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Alternative treatments for oral bisphosphonate-related osteonecrosis of the jaws: a pilot study comparing fibrin rich in growth factors and teriparatide.

Pelaz A, Junquera L, Gallego L, García-Consuegra L, Junquera S, Gómez C - Med Oral Patol Oral Cir Bucal (2014)

Bottom Line: Alendronate was the most common oral bisphosphonate associated with BRONJ in our study (four patients in group A and two in group B).Only one patient in the group B showed the same evolution.In our series, the plasma rich in growth factors showed better results than the teriparatide in the treatment of recurrent BRONJ.

View Article: PubMed Central - PubMed

Affiliation: Universidad de Oviedo, Facultad de Ciencias de la Salud, Catedrático José Serrano s/n, 33009, Oviedo, Spain, junquera@uniovi.es.

ABSTRACT

Objective: The aim of this study is to describe and compare the evolution of recurrent bisphosphonate-related osteonecrosis of the jaws (BRONJ) in patients treated with plasma rich in growth factors or teriparatide.

Material and methods: Two different types of treatments were applied in patients diagnosed of recurrent BRONJ in a referral hospital for 1.100.000 inhabitants. In the group A, plasma rich in growth factors was applied during the surgery. In the group B, the treatment consisted in the subcutaneous administration of teriparatide. All the cases of BRONJ should meet the following conditions: recurrent BRONJ, impossibility of surgery in stage 3 Ruggiero classification and absence of diagnosed neoplastic disease. Clinical and radiographic evolution of the patients from both groups was observed.

Results: Nine patients were included, 5 in group A and 4 in group B. All the patients were women on oral bisphosphonate therapy for primary osteoporosis (5 patients) or osteoporosis-related to the use of corticosteroids (4 patients). Alendronate was the most common oral bisphosphonate associated with BRONJ in our study (four patients in group A and two in group B). The mean age was 72,8 years in the group A and 73,5 years in the group B. All the patients from group A showed a complete resolution of their BRONJ. Only one patient in the group B showed the same evolution.

Conclusion: In our series, the plasma rich in growth factors showed better results than the teriparatide in the treatment of recurrent BRONJ.

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Related in: MedlinePlus

Case A4. Mandibular BRONJ with purulent sinus tract highlighted with an arrow (A). Computed tomography (B) shows the osteolytic pattern affecting the incisive mandibular area.
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Figure 2: Case A4. Mandibular BRONJ with purulent sinus tract highlighted with an arrow (A). Computed tomography (B) shows the osteolytic pattern affecting the incisive mandibular area.

Mentions: Table 1 shows the main characteristics of the five patients belonging to the group with this treatment. The mean age was 72,8 years. All of them were women treated with oral bisphosphonates for osteoporosis. The drug most commonly used was the alendronate (4 cases). In four of the patients the exposed bone was located in the mandible. Three patients had a history of tooth extraction before the development of BRONJ and four patients had been previously treated with surgery in our hospital without success. In one patient, the bone exposure was located in the mandibular incisive region (Fig. 2) and had received no surgical treatment before application of PRF (Vivostat®). This patient not only had a previous history of multiple spontaneous expulsions of sequestered bone, but also the presence of active drainage at the time of diagnosis. The recovery of the disease was observed in all patients, with a complete resolution of the symptoms including the bone exposure. The average control time was 20 months (range: 12 to 24 months).


Alternative treatments for oral bisphosphonate-related osteonecrosis of the jaws: a pilot study comparing fibrin rich in growth factors and teriparatide.

Pelaz A, Junquera L, Gallego L, García-Consuegra L, Junquera S, Gómez C - Med Oral Patol Oral Cir Bucal (2014)

Case A4. Mandibular BRONJ with purulent sinus tract highlighted with an arrow (A). Computed tomography (B) shows the osteolytic pattern affecting the incisive mandibular area.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4119305&req=5

Figure 2: Case A4. Mandibular BRONJ with purulent sinus tract highlighted with an arrow (A). Computed tomography (B) shows the osteolytic pattern affecting the incisive mandibular area.
Mentions: Table 1 shows the main characteristics of the five patients belonging to the group with this treatment. The mean age was 72,8 years. All of them were women treated with oral bisphosphonates for osteoporosis. The drug most commonly used was the alendronate (4 cases). In four of the patients the exposed bone was located in the mandible. Three patients had a history of tooth extraction before the development of BRONJ and four patients had been previously treated with surgery in our hospital without success. In one patient, the bone exposure was located in the mandibular incisive region (Fig. 2) and had received no surgical treatment before application of PRF (Vivostat®). This patient not only had a previous history of multiple spontaneous expulsions of sequestered bone, but also the presence of active drainage at the time of diagnosis. The recovery of the disease was observed in all patients, with a complete resolution of the symptoms including the bone exposure. The average control time was 20 months (range: 12 to 24 months).

Bottom Line: Alendronate was the most common oral bisphosphonate associated with BRONJ in our study (four patients in group A and two in group B).Only one patient in the group B showed the same evolution.In our series, the plasma rich in growth factors showed better results than the teriparatide in the treatment of recurrent BRONJ.

View Article: PubMed Central - PubMed

Affiliation: Universidad de Oviedo, Facultad de Ciencias de la Salud, Catedrático José Serrano s/n, 33009, Oviedo, Spain, junquera@uniovi.es.

ABSTRACT

Objective: The aim of this study is to describe and compare the evolution of recurrent bisphosphonate-related osteonecrosis of the jaws (BRONJ) in patients treated with plasma rich in growth factors or teriparatide.

Material and methods: Two different types of treatments were applied in patients diagnosed of recurrent BRONJ in a referral hospital for 1.100.000 inhabitants. In the group A, plasma rich in growth factors was applied during the surgery. In the group B, the treatment consisted in the subcutaneous administration of teriparatide. All the cases of BRONJ should meet the following conditions: recurrent BRONJ, impossibility of surgery in stage 3 Ruggiero classification and absence of diagnosed neoplastic disease. Clinical and radiographic evolution of the patients from both groups was observed.

Results: Nine patients were included, 5 in group A and 4 in group B. All the patients were women on oral bisphosphonate therapy for primary osteoporosis (5 patients) or osteoporosis-related to the use of corticosteroids (4 patients). Alendronate was the most common oral bisphosphonate associated with BRONJ in our study (four patients in group A and two in group B). The mean age was 72,8 years in the group A and 73,5 years in the group B. All the patients from group A showed a complete resolution of their BRONJ. Only one patient in the group B showed the same evolution.

Conclusion: In our series, the plasma rich in growth factors showed better results than the teriparatide in the treatment of recurrent BRONJ.

Show MeSH
Related in: MedlinePlus