ONJ ( Osteonecrosis of the Jaw) in Bisphosphonate -Treated Cancer Patients
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Transcript of ONJ ( Osteonecrosis of the Jaw) in Bisphosphonate -Treated Cancer Patients
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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
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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
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StudyStudy typePatients treated with BP, nPatients with suspected or proven ONJ, nFrequency %Hoff et al.MDACC ASCO 2006Chart review3,994290.7%Durie et alWeb-based survey1,20315212.6%Pozzi et all italian multicenter studyChart review888161.8%Badros et alChart review/observational340113.2%Tosi et al. Analysis of Bologna 2002 trialRetrospective review of trial data base25993.5%Dimopoulos et alChart review 202157.4%Cafro et alChart review1181411.9%
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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
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During bisphosphonate treatment
Seek dental maintenance care at least every 6 months
Avoid invasive dental procedures if possible
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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 therapyConservative 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
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ONJ after two years ofBiphosphonate therapyONJ healing after 3 monthsV.H.52 year old man receiving IV Biphosphonate as maintenance therapy for Multiple Myeloma
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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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THANK YOU
**ONL annual incidence : 1/300. it dropped to 1/7000 by practicing prevention dental care.