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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

Urinary levels of bone resorption marker cross-linked amino-terminal telopeptide of type I collogen (NTX). The mean of the Persistent group was lower than that of the control and remission group but there was no significance (P = 0.11).
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Figure 2: Urinary levels of bone resorption marker cross-linked amino-terminal telopeptide of type I collogen (NTX). The mean of the Persistent group was lower than that of the control and remission group but there was no significance (P = 0.11).

Mentions: Data on urinary NTX levels were collected from the physicians that had initially prescribed the BP drugs. Generally, daily variation of the urinary marker is large and is inferior in plasticity, whereas the measurement error is small and the serologic marker is superior in plasticity. The urinary NTX levels in the treatment-refractory group were low (19.2–54 nmol BCE/mmol Cr (mean: 30.8 ± 12.6)) compared with the control (mean: 39.7 ± 19.7) and remission (mean: 41.1 ± 22.3) groups, although these differences were not significant (P = 0.11). Our data showed that there were no significant differences in NTX levels between patients with no BRONJ or BRONJ stage 0 and those with stage 1–3 disease, although NTX levels tended to be lower in those patients refractory to conservative treatment than in patients showing good healing (Fig. 2).


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)

Urinary levels of bone resorption marker cross-linked amino-terminal telopeptide of type I collogen (NTX). The mean of the Persistent group was lower than that of the control and remission group but there was no significance (P = 0.11).
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 2: Urinary levels of bone resorption marker cross-linked amino-terminal telopeptide of type I collogen (NTX). The mean of the Persistent group was lower than that of the control and remission group but there was no significance (P = 0.11).
Mentions: Data on urinary NTX levels were collected from the physicians that had initially prescribed the BP drugs. Generally, daily variation of the urinary marker is large and is inferior in plasticity, whereas the measurement error is small and the serologic marker is superior in plasticity. The urinary NTX levels in the treatment-refractory group were low (19.2–54 nmol BCE/mmol Cr (mean: 30.8 ± 12.6)) compared with the control (mean: 39.7 ± 19.7) and remission (mean: 41.1 ± 22.3) groups, although these differences were not significant (P = 0.11). Our data showed that there were no significant differences in NTX levels between patients with no BRONJ or BRONJ stage 0 and those with stage 1–3 disease, although NTX levels tended to be lower in those patients refractory to conservative treatment than in patients showing good healing (Fig. 2).

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