nach oben

Supportive Care in Cancer

Erschienen in:

29.08.2019 | Original Article

Prevalence and risk factors of medication-related osteonecrosis of the jaw in osteoporotic and breast cancer patients: a cross-sectional study

verfasst von: Ana Laura Soares, Sérgio Simon, Luiz Henrique Gebrim, Afonso Celso P. Nazário, Marise Lazaretti-Castro

Erschienen in: Supportive Care in Cancer | Ausgabe 5/2020

Einloggen, um Zugang zu erhalten

Abstract

Purpose

Medication-related osteonecrosis of the jaw (MRONJ) has been reported as a side effect of bisphosphonate (BP). The aim of this study was to identify the prevalence of MRONJ in women taking BP for osteoporosis and for metastatic breast cancer and correlate it with risk factors and biochemical markers of bone metabolism.

Methods

Patients taking oral or intravenous BP with osteoporosis (G1; n = 153; median 72.8 years) and with metastatic breast cancer (G2; n = 134; median 58.2 years) had their hospital charts reviewed, were submitted to dental inspection, and answered a health questionnaire. Fasting blood samples were randomly collected from both groups to measure osteocalcin, carboxy-terminal cross-linking telopeptide of type I collagen, intact parathyroid hormone and procollagen type 1 amino-terminal propeptide (P1NP), 25 hydroxyvitamin D (25OHD), creatinine, and total calcium.

Results

G1 was older (p = 0.001) and had more cases of diabetes (p = 0.043). P1NP was higher (p = 0.022) and 25OHD lower (p = 0.004) in G2 compared with G1. MRONJ was not found in the G1, whereas 4 cases (3%) were detected in G2. Positive risk factors for MRONJ were number of BP doses and number of visits to the dentist and dental extractions. The biochemical parameters, however, could not identify those who developed MRONJ.

Conclusions

The prevalence of MRONJ was 3% in women with metastatic breast cancer receiving BP. No cases were identified in women receiving oral BP chronically for osteoporosis. P1NP was higher in women with metastatic breast cancer, even during treatment with antiresorptives, but could not differentiate those with MRONJ.

Fleisch H (1998) Bisphosphonates: mechanisms of action. Endocr Rev 19:80–100. https://doi.org/10.1210/edrv.19.1.0325 CrossRefPubMed

Ruggiero SL, Dodson TB, Fantasia J, Goodday R, Aghaloo T, Mehrotra B, O’Ryan F (2014) American Association of Oral and Maxillofacial Surgeons position paper on medication-related osteonecrosis of the jaw--2014 update. J Oral Maxillofac Surg 72:1938–1956. https://doi.org/10.1016/j.joms.2014.04.031 CrossRefPubMed

Migliorati CA, Siegel MA, Elting LS (2006) Bisphosphonate-associated osteonecrosis: a long-term complication of bisphosphonate treatment. Lancet Oncol 7:508–514. https://doi.org/10.1016/s1470-2045(06)70726-4 CrossRefPubMed

Marx RE (2003) Pamidronate (Aredia) and zoledronate (Zometa) induced avascular necrosis of the jaws: a growing epidemic. J Oral Maxillofac Surg 61:1115–1117. https://doi.org/10.1016/S0278-2391(03)00720-1 CrossRefPubMed

Khan AA, Morrison A, Hanley DA, Felsenberg D, McCauley LK, O'Ryan F, Reid IR, Ruggiero SL, Taguchi A, Tetradis S, Watts NB, Brandi ML, Peters E, Guise T, Eastell R, Cheung AM, Morin SN, Masri B, Cooper C, Morgan SL, Obermayer-Pietsch B, Langdahl BL, al Dabagh R, Davison KS, Kendler DL, Sándor GK, Josse RG, Bhandari M, el Rabbany M, Pierroz DD, Sulimani R, Saunders DP, Brown JP, Compston J, on behalf of the International Task Force on Osteonecrosis of the Jaw (2015) Diagnosis and management of osteonecrosis of the jaw: a systematic review and international consensus. J Bone Miner Res 30:3–23. https://doi.org/10.1002/jbmr.2405 CrossRefPubMed

Lee SH, Chang SS, Lee M, Chan RC, Lee CC (2014) Risk of osteonecrosis in patients taking bisphosphonates for prevention of osteoporosis: a systematic review and meta-analysis. Osteoporos Int 25:1131–1139. https://doi.org/10.1007/s00198-013-2575-3 CrossRefPubMed

Kumar SK, Gorur A, Schaudinn C, Shuler CF, Costerton JW, Sedghizadeh PP (2010) The role of microbial biofilms in osteonecrosis of the jaw associated with bisphosphonate therapy. Curr Osteoporos Rep 8:40–48. https://doi.org/10.1007/s11914-010-0008-1 CrossRefPubMed

Bugueno JM, Migliorati CA (2017) AAOM clinical practice statement: subject: the use of serum C-terminal telopeptide cross-link of type 1 collagen (CTX) testing in predicting risk of osteonecrosis of the jaw (ONJ). Oral Surg Oral Med Oral Pathol Oral Radiol 124:367–368. https://doi.org/10.1016/j.oooo.2017.07.011 CrossRef

Peisker A, Raschke GF, Fahmy MD, Guentsch A, Roshanghias K, Konig KC, Schultze-Mosgau S (2018) Cross-sectional study of four serological bone turnover markers for the risk assessment of medication-related osteonecrosis of the jaw. J Craniofac Surg 29:e137–e140. https://doi.org/10.1097/scs.0000000000004224 CrossRefPubMed

10.

Lorenzo-Pouso AI, Pérez-Sayáns M, González-Palanca S, Chamorro-Petronacci C, Bagán J, García-García A (2019) Biomarkers to predict the onset of biphosphonate-related osteonecrosis of the jaw: a systematic review. Med Oral Patol Oral Cir Bucal 24:e26–e36. https://doi.org/10.4317/medoral.22763 CrossRefPubMedPubMedCentral

11.

Patel CG, Yee AJ, Scullen TA, Nemani N, Santo L, Richardson PG, Laubach JP, Ghobrial IM, Schlossman RL, Munshi NC, Anderson KC, Raje NS (2014) Biomarkers of bone remodeling in multiple myeloma patients to tailor bisphosphonate therapy. Clin Cancer Res 20:3955–3961. https://doi.org/10.1158/1078-0432.ccr-14-0434 CrossRefPubMed

12.

Oremek G, Sauer-Eppel H, Klepzig M (2007) Total procollagen type 1 amino-terminal propeptide (total P1NP) as a bone metastasis marker in gynecological carcinomas. Anticancer Res 27:1961–1962PubMed

13.

Moraschini V, de Almeida DCF, Figueredo CM, Calasans-Maia MD (2019) Association between biomarkers and medication-related osteonecrosis of the jaws: a systematic review. Oral Surg Oral Med Oral Pathol Oral Radiol 127:504–515. https://doi.org/10.1016/j.oooo.2019.02.014 CrossRefPubMed

14.

Advisory Task Force on Bisphosphonate-Related Ostenonecrosis of the Jaws, American Association of Oral and Maxillofacial Surgeons (2007) American Association of Oral and Maxillofacial Surgeons position paper on bisphosphonate-related osteonecrosis of the jaws. J Oral Maxillofac Surg 65:369–376. https://doi.org/10.1016/j.joms.2006.11.003 CrossRef

15.

Ruggiero SL (2015) Medication-related osteonecrosis of the jaw(MRONJ) that is linked to the treatment of malignant. Introduction. Oral Maxillofac Surg Clin North Am 27:ix. https://doi.org/10.1016/j.coms.2015.08.005 CrossRef

16.

Ruggiero SL (2015) Diagnosis and staging of medication-related osteonecrosis of the jaw. Oral Maxillofac Surg Clin North Am 27:479–487. https://doi.org/10.1016/j.coms.2015.06.008 CrossRefPubMed

17.

Meneghini LS, Nogueira GT, Tavares LB, Albergaria B, Veloso TRG, de Alencar CO, Bianchi PR (2017) Evaluation of risk factors for osteonecrosis in patients using biophosphonates in HUCAM / UFES. Braz J Periodontol

18.

Saad F, Brown JE, Van Poznak C et al (2012) Incidence, risk factors, and outcomes of osteonecrosis of the jaw: integrated analysis from three blinded active-controlled phase III trials in cancer patients with bone metastases. Ann Oncol 23:1341–1347. https://doi.org/10.1093/annonc/mdr435 CrossRefPubMed

19.

Cuevas-Gonzalez MV, Diaz-Aguirre CM, Echevarria YPE, Cuevas-Gonzalez JC (2016) Prevalence of osteonecrosis of the jaw and oral characteristics of oncologic patients treated with bisphosphonates at the General Hospital of Mexico. J Korean Assoc Oral Maxillofac Surg 42:365–369. https://doi.org/10.5125/jkaoms.2016.42.6.365 CrossRefPubMedPubMedCentral

20.

Matsuo A, Hamada H, Takahashi H, Okamoto A, Kaise H, Chikazu D (2016) Evaluation of dental implants as a risk factor for the development of bisphosphonate-related osteonecrosis of the jaw in breast cancer patients. Odontology 104:363–371. https://doi.org/10.1007/s10266-015-0207-4 CrossRefPubMed

21.

de Lima PB, Brasil VL, de Castro JF, de Moraes Ramos-Perez FM, Alves FA, Pontual MLDA, Perez DEDC (2015) Knowledge and attitudes of Brazilian dental students and dentists regarding bisphosphonate-related osteonecrosis of the jaw. Support Care Cancer 23:3421–3426. https://doi.org/10.1007/s00520-015-2689-6 CrossRefPubMed

22.

Rodrigues F, Carrion SJ, Mármora A, Câmara B, Silva MB (2014) A questionnaire survey on the knowledge regarding bisphosphonates and implant dentistry: indications, uses, and jaw-associated osteonecrosis at Porto Alegre – Brazil. ImplantNews 11:69–76

23.

Baim S, Miller PD (2009) Assessing the clinical utility of serum CTX in postmenopausal osteoporosis and its use in predicting risk of osteonecrosis of the jaw. J Bone Miner Res 24:561–574. https://doi.org/10.1359/jbmr.090203 CrossRefPubMed

24.

dal Pra KJ, Lemos CA, Okamoto R, Soubhia AM, Pellizzer EP (2017) Efficacy of the C-terminal telopeptide test in predicting the development of bisphosphonate-related osteonecrosis of the jaw: a systematic review. Int J Oral Maxillofac Surg 46:151–156. https://doi.org/10.1016/j.ijom.2016.10.009 CrossRefPubMed

25.

Lehrer S, Montazem A, Ramanathan L, Pessin-Minsley M, Pfail J, Stock RG, Kogan R (2008) Normal serum bone markers in bisphosphonate-induced osteonecrosis of the jaws. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 106:389–391. https://doi.org/10.1016/j.tripleo.2008.01.033 CrossRefPubMed

26.

Marx RE, Cillo JE Jr, Ulloa JJ (2007) Oral bisphosphonate-induced osteonecrosis: risk factors, prediction of risk using serum CTX testing, prevention, and treatment. J Oral Maxillofac Surg 65:2397–2410. https://doi.org/10.1016/j.joms.2007.08.003 CrossRefPubMed

27.

Thumbigere-Math V, Michalowicz BS, Hughes PJ, Basi DL, Tsai ML, Swenson KK, Rockwell L, Gopalakrishnan R (2016) Serum markers of bone turnover and angiogenesis in patients with bisphosphonate-related osteonecrosis of the jaw after discontinuation of long-term intravenous bisphosphonate therapy. J Oral Maxillofac Surg 74:738–746. https://doi.org/10.1016/j.joms.2015.09.028 CrossRefPubMed

28.

Heim N, Warwas FB, Wilms CT, Reich RH, Martini M (2017) Vitamin D (25-OHD) deficiency may increase the prevalence of medication-related osteonecrosis of the jaw. J Craniomaxillofac Surg 45:2068–2074. https://doi.org/10.1016/j.jcms.2017.09.015 CrossRefPubMed

Titel: Prevalence and risk factors of medication-related osteonecrosis of the jaw in osteoporotic and breast cancer patients: a cross-sectional study
verfasst von: Ana Laura Soares
Sérgio Simon
Luiz Henrique Gebrim
Afonso Celso P. Nazário
Marise Lazaretti-Castro
Publikationsdatum: 29.08.2019
Verlag: Springer Berlin Heidelberg
Erschienen in: Supportive Care in Cancer / Ausgabe 5/2020
Print ISSN: 0941-4355
Elektronische ISSN: 1433-7339
DOI: https://doi.org/10.1007/s00520-019-05044-0

Neu im Fachgebiet Onkologie

Wo hapert es noch bei der Umsetzung der POMGAT-Leitlinie?

03.05.2024 DCK 2024 Kongressbericht

Seit November 2023 gibt es evidenzbasierte Empfehlungen zum perioperativen Management bei gastrointestinalen Tumoren (POMGAT) auf S3-Niveau. Vieles wird schon entsprechend der Empfehlungen durchgeführt. Wo es im Alltag noch hapert, zeigt eine Umfrage in einem Klinikverbund.

Bestrahlung nach Prostatektomie: mehr Schaden als Nutzen?

02.05.2024 Prostatakarzinom Nachrichten

Eine adjuvante Radiotherapie nach radikaler Prostata-Op. bringt den Betroffenen wahrscheinlich keinen Vorteil. Im Gegenteil: Durch die Bestrahlung steigt offenbar das Risiko für Harn- und Stuhlinkontinenz.

ASS schützt nicht vor Brustkrebsrezidiven

02.05.2024 Mammakarzinom Nachrichten

Nützt nichts und ist vielleicht sogar schädlich: In einer Phase-3-Studie konnten täglich 300 mg ASS keine Brustkrebsrezidive bei Frauen vermeiden, die ein hohes Risiko für eine Tumorrückkehr aufwiesen. Tendenziell traten unter ASS sogar häufiger Rezidive auf als unter Placebo.

CUP-Syndrom: Künstliche Intelligenz kann Primärtumor finden

30.04.2024 Künstliche Intelligenz Nachrichten

Krebserkrankungen unbekannten Ursprungs (CUP) sind eine diagnostische Herausforderung. KI-Systeme können Pathologen dabei unterstützen, zytologische Bilder zu interpretieren, um den Primärtumor zu lokalisieren.

Bildnachweise

Frau nutzt Gehhilfe /© Photographee.eu / Fotolia (Symbolbild mit Fotomodellen), Darstellung der Dosisverteilung bei Bestrahlung eines Prostatakarzinoms/© Degener, S et al. / all rights reserved Springer Medizin Verlag GmbH, Frau mit Tablette und Wasserglas in Händen/© fizkes / stock.adobe.com (Symbolbild mit Fotomodell), Ärztin und künstliche Intelligenz sehen sich Befunde an/© Alexander Limbach / Zoonar/picture alliance (Symbolbild mit Fotomodell)

Live-Webinar "Chronische Unterbauch- und Viszeralschmerzen in der Praxis managen"

Springer Medizin

Prevalence and risk factors of medication-related osteonecrosis of the jaw in osteoporotic and breast cancer patients: a cross-sectional study