Download ONJ (Osteonecrosis of the Jaw) in Bisphosphonate

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Bisphosphonates effectively manage bone
complications from cancer
Approved for treatment of malignant bone
disease from solid tumors and multiple
myeloma
Zoledronic acid (Zometa) is approved for the
treatment of any advanced malignancy
involving bone
● Common adverse events
- Flu-like symptoms
- Fever
- Myalgias/ Arthralgias
● Uncommon adverse events:
- Renal-function effects
- Osteonecrosis of the jaw
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Etiology and pathogenesis are not well
characterized
The clinical identification of ONJ is usually
made on the basis of visual inspection and/or
radiographic appearance
Study
Study type
Patients
treated with
BP, n
Patients with
suspected or
proven ONJ, n
Frequency %
Hoff et
al.MDACC
ASCO 2006
Chart review
3,994
29
0.7%
Durie et al
Web-based
survey
1,203
152
12.6%
Pozzi et all
italian
multicenter
study
Chart review
888
16
1.8%
Badros et al
Chart
review/observ
ational
340
11
3.2%
 Risk
Factors for ONJ
•Periodontal disease
•Dento-alveolar surgery
•Oral trauma
•Corticosteroid therapy
•Immuno-compromised state
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Prevention of ONJ
• Prior to treatment with bisphosphonates:
– Dental exam with appropriate preventive
dentistry
– Remove abscessed teeth, and teeth with poor
long-term prognosis
– Educate patients on oral hygiene and signs
and symptoms of ONJ
• During bisphosphonate treatment
– Seek dental maintenance care at least every
6 months
– Avoid invasive dental procedures if possible
• In case of ONJ
– Refer to dental professional as soon as
possible
– Reassess benefit/risk of continued
bisphosphonate therapy
• No prospective data exist to withhold
therapy–Conservative management
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ONJ Outcomes
• Emerging data indicate that stability /
improvement of lesions occurs in the majority
of patients with conservative management
– With preventive measures and conservative
management, deterioration occurs only in a
minority of patients
V.H.52 year old man receiving IV
Biphosphonate as maintenance
therapy for Multiple Myeloma
ONJ healing after 3
months
ONJ after two years of
Biphosphonate therapy
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Summary
- ONJ is an uncommon event
- Most patients can be managed
conservatively according to guidelines with
minimal impact on quality of life
- Ongoing studies will increase the
understanding of ONJ…
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