratamento farmacológico , Estudos Retrospectivos , Resultado do Tratamento
4.
Acta Chir Orthop Traumatol Cech ; 89(4): 312-314, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36055673

RESUMO

Bisphosphonates are commonly used in the treatment of osteoporosis. Long-term use without drug holiday causes the risk of atypical fractures. Subtrochanteric and femoral stress fractures are among the frequently described complications. In our case report; a stress fracture of the scapular spine, a previously undescribed adverse effect of bisphosphonates, is presented. Key words: bisphosphonates, scapular spine, stress fracture, drug holiday.


Assuntos
Conservadores da Densidade Óssea , Fraturas do Fêmur , Fraturas de Estresse , Fraturas do Ombro , Fraturas da Coluna Vertebral , Conservadores da Densidade Óssea/efeitos adversos , Difosfonatos/efeitos adversos , Fraturas do Fêmur/induzido quimicamente , Fraturas do Fêmur/diagnóstico por imagem , Fraturas do Fêmur/cirurgia , Fraturas de Estresse/induzido quimicamente , Fraturas de Estresse/diagnóstico por imagem , Humanos , Fraturas da Coluna Vertebral/induzido quimicamente , Fraturas da Coluna Vertebral/complicações
5.
Genesis ; 60(8-9): e23500, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-36106755

RESUMO

Since the initial description of medication-related osteonecrosis of the jaw (MRONJ) almost two decades ago, the potential pathophysiology and risk factors have been elaborated on in many investigations and guidelines. However, the definitive pathophysiology based on scientific evidence remains lacking. Consequently, the optimal clinical treatment and prevention strategies for MRONJ have not been established. Despite their different mechanisms of action, many drugs, including bisphosphonates, denosumab, angiogenesis inhibitors, and other medications, have been reported to be associated with MRONJ lesions in cancer and osteoporosis patients. Importantly, MRONJ occurs predominantly in the jawbones and other craniofacial regions, but not in the appendicular skeleton. In this up-to-date review, the currently available information and theories regarding MRONJ are presented from both clinical and basic science perspectives. The definition and epidemiology of MRONJ, triggering medication, and histopathology are comprehensively summarized. The immunopathology and the potential pathophysiology based on immune cells such as neutrophils, T and B cells, macrophages, dendritic cells, and natural killer cells are also discussed. In addition, antiangiogenesis, soft tissue toxicity, necrotic bone, osteocyte death, and single-nucleotide polymorphisms are examined. Moreover, other possible mechanisms of MRONJ development are considered based on the unique embryological characteristics, different cell behaviors between jawbones and appendicular skeleton, unique anatomical structures, and sustained bacterial exposure in the oral cavity as a basis for MRONJ site specificity. Based on the literature review, it was concluded that multiple factors may contribute to the development of MRONJ, although which one is the key player triggering MRONJ in the craniofacial region remains unknown.


Assuntos
Osteonecrose da Arcada Osseodentária Associada a Difosfonatos , Conservadores da Densidade Óssea , Inibidores da Angiogênese/efeitos adversos , Osteonecrose da Arcada Osseodentária Associada a Difosfonatos/tratamento farmacológico , Osteonecrose da Arcada Osseodentária Associada a Difosfonatos/etiologia , Osteonecrose da Arcada Osseodentária Associada a Difosfonatos/prevenção & controle , Conservadores da Densidade Óssea/efeitos adversos , Denosumab/efeitos adversos , Difosfonatos/efeitos adversos , Humanos , Nucleotídeos
6.
Sr Care Pharm ; 37(9): 458-467, 2022 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-36038998

RESUMO

Antiresorptive medications, including bisphosphonates and RANK-L inhibitors, are commonly used to treat various skeletal pathologies. One devastating complication associated with these drugs is medication-related osteonecrosis of the jaw (MRONJ). Patients who develop MRONJ suffer immensely from oral lesions that may persist, even with treatment, until their death. The jawbone is known to remodel 5 to 10 times faster than skeletal bone. Dentists are at the forefront in managing the severe maxillofacial repercussions of MRONJ. Because MRONJ risk is relatively low (reportedly 0.7% to 6.7%) it is underappreciated by many clinical specialties. The minimization of MRONJ is further compounded because it may take months or years to develop. To date, dental treatment protocols are based more on expert opinion than concrete scientific evidence. This iatrogenic, intractable illness is discouraging for both the patient and the treating dentist. To promote multidisciplinary understanding and cooperation, a single MRONJ case caused by intravenous pamidronate is presented, along with commentary from a dentist's perspective. The intent is that these data will increase awareness of MRONJ's stomatognathic consequences to the physician, who prescribed the causative agent, and the pharmacist, who dispensed it. Collaboration between the dentist, physician, and pharmacist has tremendous potential to improve treatment strategies and, ultimately, optimize patient care.


Assuntos
Osteonecrose da Arcada Osseodentária Associada a Difosfonatos , Conservadores da Densidade Óssea , Médicos , Osteonecrose da Arcada Osseodentária Associada a Difosfonatos/etiologia , Osteonecrose da Arcada Osseodentária Associada a Difosfonatos/prevenção & controle , Conservadores da Densidade Óssea/efeitos adversos , Odontólogos , Difosfonatos/efeitos adversos , Humanos
7.
Ugeskr Laeger ; 184(28)2022 07 11.
Artigo em Dinamarquês | MEDLINE | ID: mdl-35959811

RESUMO

The inflammatory side effects of bisphosphonates are well-known. We report a case of orbital and ocular inflammation secondary to the use of intravenous zoledronic acid and a case of scleritis secondary to oral alendronate. Bisphosphonate-induced inflammation can present as uveitis, (epi)scleritis, and orbital inflammation. The course is typically self-limiting after cessation of bisphosphonate therapy, but resolution can be further promoted by steroid therapy. The ocular side effects of bisphosphonates should be duly considered.


Assuntos
Conservadores da Densidade Óssea , Esclerite , Alendronato/efeitos adversos , Conservadores da Densidade Óssea/efeitos adversos , Difosfonatos/efeitos adversos , Humanos , Inflamação/induzido quimicamente , Inflamação/tratamento farmacológico
9.
An Pediatr (Engl Ed) ; 97(3): 190-198, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-35915035

RESUMO

INTRODUCTION: There are few studies on effectiveness and safety of bisphosphonate therapy in secondary osteoporosis in children. The aim of this research was to analyse effectiveness and safety of bisphosphonates in secondary osteoporosis in children. PATIENTS AND METHODS: Multicentre retrospective study in patients younger than 18 suffering from secondary osteoporosis and who have received bisphosphonates. Clinical data were recorded. Bone mineral density (BMD) was assessed in terms of BMD Z-score in lumbar spine (ZBMDls) measured by dual-energy X-ray absorptiometry (DXA). Effectiveness was valued at changes in ZBMDls one and two years after the onset of bisphosphonates and at the decrese in the number of fractures a year. Adverse events reported were recorded. Descriptive and bivariant analysis was performed. RESULTS: 32 patients were recruited. ZBMDls increased one year after the onset of treatment ((-2.46 ± 0.96) vs. (-1.54 ± 1.38); p < .001). Fractures a year dicreased significantly (1 (1-2) vs. 0 (0-0.61); p < .001). ZBMDls increase was higher in patients who were able to walk (1.88 ± 0.72 vs. 0.55 ± 0.82; p = .07) and correlated positively with body mass index (BMI)- for- age percentile (rho: 0.564; p < .001). The decrease in the number of fractures a year was higher in patients with lower initial fracture rate (rho: -0,47; p = .006) and with higher initial ZBMDls (rho: -0.47; p = .07). 10 adverse events were reported in 7 patients (22%), all of them intravenous bisphosphonates related. No association was found between adverse events and studied variables. CONCLUSIONS: Bisphosphonates are effective in secondary osteoporosis in children. Response seems to be better in patients who are able to walk, well-nourished and in the early stages of the disease. Adverse events were frequent but mild.


Assuntos
Conservadores da Densidade Óssea , Fraturas Ósseas , Osteoporose , Densidade Óssea , Conservadores da Densidade Óssea/efeitos adversos , Criança , Difosfonatos/efeitos adversos , Humanos , Osteoporose/induzido quimicamente , Osteoporose/complicações , Osteoporose/tratamento farmacológico , Estudos Retrospectivos
10.
Elife ; 112022 Aug 26.
Artigo em Inglês | MEDLINE | ID: mdl-36017995

RESUMO

Bisphosphonate-related osteonecrosis of the jaw (BRONJ) presents as a morbid jawbone lesion in patients exposed to a nitrogen-containing bisphosphonate (N-BP). Although it is rare, BRONJ has caused apprehension among patients and healthcare providers and decreased acceptance of this antiresorptive drug class to treat osteoporosis and metastatic osteolysis. We report here a novel method to elucidate the pathological mechanism of BRONJ by the selective removal of legacy N-BP from the jawbone using an intra-oral application of hydroxymethylene diphosphonate (HMDP) formulated in liposome-based deformable nanoscale vesicles (DNV). After maxillary tooth extraction, zoledronate-treated mice developed delayed gingival wound closure, delayed tooth extraction socket healing and increased jawbone osteonecrosis consistent with human BRONJ lesions. Single cell RNA sequencing of mouse gingival cells revealed oral barrier immune dysregulation and unresolved proinflammatory reaction. HMDP-DNV topical applications to nascent mouse BRONJ lesions resulted in accelerated gingival wound closure and bone socket healing as well as attenuation of osteonecrosis development. The gingival single cell RNA sequencing demonstrated resolution of chronic inflammation by increased anti-inflammatory signature gene expression of lymphocytes and myeloid-derived suppressor cells. This study suggests that BRONJ pathology is related to N-BP levels in jawbones and demonstrates the potential of HMDP-DNV as an effective BRONJ therapy.


Assuntos
Osteonecrose da Arcada Osseodentária Associada a Difosfonatos , Animais , Osteonecrose da Arcada Osseodentária Associada a Difosfonatos/etiologia , Osteonecrose da Arcada Osseodentária Associada a Difosfonatos/patologia , Osteonecrose da Arcada Osseodentária Associada a Difosfonatos/terapia , Difosfonatos/efeitos adversos , Humanos , Lipossomos , Camundongos , Nitrogênio , Ácido Zoledrônico
11.
Anticancer Res ; 42(8): 4139-4143, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35896231

RESUMO

BACKGROUND/AIM: Post-menopausal breast cancer (BC) patients who receive adjuvant aromatase inhibitor (AI) therapy may be at increased risk of bone loss, osteoporosis, and bone fracture. We aimed to evaluate the efficacy and safety of oral bisphosphonate minodronate in preventing bone loss complications. PATIENTS AND METHODS: Patients receiving AI and 80% of those with suboptimal bone mineral density (BMD) were prescribed monthly oral minodronate 50 mg every 4 weeks for 72 weeks. BMD, bone metabolism markers, incidence of bone fractures, medication compliance, and other adverse events (AE) were examined every 24 weeks following administration. RESULTS: Fifty postmenopausal BC patients with a median age of 64.0 years were enrolled. The mean value of lumbar spine BMD was higher than that of the value before the minodronate administration at each observation point. Before and after the treatment, the median serum values of Tartrate-resistant Acid Phosphatase 5b (TRACP-5b) (mU/dl) and serum type I collagen cross-linked N-telopeptide (NTX) (nmolBCE/l) were decreased from 535.7 and 18.5 to 230.1 and 11.9, respectively. No adverse grade 2 or higher event was observed throughout this study. CONCLUSION: The combined administration of minodronate and AIs was safe and effective in preventing bone loss complications in postmenopausal BC patients.


Assuntos
Conservadores da Densidade Óssea , Doenças Ósseas Metabólicas , Neoplasias da Mama , Fraturas Ósseas , Inibidores da Aromatase/efeitos adversos , Densidade Óssea , Conservadores da Densidade Óssea/efeitos adversos , Neoplasias da Mama/complicações , Difosfonatos/efeitos adversos , Feminino , Fraturas Ósseas/etiologia , Humanos , Imidazóis , Pessoa de Meia-Idade , Pós-Menopausa
12.
BMC Oral Health ; 22(1): 291, 2022 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-35843929

RESUMO

OBJECTIVE: Implantology represents the gold standard for oral rehabilitation, unfortunately, often, despite there are no local contraindications to this type of rehabilitation, there are uncertainties regarding the general health of our patients. Many patients nowadays take bisphosphonate drugs, often without first seeking advice from an oral surgeon or a dentist. The purpose of this review is precisely to highlight any contraindications to this type of treatment reported in the literature, in patients who take or have taken bisphosphonate drugs. METHODS: For this study the scientific information sources were consulted using as search terms "("bisphosphonate AND "dental implant")", obtaining 312 results, these were subsequently skimmed according to the inclusion and exclusion criteria, and further evaluated their relevance to the study and the presence of requested outcomes. RESULTS: Only 9 manuscripts (RCTs, Multicentric studies and Clinical Trials) were included in this review, as they respected the parameters of this review, they were analyzed and it was possible to draw important results from them. Surely from this study it is understood that the use of bisphosphonate drugs does not represent an absolute contraindication to implant therapy, it is evident how adequate pharmacological prophylaxis, and an adequate protocol reduce the risks regarding implant failures. Furthermore, the values of marginal bone loss over time seem, even if not statistically significant, to be better in implant rehabilitation with bisphosphonate drugs association. Only a few molecules like risedronate, or corticosteroids, or some conditions like smoking or diabetes have shown a high risk of surgical failure. CONCLUSION: Although this study considered different studies for a total of 378 patients and at least 1687 different dental implants, showing better results in some cases for dental implant therapy in cases of bisphosphonate intake, further clinical, randomized and multicentric studies are needed, with longer follow-ups, to fully clarify this situation which often negatively affects the quality of life of our patients and places clinicians in the face of doubts.


Assuntos
Implantes Dentários , Difosfonatos , Implantação Dentária Endóssea/métodos , Implantes Dentários/efeitos adversos , Falha de Restauração Dentária , Difosfonatos/efeitos adversos , Humanos , Qualidade de Vida
13.
J Hand Surg Asian Pac Vol ; 27(3): 553-559, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35808877

RESUMO

Atypical ulna fracture (AUF) is relatively rare and is known to be associated with prolonged bisphosphonate (BP) use. The developmental mechanism remains unclear. We report a patient with an AUF associated with BP and severe spinal deformity. The patient was an 85-year-old woman receiving oral alendronate for 8 years without vitamin D supplementation. During regular kitchen work, she needed left upper limb support. She presented with atraumatic pain over the ulna. Radiographs revealed a transverse fracture in the proximal ulna and ulna bowing deformity. Whole-spine standing radiographs showed severe degenerative kyphoscoliosis. The skin induration with pigmentation on her left elbow that suggested prolonged overload and during standing work, coincided exactly with fracture location. This report suggests that 'direct stress', with persistent local overload on the proximal ulna, is one of the developmental mechanisms of AUF, in addition to persistent suppression of bone remodelling by prolonged BP use and vitamin D deficiency. Level of Evidence: Level V (Therapeutic).


Assuntos
Conservadores da Densidade Óssea , Fraturas Ósseas , Fraturas da Ulna , Idoso de 80 Anos ou mais , Alendronato/uso terapêutico , Conservadores da Densidade Óssea/efeitos adversos , Difosfonatos/efeitos adversos , Feminino , Humanos , Radiografia , Fraturas da Ulna/induzido quimicamente , Fraturas da Ulna/diagnóstico por imagem
14.
Front Cell Infect Microbiol ; 12: 886411, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35811676

RESUMO

One of the most prominent characteristics of bisphosphonate-related osteonecrosis of the jaw(BRONJ) is its site-specificity. Osteonecrosis tends to occur specifically in maxillofacial bones, in spite of a systemic administration of the medicine. Previous studies suggested rich blood supply and fast bone turnover might be reasons for BRONJ. Yet, a sound scientific basis explaining its occurrence is still lacking. The present study aimed to explore the role of Porphyromonas gingivalis (P. gingivalis), an important oral pathogen, on the site-specificity of bisphosphonate-induced osteonecrosis and to elucidate its underlying mechanism. Mice were intraperitoneally injected with zoledronic acid (ZA) or saline for 3 weeks. In the third week, the right mandibular first molars were extracted and circular bone defects with a diameter of 1 mm were created in right femurs. After the operation, drug administration was continued, and P. gingivalis suspension was applied to the oral cavities and femur defects. The mice were killed after four or eight weeks postoperatively. The right mandibles and femurs were harvested for micro-CT and histological analyses. A poor healing of bone defects of both jaws and femurs was noted in mice injected with both ZA and P. gingivalis. Micro-CT analysis showed a decreased bone volume, and histological staining showed an increased number of empty osteocyte lacunae, a decreased collagen regeneration, an increased inflammatory infiltration and a decreased number of osteoclasts. In addition, the left femurs were collected for isolation of osteoclast precursors (OCPs). The osteoclastogenesis potential of OCPs was analyzed in vitro. OCPs extracted from mice of ZA-treated groups were shown to have a lower osteoclast differentiation potential and the expression level of related genes and proteins was declined. In conclusion, we established a mouse model of bisphosphonate-related osteonecrosis of both the jaw and femur. P. gingivalis could inhibit the healing of femur defects under the administration of ZA. These findings suggest that P. gingivalis in the oral cavity might be one of the steering compounds for BRONJ to occur.


Assuntos
Osteonecrose da Arcada Osseodentária Associada a Difosfonatos , Animais , Osteonecrose da Arcada Osseodentária Associada a Difosfonatos/tratamento farmacológico , Osteonecrose da Arcada Osseodentária Associada a Difosfonatos/patologia , Difosfonatos/efeitos adversos , Fêmur/patologia , Imidazóis/farmacologia , Camundongos , Porphyromonas gingivalis , Ácido Zoledrônico/uso terapêutico
15.
Cochrane Database Syst Rev ; 7: CD012432, 2022 07 12.
Artigo em Inglês | MEDLINE | ID: mdl-35866376

RESUMO

BACKGROUND: Medication-related osteonecrosis of the jaw (MRONJ) is a severe adverse reaction experienced by some individuals to certain medicines commonly used in the treatment of cancer and osteoporosis (e.g. bisphosphonates, denosumab, and antiangiogenic agents), and involves the progressive destruction of bone in the mandible or maxilla. Depending on the drug, its dosage, and the duration of exposure, this adverse drug reaction may occur rarely (e.g. following the oral administration of bisphosphonate or denosumab treatments for osteoporosis, or antiangiogenic agent-targeted cancer treatment), or commonly (e.g. following intravenous bisphosphonate for cancer treatment). MRONJ is associated with significant morbidity, adversely affects quality of life (QoL), and is challenging to treat. This is an update of our review first published in 2017. OBJECTIVES: To assess the effects of interventions versus no treatment, placebo, or an active control for the prophylaxis of MRONJ in people exposed to antiresorptive or antiangiogenic drugs. To assess the effects of non-surgical or surgical interventions (either singly or in combination) versus no treatment, placebo, or an active control for the treatment of people with manifest MRONJ. SEARCH METHODS: Cochrane Oral Health's Information Specialist searched four bibliographic databases up to 16 June 2021 and used additional search methods to identify published, unpublished, and ongoing studies.  SELECTION CRITERIA: We included randomised controlled trials (RCTs) comparing one modality of intervention with another for the prevention or treatment of MRONJ. For 'prophylaxis of MRONJ', the primary outcome of interest was the incidence of MRONJ; secondary outcomes were QoL, time-to-event, and rate of complications and side effects of the intervention. For 'treatment of established MRONJ', the primary outcome of interest was healing of MRONJ; secondary outcomes were QoL, recurrence, and rate of complications and side effects of the intervention. DATA COLLECTION AND ANALYSIS: Two review authors independently screened the search results, extracted the data, and assessed the risk of bias in the included studies. For dichotomous outcomes, we reported the risk ratio (RR) (or rate ratio) and 95% confidence intervals (CIs). MAIN RESULTS: We included 13 RCTs (1668 participants) in this updated review, of which eight were new additions. The studies were clinically diverse and examined very different interventions, so meta-analyses could not be performed. We have low or very low certainty about available evidence on interventions for the prophylaxis or treatment of MRONJ. Prophylaxis of MRONJ Five RCTs examined different interventions to prevent the occurrence of MRONJ. One RCT compared standard care with regular dental examinations at three-month intervals and preventive treatments (including antibiotics before dental extractions and the use of techniques for wound closure that avoid exposure and contamination of bone) in men with metastatic prostate cancer treated with zoledronic acid. The intervention seemed to lower the risk of MRONJ (RR 0.10, 95% CI 0.02 to 0.39, 253 participants). Secondary outcomes were not evaluated. Dentoalveolar surgery is considered a common predisposing event for developing MRONJ and five RCTs tested various preventive measures to reduce the risk of postoperative MRONJ. The studies evaluated plasma rich in growth factors inserted into the postextraction alveolus in addition to standardised medical and surgical care versus standardised medical and surgical care alone (RR 0.08, 95% CI 0.00 to 1.51, 176 participants); delicate surgery and closure by primary intention versus non-traumatic tooth avulsion and closure by secondary intention (no case of postoperative MRONJ in either group); primary closure of the extraction socket with a mucoperiosteal flap versus application of platelet-rich fibrin without primary wound closure (no case of postoperative MRONJ in either group); and subperiosteal wound closure versus epiperiosteal wound closure (RR 0.09, 95% CI 0.00 to 1.56, 132 participants).  Treatment of MRONJ Eight RCTs examined different interventions for the treatment of established MRONJ; that is, the effect on MRONJ cure rates.  One RCT analysed hyperbaric oxygen (HBO) treatment used in addition to standard care (antiseptic rinses, antibiotics, and surgery) compared with standard care alone (at last follow-up: RR 1.56, 95% CI 0.77 to 3.18, 46 participants).  Healing rates from MRONJ were not significantly different between autofluorescence-guided bone surgery and conventional bone surgery (RR 1.08, 95% CI 0.85 to 1.37, 30 participants). Another RCT that compared autofluorescence- with tetracycline fluorescence-guided sequestrectomy for the surgical treatment of MRONJ found no significant difference (at one-year follow-up: RR 1.05, 95% CI 0.86 to 1.30, 34 participants).  Three RCTs investigated the effect of growth factors and autologous platelet concentrates on healing rates of MRONJ: platelet-rich fibrin after bone surgery versus surgery alone (RR 1.05, 95% CI 0.90 to 1.22, 47 participants), bone morphogenetic protein-2 together with platelet-rich fibrin versus platelet-rich fibrin alone (RR 1.10, 95% CI 0.94 to 1.29, 55 participants), and concentrated growth factor and primary wound closure versus primary wound closure only (RR 1.38, 95% CI 0.81 to 2.34, 28 participants).   Two RCTs focused on pharmacological treatment with teriparatide: teriparatide 20 µg daily versus placebo in addition to standard care (RR 0.96, 95% CI 0.31 to 2.95, 33 participants) and teriparatide 56.5 µg weekly versus teriparatide 20 µg daily in addition to standard care (RR 1.60, 95% CI 0.25 to 1.44, 12 participants). AUTHORS CONCLUSIONS: Prophylaxis of medication-related osteonecrosis of the jaw One open-label RCT provided some evidence that dental examinations at three-month intervals and preventive treatments may be more effective than standard care for reducing the incidence of medication-related osteonecrosis of the jaw (MRONJ) in individuals taking intravenous bisphosphonates for advanced cancer. We assessed the certainty of the evidence to be very low. There is insufficient evidence to either claim or refute a benefit of the interventions tested for prophylaxis of MRONJ in patients with antiresorptive therapy undergoing dentoalveolar surgery. Although some interventions suggested a potential large effect, the studies were underpowered to show statistical significance, and replication of the results in larger studies is pending. Treatment of medication-related osteonecrosis of the jaw The available evidence is insufficient to either claim or refute a benefit, in addition to standard care, of any of the interventions studied for the treatment of MRONJ.


Assuntos
Osteonecrose , Osteoporose , Antibacterianos/uso terapêutico , Denosumab/efeitos adversos , Difosfonatos/efeitos adversos , Humanos , Masculino , Osteoporose/tratamento farmacológico , Teriparatida
16.
Arch Soc Esp Oftalmol (Engl Ed) ; 97(9): 497-503, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-35787381

RESUMO

OBJECTIVE: We aimed to investigate ocular involvement findings in female osteoporosis patients using oral bisphosphonate (BP). METHODS: A total of 51 female osteoporosis patients aged 50-75 years using oral BP for at least one year for the study group and 64 age-matched non-osteoporosis female patients for the control group were included in the study. The BP type and exposure time were noted. The ophthalmic examination findings and measurements of the flare of the patients who received oral BP due to osteoporosis and the controls were evaluated. RESULTS: The mean duration of BP use was 3.96 years. In the study group, it was detected four of 51 patients were diagnosed with meibomian gland dysfunction (MGD) (7.8%), seven of 102 eyes had erythematous, irregular, thickened lid margin or telangiectasia around the glandular orifices. There were no pathological findings on fundus examination. The mean value of measurements of the flare (ph/ms) was 7.90±7.96 in the study group, and 5.02±0.81 in the control group. When the mean values were compared, there was a significant difference between the two groups (P=.001). A significant difference was found in the mean value of measurements of the flare between the patients using alendronate, and ibandronate with the control group (P=.001; P=.005, respectively). CONCLUSION: Our study showed that the flare in the anterior chamber associated with chronic ocular inflammation can be seen higher rate in patients using oral alendronate, and ibandronate compared to those who do not. Morever it can be said that oral BPs may cause similar ocular side effects like as intravascular BPs.


Assuntos
Alendronato , Difosfonatos , Administração Oral , Alendronato/efeitos adversos , Difosfonatos/efeitos adversos , Feminino , Humanos , Ácido Ibandrônico
17.
Quintessence Int ; 53(7): 616-623, 2022 Jun 20.
Artigo em Inglês | MEDLINE | ID: mdl-35674165

RESUMO

OBJECTIVE: The objective of this systematic review was to evaluate the risks of medication-related osteonecrosis of the jaw (MRONJ) in fibrous dysplasia (FD) and McCune-Albright syndrome (MAS) patients treated with bisphosphonates. METHOD AND MATERIALS: A systematic review of the literature was performed by searching PubMed and Embase databases using MeSH terms (fibrous dysplasia of bone, "fibrous dysplasia, polyostotic," osteonecrosis, jaw, therapeutics, diphosphonates, denosumab, teriparatide, estrogens, hormones, raloxifene hydrochloride, calcitonin, cathepsin K) and non-MeSH terms (antiresorptive therapy, antiresorptives, bisphosphonate, estrogen therapy, hormone therapy, bazedoxifene, cathepsin K inhibitor). Articles were limited to human studies, in English language, in which patients were on antiresorptives for at least 1 year. PRISMA statement guidelines were used to eliminate non-relevant studies. The PICOT question asked was, "Does exposure to bisphosphonates and other antiresorptives cause occurrence of MRONJ in fibrous dysplasia and fibrous dysplasia/McCune-Albright syndrome patients followed up for at least 1 year?" RESULTS: Eight eligible articles were included in the quantitative synthesis after articles were screened using a PRISMA flowchart. There were 12 reported occurrences of MRONJ among a combined total of 312 fibrous dysplasia and fibrous dysplasia/McCune-Albright syndrome patients (3.85%). CONCLUSION: Patients with fibrous dysplasia or fibrous dysplasia/McCune-Albright syndrome have a low incidence of MRONJ and may apparently have low susceptibility to spontaneous development of MRONJ.


Assuntos
Conservadores da Densidade Óssea , Displasia Fibrosa Óssea , Displasia Fibrosa Poliostótica , Osteonecrose , Conservadores da Densidade Óssea/efeitos adversos , Catepsina K , Difosfonatos/efeitos adversos , Displasia Fibrosa Óssea/induzido quimicamente , Displasia Fibrosa Poliostótica/complicações , Displasia Fibrosa Poliostótica/tratamento farmacológico , Displasia Fibrosa Poliostótica/epidemiologia , Humanos
18.
Brasília; CONITEC; jun. 2022.
Não convencional em Português | BRISA/RedTESA, BRISA/RedTESA | ID: biblio-1382316

RESUMO

INTRODUÇÃO: A osteoporose é uma doença osteometabólica caracterizada por diminuição da massa óssea e deterioração da microarquitetura do tecido ósseo com consequente aumento da fragilidade óssea e da susceptibilidade a fraturas, sendo a principal causa de fraturas para a população acima de 50 anos, assim como apresenta uma prevalência de 6% em homens e 24% em mulheres nesta faixa etária. A doença possui elevada morbimortalidade relacionada e nos pacientes com fratura osteoporótica recente são considerados de alto risco para novas fraturas. As fraturas osteoporóticas mais comuns ocorrem nas vértebras, rádio distal e fêmur proximal, ocasionando dor, incapacidade física, deformidades e promovem a deterioração da qualidade e expectativa de vida. Aproximadamente 75% das fraturas de quadril, coluna e antebraço distal ocorrem em pacientes com 65 anos ou mais. Uma perda de 10% de massa óssea nas vértebras pode dobrar o risco de fraturas vertebrais e, da mesma forma, uma perda de 10% de massa óssea no quadril pode resultar em um risco 2,5 vezes maior de fratura de quadril. O tratamento farmacológico com bisfosfonatos é um importante redutor de risco para fraturas, com um amplo benefício em relação aos riscos. Entretanto, os bisfosfonatos orais são conhecidos por causar efeitos adversos no trato gastrointestinal superior, e dificuldades em relação à adesão ao tratamento para pacientes que


Assuntos
Humanos , Osteoporose/tratamento farmacológico , Difosfonatos/efeitos adversos , Ácido Zoledrônico/uso terapêutico , Sistema Único de Saúde , Brasil , Análise Custo-Benefício/economia
19.
Medicina (Kaunas) ; 58(6)2022 Jun 09.
Artigo em Inglês | MEDLINE | ID: mdl-35744041

RESUMO

Background and Objectives: The objective of this study was to evaluate the effects of bisphosphonate (BP) administration on tooth growth, using CT-data of a minipig animal model investigation. Materials and Methods: Tooth growth was evaluated in minipigs, with eight animals receiving weekly zoledronate (ZOL) and three animals serving as the control group. Tooth growth was evaluated at the right 2nd molar (M2) in the maxilla. A computed tomography-based measuring method was applied to evaluate tooth growth in the coronal-apical, buccal-oral and mesial-distal axis. Results: ZOL-administration was found to impact tooth growth in all evaluated measuring axes, with the highest effect observed in the coronal-apical axis. Conclusions: Detrimental effects of BP administration on growing teeth have been reported by a number of investigators. The results of this investigation demonstrate that intravenous ZOL affects the growth of the whole tooth within a short period of administration. With BPs being administered to a growing number of pediatric patients, further studies should be conducted to qualify and quantify the effects of BPs on developing teeth.


Assuntos
Difosfonatos , Tomografia Computadorizada por Raios X , Animais , Difosfonatos/efeitos adversos , Modelos Animais de Doenças , Humanos , Suínos , Porco Miniatura , Tomografia , Ácido Zoledrônico
20.
Nutrients ; 14(12)2022 Jun 07.
Artigo em Inglês | MEDLINE | ID: mdl-35745099

RESUMO

Both osteoporosis with related fragility fractures and cardiovascular diseases are rapidly outspreading worldwide. Since they are often coexistent in elderly patients and may be related to possible common pathogenetic mechanisms, the possible reciprocal effects of drugs employed to treat these diseases have to be considered in clinical practice. Bisphosphonates, the agents most largely employed to decrease bone fragility, have been shown to be overall safe with respect to cardiovascular diseases and even capable of reducing cardiovascular morbidity in some settings, as mainly shown by real life studies. No randomized controlled trials with cardiovascular outcomes as primary endpoints are available. While contradictory results have emerged about a possible BSP-mediated reduction of overall mortality, it is undeniable that these drugs can be employed safely in patients with high fracture risk, since no increased mortality has ever been demonstrated. Although partial reassurance has emerged from meta-analysis assessing the risk of cardiac arrhythmias during bisphosphonates treatment, caution is warranted in administering this class of drugs to patients at risk for atrial fibrillation, possibly preferring other antiresorptives or anabolics, according to osteoporosis guidelines. This paper focuses on the complex relationship between bisphosphonates use and cardiovascular disease and possible co-management issues.


Assuntos
Conservadores da Densidade Óssea , Doenças Cardiovasculares , Fraturas Ósseas , Osteoporose Pós-Menopausa , Osteoporose , Idoso , Conservadores da Densidade Óssea/efeitos adversos , Doenças Cardiovasculares/complicações , Difosfonatos/efeitos adversos , Feminino , Fraturas Ósseas/etiologia , Fraturas Ósseas/prevenção & controle , Humanos , Osteoporose/complicações , Osteoporose/tratamento farmacológico , Osteoporose Pós-Menopausa/tratamento farmacológico
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