[DOWNLOAD] "Bisphosphonate-Related Osteonecrosis of the Jaws an Old Disease with a New Drug?" by Eric R. Carlson ~ eBook PDF Kindle ePub Free
eBook details
- Title: Bisphosphonate-Related Osteonecrosis of the Jaws an Old Disease with a New Drug?
- Author : Eric R. Carlson
- Release Date : January 01, 2010
- Genre: Engineering,Books,Professional & Technical,
- Pages : * pages
- Size : 64 KB
Description
In 2003, reports came about that identified cases of osteonecrosis of the jaws in patients being treated with bisphosphonate medications, such as zoledronic acid (Zometa, Novartis, East Hanover, NJ), pamidronate (Aredia, Novartis, East Hanover, NJ), alendronate (Fosamax, Merck and Co., Whitehouse Station, NJ), and risedronate (Actonel, Proctor & Gamble Pharmaceuticals, Cincinnati, Ohio) for a variety of diagnoses, typically metastatic breast cancer, multiple myeloma, and osteoporosis. The first report, an abstract presented by a member of the division of oral and maxillofacial surgery at Long Island Jewish Medical Center in New York, reviewed 26 cases of osteonecrosis of the maxilla and mandible noted in these patients receiving bisphosphonate therapy for metastatic bone disease. (1) These cases were referred for evaluation and management of refractory osteomyelitis of varying duration, an old disease well known to dentists and physicians. The typical presentation was a nonhealing extraction socket, or exposed jawbone with progression to sequestrum formation, localized swelling, and purulent discharge. The second report involved a letter to the editor of the Journal of Oral and Maxillofacial Surgery that reviewed 36 cases of painful bone exposure in the jaws. (2) The author of this letter to the Editor indicated that the difficulty in treating this disease was that debridement could not be carried out to uninvolved bone for fear of causing further exposure of bone. In addition, this author indicated that the dentist or oral and maxillofacial surgeon was likely the responsible party in creating this disease. The first peer reviewed paper published on the topic of osteonecrosis of the jaws in patients exposed to bisphosphonate medications was authored by Ruggiero et al., (3) in the Journal of Oral and Maxillofacial Surgery in 2004. Since that time to the present, hundreds of papers have been published on this subject. What has followed can only be described as unnecessary panic on the part of members of the dental profession who treat these patients, medical oncologists and other physicians who prescribe these medications, and patients who develop osteonecrosis of the jaws. Specifically, non-evidenced based comments were published regarding a cause and effect relationship between bisphosphonate exposure and the subsequent development of osteonecrosis of the jaws, and the inability to treat patients who develop this disease. In 2010, neither issue is scientifically valid. Bisphosphonates have a broad array of indications, including the use of intravenous bisphosphonate medications in the management of hypercalcemia of malignancy, skeletal related events associated with bone metastases from solid tumors, and in the management of bone lesions in the setting of multiple myeloma. A significant prolongation in the length and quality of life has been realized by the use of the intravenous bisphosphonate medications in patients with cancer. Newer indications for the intravenous bisphosphonate medications include their use in osteoporosis as alternatives to the oral bisphosphonates. Oral bisphosphonates are approved to treat osteoporosis and prevent from 40-70% of fractures of the hip and spine that have been shown to be fatal in 50% of patients within five years. (4,5) Clearly, bisphosphonate medications help many otherwise hopeless patients each year.