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Prognosis factors in the treatment of bisphosphonate-related osteonecrosis of the jaw - Prognostic factors in the treatment of BRONJ.

Yoshiga D, Nakamichi I, Yamashita Y, Yamamoto N, Yamauchi K, Nogami S, Kaneuji T, Mitsugi S, Tanaka K, Kataoka Y, Sakurai T, Kiyomiya H, Miyamoto I, Takahashi T - J Clin Exp Dent (2014)

Bottom Line: Notably, urinary cross-linked N-terminal telopeptide of type 1 collagen (NTX) levels in those resistant to conservative treatment tended to be lower than in patients that healed well.We confirm that a significant proportion of BRONJ sufferers are refractory to a recommended conservative treatment and find that anticancer drugs, periodontal disease, the level of bone exposure and the dosage of intravenous BPs (e.g. zoledronate) represent specific risk factors in BRONJ that may determine the success of a recommended conservative treatment.Additionally, the NTX levels might be able to be a prognostic factor for the conservative treatment of BRONJ; additional research is necessary.

View Article: PubMed Central - PubMed

Affiliation: Division of Oral and Maxillofacial Reconstructive Surgery, Department of Oral and Maxillofacial Surgery, Kyushu Dental University, Fukuoka, Japan.

ABSTRACT

Objectives: Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a relatively rare but serious side effect of bisphosphonate (BP)-based treatments. This retrospective study aimed to investigate the risk factors and predictive markers in cases where patients were refractory to a recommended conservative treatment offered in our hospital.

Patients and methods: This single-center study collated the medical records of all patients treated for BRONJ between 2004 and 2011. A complete medical history, including detailed questionnaires, was collected for all patients, focusing on identifying underlying risk factors, clinical features, location and bone marker levels of BRONJ.

Results: The mean BRONJ remission rate was 57.6%, and the median duration of remission was seven months. Eighteen patients (34.6%) had persistent or progressive disease with a recommended conservative treatment for BRONJ. Notably, urinary cross-linked N-terminal telopeptide of type 1 collagen (NTX) levels in those resistant to conservative treatment tended to be lower than in patients that healed well.

Conclusions: We confirm that a significant proportion of BRONJ sufferers are refractory to a recommended conservative treatment and find that anticancer drugs, periodontal disease, the level of bone exposure and the dosage of intravenous BPs (e.g. zoledronate) represent specific risk factors in BRONJ that may determine the success of a recommended conservative treatment. Additionally, the NTX levels might be able to be a prognostic factor for the conservative treatment of BRONJ; additional research is necessary. Key words:Bisphosphonate, osteonecrosis, jaw, prognostic, retrospective.

No MeSH data available.


Related in: MedlinePlus

Kaplan-Meier curve showing the time after diagnosis until no further bone exposure was evident.
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Figure 1: Kaplan-Meier curve showing the time after diagnosis until no further bone exposure was evident.

Mentions: The 52 patients selected were all referred to our hospital for intraoral symptoms such as swelling, pain, pus discharge, and bone denudation. Of these, 19 cases (36.5%) were stage 0, five cases (9.6%) were stage 1, 22 cases (42.3%) were stage 2 and six cases (11.5%) were stage 3. When the stage distribution was analyzed according to age, we found the greatest proportion of patients to be in their 70’s (19 patients). This was similar to the distribution of patients treated with BPs, as in previous reports. Stage 3 disease was present only in patients over 60 years of age. Furthermore, we investigated the cure period for patients who were initially diagnosed as stages 1–3 with bone exposure using the Kaplan–Meier method. In this analysis, the cure period was defined as ending at the point when no bone exposure remained. In terms of the therapeutic ratio, there were no major differences between women and men. The cure period ranged from 1–24 months, and the median cure period was seven months. Of the 33 patients included in this group, seven (21.2%) either died or dropped out during the treatment period and the cure rate of the remainder was 61.5% (16 patients) (Fig. 1). Therefore, we investigated intractable cases for which the cure period was longer than 7 months or in which the disease progressed to a higher stage during conservative treatment.


Prognosis factors in the treatment of bisphosphonate-related osteonecrosis of the jaw - Prognostic factors in the treatment of BRONJ.

Yoshiga D, Nakamichi I, Yamashita Y, Yamamoto N, Yamauchi K, Nogami S, Kaneuji T, Mitsugi S, Tanaka K, Kataoka Y, Sakurai T, Kiyomiya H, Miyamoto I, Takahashi T - J Clin Exp Dent (2014)

Kaplan-Meier curve showing the time after diagnosis until no further bone exposure was evident.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3935901&req=5

Figure 1: Kaplan-Meier curve showing the time after diagnosis until no further bone exposure was evident.
Mentions: The 52 patients selected were all referred to our hospital for intraoral symptoms such as swelling, pain, pus discharge, and bone denudation. Of these, 19 cases (36.5%) were stage 0, five cases (9.6%) were stage 1, 22 cases (42.3%) were stage 2 and six cases (11.5%) were stage 3. When the stage distribution was analyzed according to age, we found the greatest proportion of patients to be in their 70’s (19 patients). This was similar to the distribution of patients treated with BPs, as in previous reports. Stage 3 disease was present only in patients over 60 years of age. Furthermore, we investigated the cure period for patients who were initially diagnosed as stages 1–3 with bone exposure using the Kaplan–Meier method. In this analysis, the cure period was defined as ending at the point when no bone exposure remained. In terms of the therapeutic ratio, there were no major differences between women and men. The cure period ranged from 1–24 months, and the median cure period was seven months. Of the 33 patients included in this group, seven (21.2%) either died or dropped out during the treatment period and the cure rate of the remainder was 61.5% (16 patients) (Fig. 1). Therefore, we investigated intractable cases for which the cure period was longer than 7 months or in which the disease progressed to a higher stage during conservative treatment.

Bottom Line: Notably, urinary cross-linked N-terminal telopeptide of type 1 collagen (NTX) levels in those resistant to conservative treatment tended to be lower than in patients that healed well.We confirm that a significant proportion of BRONJ sufferers are refractory to a recommended conservative treatment and find that anticancer drugs, periodontal disease, the level of bone exposure and the dosage of intravenous BPs (e.g. zoledronate) represent specific risk factors in BRONJ that may determine the success of a recommended conservative treatment.Additionally, the NTX levels might be able to be a prognostic factor for the conservative treatment of BRONJ; additional research is necessary.

View Article: PubMed Central - PubMed

Affiliation: Division of Oral and Maxillofacial Reconstructive Surgery, Department of Oral and Maxillofacial Surgery, Kyushu Dental University, Fukuoka, Japan.

ABSTRACT

Objectives: Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a relatively rare but serious side effect of bisphosphonate (BP)-based treatments. This retrospective study aimed to investigate the risk factors and predictive markers in cases where patients were refractory to a recommended conservative treatment offered in our hospital.

Patients and methods: This single-center study collated the medical records of all patients treated for BRONJ between 2004 and 2011. A complete medical history, including detailed questionnaires, was collected for all patients, focusing on identifying underlying risk factors, clinical features, location and bone marker levels of BRONJ.

Results: The mean BRONJ remission rate was 57.6%, and the median duration of remission was seven months. Eighteen patients (34.6%) had persistent or progressive disease with a recommended conservative treatment for BRONJ. Notably, urinary cross-linked N-terminal telopeptide of type 1 collagen (NTX) levels in those resistant to conservative treatment tended to be lower than in patients that healed well.

Conclusions: We confirm that a significant proportion of BRONJ sufferers are refractory to a recommended conservative treatment and find that anticancer drugs, periodontal disease, the level of bone exposure and the dosage of intravenous BPs (e.g. zoledronate) represent specific risk factors in BRONJ that may determine the success of a recommended conservative treatment. Additionally, the NTX levels might be able to be a prognostic factor for the conservative treatment of BRONJ; additional research is necessary. Key words:Bisphosphonate, osteonecrosis, jaw, prognostic, retrospective.

No MeSH data available.


Related in: MedlinePlus