Colocación de implantes en paciente con antecedentes de toma de bifosfonatos / Placement of implants in a patient with a history of bisphosphonates taken

El uso de bifosfonatos es un excelente tratamiento para pacientes con artritis reumatoide y enfermedades óseas, por ejemplo, osteoporosis. Se realiza un reporte de caso de paciente femenino, quien estuvo bajo consumo de este fármaco por prescripción de su médico para la prevención de artritis reumatoide postmenopausia. La paciente acude a consulta para la colocación de implantes en zona desdentada y comenta haber terminado el tratamiento de bifosfonatos hace un año. Se tomaron pruebas de diagnóstico y se realizó la colocación de implantes sin ninguna complicación. Sus citas de control fueron más frecuentes en cuatro meses, sobre todo por el detalle de consumo de bifosfonatos, pero en ninguna cita hubo algún detalle alarmante, la cicatrización iba en forma. Se dio de alta a la paciente después de sus citas periódicas y de asegurar su buena cicatrización a un implante bien situado (AU))

The use of bisphosphonates is an excellent treatment for patients with rheumatoid arthritis and bone diseases such as osteoporosis. Here is a case report of a female patient, who was under consumption of this drug by prescription of her doctor for the prevention of post-menopausal rheumatoid arthritis. The patient went to the consultation for the placement of implants in the edentulous area and comments having finished the bisphosphonate treatment one year ago. The diagnostic tests were taken, and the implant placement was performed well without any complications. The control appointments were more frequent in four months, especially due to the detail of bisphosphonate consumption, but in no appointment, there were any alarming details, the healing was in good shape. The patient discharged after her regular appointments and to ensure that she was healing well and that implant was well placed (AU)

Conocimiento y conciencia de los médicos sobre la osteonecrosis relacionada con bifosfonatos / Knowledge and awareness of physicians about bisphosphonate-related osteonecrosis of the jaws

Objetivo: Determinar el conocimiento y la conciencia que tienen los médicos sobre la osteonecrosis relacionada con bifosfonatos. Material y métodos: Se realizó un estudio transversal, en el cual se encuestó a médicos generales y especialistas con la finalidad de identificar el nivel de conocimientos y conciencia que tienen sobre el tema. Resultados: Se entrevistó a un total de 475 médicos generales y especialistas, de los cuales 210 (44.2%) mencionaron prescribir bifosfonatos, de este grupo 58.1% no envía a los pacientes con el odontólogo para eliminar factores de riesgo, a pesar de que 61.8% de los mismos mencionó conocer las reacciones adversas; 36 médicos (17.4%) han visto a algún paciente con osteonecrosis por bifosfonatos. El 37% de los médicos que prescriben medicamentos consideran que no es necesario remitir a los pacientes al odontólogo. Conclusiones: La prescripción de bifosfonatos en la práctica médica va en aumento, los médicos deben tener el conocimiento adecuado sobre las reacciones adversas de estos medicamentos para así poder referir oportunamente al odontólogo, educar al paciente y poder prevenir complicaciones como la osteonecrosis relacionada con bifosfonatos (AU)

Objectives : To evaluate the knowledge and awareness of physicians about bisphosphonate-related osteonecrosis of the jaws. Material and methods: A cross-sectional survey was carried out among general practitioners and specialized physicians to determine their knowledge and awareness of bisphosphonate-related osteonecrosis of the jaws. Results: Of the 475 interviewed general practitioners and specialized physicians, 210 (44.2%) claimed to prescribe bisphosphonates. A total of 58.1% of these physicians did not refer their patients to the dentist for the elimination of risk factors, despite the fact that 61.8% of them reported knowledge of the adverse reactions of these drugs. Thirty-six physicians (17.4%) had seen some patient with bisphosphonate-related osteonecrosis of the jaws. A total of 37% of the physicians that prescribed drugs considered it not necessary to refer patients to the dentist. Conclusions: Bisphosphonate prescription is increasingly common in medical practice, and physicians must have adequate knowledge of the adverse reactions of these drugs in order to ensure opportune patient referral to the dentist, educate their patients, and avoid complications such as bisphosphonate-related osteonecrosis of the jaws (AU)

Osteonecrosis asociada a pacientes con consumo de antirresortivos bajo tratamiento oncológico / Osteonecrosis associated to patients who take anti-resorptive drugs, undergoing oncologic treatment

La Asociación Americana de Cirugía Oral y Maxilofacial (American Association of Oral and Maxillofacial Surgeons [AAOMS]): define el concepto de osteonecrosis maxilar asociada a drogas antirresortivas (MRONJ) como: «área ósea necrótica expuesta al medio bucal con más de ocho semanas de permanencia, en presencia de tratamiento crónico con bifosfonatos en ausencia de radioterapia en cabeza y cuello¼. El objetivo de este artículo es asociar la enfermedad oncológica en relación con las drogas antirresortivas consumidas por pacientes, la prescripción de dichas drogas y el depósito de ellas en el organismo. Al mismo tiempo, la interacción médico-odontológico debe implementarse en favor de la salud de nuestros pacientes (AU)

American Association of Oral and Maxillofacial Surgeons AAOMS defined Medication Related of the Jaw (MRONJ) as «necrotic bone area exposed to the oral environment with more than eight weeks of permanence, in the presence of chronic treatment with BPs, in the absence of radiation therapy to the head and neck¼. The objective of this article is associate oncology antiresorptives treatments prescribed by physicians, their prescription and body accumulation in patients whose are treated with them. Interdisciplinary dental and physician clinical treatments must be implemented in patient favours (AU)

Actualización de medicamentos asociados a necrosis avascular de los maxilares: perspectiva y revisión de literatura / Update of medications associated with avascular necrosis of the jaws: a perspective and literature review

La osteonecrosis de los maxilares está definida como la exposición de hueso necrótico en la región maxilofacial al menos por ocho semanas en pacientes que están recibiendo medicamentos antirresortivos para el tratamiento del cáncer primario o metastásico hacia el hueso, osteoporosis o enfermedad de Paget, sin historia previa de radiación. Desde el año 2003, la terminología utilizada estaba en relación con los bifosfonatos, en la actualidad ha sido introducido el término osteonecrosis de los maxilares relacionada por medicamentos (OMAM). La cirugía oral (implantología o cirugía periapical) incrementa el riesgo de OMAM, así como los desbalances concomitantes de la salud oral (inflamación dental y formación de abscesos). Las estrategias conservadoras en el tratamiento varían desde el cuidado local conservador hasta la resección quirúrgica radical del hueso necrótico. En el presente artículo se expone un análisis sistemático retrospectivo de la literatura en páginas como PubMed, ScienceDirect y Springer, Cochrane Library. Con el objetivo de resaltar el aumento de la incidencia de OMAM a nivel mundial con el uso de antirresortivos y otros medicamentos asociados en su patogenia en el Hospital Regional «General Ignacio Zaragoza¼ del ISSSTE, UNAM, en la Ciudad de México (AU)

Osteonecrosis of the jaws is defined as the exposure of necrotic bone in the maxillofacial region for at least 8 weeks in patients receiving antiresorptive medications for the treatment of primary or metastatic cancer towards the bone, osteoporosis, or Paget's disease, without previous history of radiation. Since 2003, the terminology used was related to bisphosphonates, the term medication-related osteonecrosis of the jaws has now been introduced. Oral surgery (implantology or periapical surgery) increases the risk of avascular necrosis, as well as concomitant imbalances in oral health (dental inflammation and abscess formation). Conservative strategies in treatment vary from conservative local care to radical surgical resection of the necrotic bone. In this article, a systematic retrospective analysis of the literature is presented on pages such as PubMed, Science Direct and Springer, Cochrane Library. And in which the objective is to highlight the increase in the incidence of medication related osteonecrosis of the jaws worldwide with the use of antiresorptive, and other associated medications in its pathogenesis at the Hospital Regional «General Ignacio Zaragoza¼ ISSSTE, UNAM in Mexico City (AU)

Evaluation of a collagen matrix in a mandible defect in rats submitted to the use of bisphosphonates

Abstract Purpose: To assess the effect of a collagen matrix (Mucograft®) on the inflammatory process in a semi-critical experimental defect model in rats treated with bisphosphonates. Methods: Eighteen Wistar rats were randomly divided into three groups: saline (CG), alendronate (ALD) 5mg/kg (AG) or zoledronic acid (ZA) 0.2mg/kg (ZG). ALD was administered orally for 10 weeks and ZA was administered intravascularly on days 0, 7 and 14 and 49. On day 42, a 2mm defect was created and filled with Mucograft® collagen matrix. The contralateral side was filled with a clot (control side). The animals were euthanized 70 days after the beginning of the experiment and the hemimandibles were radiographically and histologically (counting of empty osteocyte lacunae (%), apoptotic (%) and total osteoclasts, neutrophil and mononuclear inflammatory cells) analyzed. The variables were submitted to ANOVA/Bonferroni and t test (parametric data) (p <0.05, GraphPad Prism 5.0). Results: Significant bone repair occurred in the groups treated with Mucograft®. High number of total inflammatory cells and neutrophils cells were showed in AG (p=0.026 and p=0.035) and AZ groups (p=0.005, p=0.034) on the control sides associated with delayed bone repair and the presence of devitalized bone tissue in AG and ZG on the Mucograft® side. Conclusion: Mucograft® collagen matrix attenuated the inflammatory process in a mandible defect in rats submitted to the use of bisphosphonates (AG and ZG).

Agentes antirresortivos y antiangiogénicos y su relación con la osteonecrosis de los maxilares asociada a medicamentos / Antiresorptive and antiangiogenic agents and their relationship with osteonecrosis of the jaws related to medication

El objetivo de este trabajo es revisar los conocimientos actuales sobre el manejo clínico-odontológico de pacientes que consumen medicamentos antirresortivos y medicamentos antiangiogénicos o quimioterapéuticos, en relación con la prevención y/o el tratamiento de la osteonecrosis de los maxilares asociada a medicamentos. Se evaluaron similitudes y diferencias entre los bifosfonatos, denosumab y medicamentos antiangiogénicos, así como el manejo clínico de pacientes, vacaciones de medicamentos y el manejo de osteonecrosis de los maxilares ya instalada. Se encontraron similitudes en la presentación clínica, la prevención, el uso de antibioticoterapia antes de procedimientos invasivos y el tratamiento de la osteonecrosis ya instalada. Entre las diferencias, podemos mencionar que el tratamiento quirúrgico respondería mejor en pacientes medicados con denosumab o antiangiogénicos, y su suspensión sería más efectiva si se iniciara un proceso de osteonecrosis, al igual que su tasa de resolución. En cuanto a las vacaciones de medicamentos, no hay datos concluyentes para guiar esta decisión, al igual que no existe un protocolo clínico de atención en pacientes que consumen denosumab o antiangiogénicos (AU)

The aim of this study is to review the currents knowledge about the clinical and dental management of patients who consume antiresorptive and antiangiogenic agents or chemotherapeutic drugs, in relation to the prevention and/or treatment of osteonecrosis of the jaws related to medication. Similarities and differences between bisphosphonates, denosumab and antiangiogenic medications were evaluatted, as well as the clinical management of patients, drugs holidays and management of osteonecrosis of the jaws already setted. Similarities were found in the clinical presentation, prevention, use of antibiotic therapy before invasive procedures and the treatment of osteonecrosis already installed. Regarding the differences, we can mention that the surgical treatment would be better in patients medicated with denosumab or antiangiogenics and its suspension would be more effective if an osteonecrosis process is initiated, as well as its resolution rate. There are no conclusive data about drug holidays to guide this decision, and no clinical protocol of care in patients who consume denosumab or antiangiogenic agents (AU)

Terapia láser de baja frecuencia en el manejo del dolor en pacientes con osteonecrosis mandibular / Low level laser therapy in the management of pain in patients with osteonecrosis of the jaw

La terapia láser de baja frecuencia (TLBF) o fotobioestimulación es aquella que cuya luz provoca la regeneración y remodelación ósea, la restauración de la función neural, la disminución del dolor y la modulación del sistema inmune; esta terapia es un coadyuvante junto a la terapia conservadora y/o quirúrgica. Se considera un estándar de oro para el manejo del dolor en la osteonecrosis en aquellos pacientes que consumen o han consumido bifosfonatos como terapia para inhibir la resorción ósea. La Sociedad Americana de Investigación de Hueso y Minerales (SAIHM) definió la osteonecrosis mandibular como «un área de hueso expuesto en la región maxilofacial que no cicatriza dentro de las ocho semanas posteriores a la identificación, en un paciente que está recibiendo o ha estado expuesto a bifosfonatos y que no ha recibido radioterapia en la región craneofacial¼. En este reporte presentamos dos casos de pacientes con osteonecrosis mandibular relacionada a bifosfonatos tratados con TLBF. Se evaluó el dolor antes y después de la terapia con la escala visual análoga (EVA). Ambos casos tuvieron disminución del dolor al 100%. Se presentan los métodos de diagnóstico clínico y radiográfico, el tratamiento elegido y los resultados obtenidos (AU)

Low level laser therapy (LLLT) or photobiostimulation is one whose light causes bone regeneration and remodeling, restoration of neural function, reduction of pain, and modulation of the immune system; this therapy is an adjuvant together with conservative and / or surgical therapy. It is considered a gold standard for pain management in osteonecrosis in those patients who consume or have used bisphosphonates as antiresorptive therapy. The American Society for Bone and Mineral Research (ASBMR) defined osteonecrosis of the jaw as «an area of exposed bone in the maxillofacial region that does not heal within eight weeks after identification by a health care provider, in a patient who was receiving or had been exposed to a BP and who has not received radiation therapy to the craniofacial region¼. In this report we present two cases of patients with mandibular osteonecrosis related to bisphosphonates treated with LLLT. Pain before and after visual analogue scale (VAS) was evaluated. Both cases had pain reduction at 100%. The methods of clinical and radiographic diagnosis, the treatment chosen and the results obtained are presented (AU)

El tratamiento con bifosfonatos mejora la calidad de vida en pacientes con diagnóstico de osteogénesis imperfecta / Treatment with bisphosphonates improves the quality of life in patients with diagnosis of osteogenesis imperfecta

Resumen: Introducción: La osteogénesis imperfecta (OI) es un grupo heterogéneo de enfermedades hereditarias, las cuales cursan con la presencia de fragilidad ósea, fracturas frecuentes, deformidades óseas y talla baja. El tratamiento con bifosfonatos en los pacientes con diagnóstico de OI ha demostrado un decremento en la frecuencia de fracturas, así como una mejoría en la densidad ósea vertebral. Existe poca evidencia sobre la calidad de vida en pacientes con OI posterior al tratamiento con bifosfonatos. ¿Los bifosfonatos mejoran la calidad de vida de los pacientes con OI? Material y métodos: Se trata de un ensayo prospectivo, de intervención deliberada, ensayo clínico autocontrolado. Nueve pacientes que se encontraban entre las edades de dos y 13 años con diagnóstico de OI fueron tratados con ácido zolendrónico. Se realizó una medición de la calidad de vida en los pacientes previa y posteriormente. Para la medición de la calidad de vida de los pacientes utilizamos la encuesta de calidad de vida PedsQL 4.0 que fue aplicada tanto a los niños como a los padres. Resultados: En la encuesta de calidad de vida efectuada a los padres se observó un incremento en las cuatro dimensiones evaluadas. En la encuesta realizada a los niños se apreció un aumento en dos dimensiones. El número de fracturas disminuyó posterior al tratamiento. Conclusiones: Existe una correlación entre la disminución del número de fracturas y la percepción que tienen tanto los padres como los niños en la calidad de vida posterior al tratamiento con bifosfonatos.

Abstract: Introduction: Osteogenesis imperfeta (OI) is defined as a heterogeneous group of hereditary diseases, which present with the presence of bone fragility, frequent fractures, bone deformities and short stature. Treatment with biphosfonates in patients with diagnosis of OI has shown a decrease in the frecuency of fractures, as well as an improvement in vertebral bone density. There is little evidence on quality of life in patients diagnosed with OI treated with bisphosphonates, Therefore this study evaluated the quality of life of patients diagnosed with OI after treatment with bisphosphonates. Material and methods: It is a prospective, deliberate intervention, self-controlled clinical trial. Nine patients with ages between two and thirteen ages and diagnosed with OI were treated with Zolendronic, a quality of life measurement was performed in the patients before and after the application. For measuring the quality of life in the patients we used the PedsQL 4.0 quality of life survey that was applied to both children and parents. Results: In the quality of life survey performed on the parents, an increase was observed in the four dimensions evaluated. In the survey made on the children two dimensions showed a significant increase. The number of fractures decreased after the treatment. Conclusions: There is a correlation between the decrease in the number of fractures and the perception that both parents and children have in the quality of life after treatment with bisphosphonates.

Effect of 1% sodium alendronate in the non-surgical treatment of periodontal intraosseous defects: a 6-month clinical trial

Abstract Background and objectives Few studies have evaluated the effect of the topical application of sodium alendronate (ALN) on the treatment of intrabuccal bone defects, especially those caused by periodontitis. This 6-month randomized placebo controlled clinical trial aimed at evaluating the effect of non-surgical periodontal treatment associated with the use of 1% ALN, through clinical evaluations and cone-beam computed tomography (CBCT). Material and Methods Twenty individuals with chronic periodontitis underwent periodontal examination at the baseline as well as 3 and 6 months after periodontal treatment, registering clinical attachment level (CAL), periodontal probing depth (PPD), and bleeding on probing (BOP) as the clinical outcomes. After manual scaling and root planing, 40 bilateral sites with interproximal vertical bone defects were randomly treated with either 1% ALN gel or a placebo. Bone defects were evaluated through CBCT at the baseline and 6 months post-treatment. The clinical and CBCT parameters were compared using the Wilcoxon and Friedman tests (p<0.05). Results Although ALN produced a greater CAL gain when compared to the placebo at 6 months post-treatment (p=0.021), both treatments produced similar effects on the PPD, BOP, and bone height. Significant differences in bone fill were observed only in patients of the ALN group (4.5 to 3.8 mm; p=0.003) at 6 months post-treatment. Conclusions Topical application of 1% ALN might be a beneficial adjuvant to non-surgical periodontal therapy.

Enfermedad de paget ósea: breve revisión de la literatura a propósito de un caso / Paget ́s bone disease: case report and brief literature review

La osteítis deformante o enfermedad de Paget es un trastorno óseo, crónico, poco frecuente en Chile, que puede afectar típicamente a pacientes después de los 55 años. Su etiología es probablemente multifactorial: actualmente se considera como posiblemente implicados factores ambientales y genéticos.La mayor parte de los pacientes son asintomáticos. Los diagnósticos habitualmente se realizan en base a hallazgos radiológicos. Cuando existen síntomas, suelen ser dolor y/o deformidad ósea. Pueden comprometerse uno o varios huesos.Ante su sospecha clínica, la exploración diagnóstica requiere de al menos el estudio con radiografías simples de las lesiones sospechosas, cintigrama óseo y parámetros de actividad metabólica ósea; recomendándose los niveles séricos de fosfatasas alca-linas, por su bajo costo y elevada disponibilidad.Las metástasis óseas condensantes son un importante diagnóstico diferencial a con-siderar.Sobre el tratamiento, se recomienda el uso de fármacos antirresortivos como terapia específica, y el uso de ortesis y terapia física.El seguimiento es clínico y con biomarcadores de recambio óseo.

Osteitis-deformans or Paget's disease is a chronic bone disorder uncommon in Chile, with a typical presentation after age 55. Its etiology is probably multifactorial: It is actualy considered that environmental and genetic factors are mainly involved.Most patients are asymptomatic. Diagnoses are usualy performed based on radio-logical findings. When symptoms exist, they are pain and/or bone deformity. One or several bones can be affects.If it ́s suspect, the diagnostic exploration requires at least the study with x-rays of the suspicious lesions, bone scintigraphy and parameters of bone metabolic activity, being recommended the serum levels of alkaline phosphatases, for its low cost and high availability.Condensing bone metatases have to be considered like an important differential di-agnosis.For the treatment, the use of antiresorptive drugs as specific therapy is recommend-ed, and the use of orthotics and physical therapy.Follow-up is made with clinical findings and with biomarkers of bone turnover.

Osteonecrosis de los maxilares inducida por bifosfonatos

La osteonecrosis de los maxilares inducida por bifosfonatos es una reacción adversa asociada al uso a largo plazo de estos fármacos; se caracteriza por la presencia de hueso expuesto o necrótico en la región maxilar, y/o mandibular la cual se desarrolla en la gran mayoría de los casos posterior a la realización de un tratamiento dental invasivo. No se conocen aún detalles importantes sobre su etiopatogenia; sin embargo, se ha logrado establecer asociaciones con ciertos factores de riesgo. Uno de los aspectos más relevantes en relación con la osteonecrosis de los maxilares inducida por bifosfonatos es su prevención, la cual actualmente en Costa Rica es muy escasa, por lo que existe una necesidad manifiesta de capacitación en el tema para los profesionales del área de la salud.

Osteonecrosis of the jaw induced by bisphosphonates is an undesirable effect associated with long term use of these drugs, is characterized by the presence of exposed and/or necrotic bone in the maxillar and/or mandibular region, which develops in the majority of cases after performing an invasive dental treatment. Many important details about its pathogenesis are still unknown, however there have been established partnerships with certain risk factors. One of the most important aspects related to osteonecrosis of the jaws induced by bisphosphonate is prevention, which currently in Costa Rica is low, therefore there is a clear need for training health professionals in the subject.

Osteonecrosis del maxilar inferior por bifosfonatos: Presentación de caso / Osteonecrosis of the jaw secondary to bisphosphonates. A case report

La osteonecrosis del maxilar inferior secundaria a la administración de bifosfonatos es una patología infrecuente. Se produce en los pacientes medicados con esta droga, ya sea por vía oral o endovenosa, que luego de realizarse un procedimiento odontológico presentan necrosis ósea en la mandíbula. Desde el primer reporte en el año 2003, se evidenció un crecimiento exponencial de esta patología. Presentamos dos casos clínicos de osteonecrosis del maxilar inferior por la administración de bifosfonatos, con el objetivo de difundir y crear conciencia entre los profesionales de la salud, considerando que no existe un tratamiento efectivo para esta entidad.

The osteonecrosis of the jaw originated by the biphosphonate administration is an infrequent pathology in patients under treatment with biophosphonates given orally or through parenteral administration after some odontological treatment. These patients manifested osteonecrosis of the jaw. Since the first case of osteonecrosis of the maxilar bone was reported in 2003, the number of patients with osteonecrosis of the jaw who have been treated with these drugs has increased notoriously. We report 2 clinical cases of patients with osteonecrosis of the jaw treated with bifosfonatos, in order to make this pathology known among the health professionals and raise awareness considering that there is no effective treatment.

Efecto del ácido zoledrónico en pacientes pediátricos con diagnóstico clínico de osteogénesis imperfecta: un estudio de cohorte / Effect of zoledronic acid in pediatric patients with clinical diagnosis of osteogenesis imperfecta: a cohort study

Introducción: la osteogénesis imperfecta es un trastorno congénito caracterizado por la fragilidad del hueso, causado por mutaciones en los genes del procolágeno tipo I. La incidencia es variable, encontrando un caso por cada 5.000 a 70.000 nacidos vivos. Debido a las limitaciones en el tratamiento se ha planteado el uso de bifosfonatoscomo el ácido zoledrónico. Objetivo: describir el efecto del tratamiento con ácido zoledrónico endovenosoen pacientes pediátricos con osteogénesis imperfecta atendidos en el Hospital Universitario San José (Popayán,Colombia) durante 2013 y 2014. Materiales y métodos: se realizó un estudio observacional tipo cohorte de carácter cerrado y sin grupo de comparación. El tratamiento con ácido zoledrónico se realizó trimestralmente durante un año, tiempo en el que se determinaron los efectos positivos y adversos del tratamiento. Resultados: seis pacientes presentaron diagnóstico de osteogénesis imperfecta; uno fue excluido porque inició tratamiento quirúrgico, los demás iniciaron tratamiento con ácido zoledrónico. Un paciente se retiró voluntariamente y cuatro completaron el estudio, dos sin fracturas y dos con una fractura durante este período. La densidad mineral ósea de la columna lumbar y femoral presentó mejoría, documentándose en dos pacientes valores normales a los tres meses de finalizado el tratamiento. La intensidad del dolor óseo, según la escala visual análoga al inicio del estudio, fue entre 5 y 8, y al final entre 0 y 2. No se encontraron cambios en la limitación funcional ni efectos adversos...

Introduction: osteogenesis imperfecta is a congenital disorder characterized by bone fragility, caused by mutationsin genes encoding the type I procollagen. The incidence is variable with ranges reported from one case per 5,000 to 70,000 live births. Due to limitations in the treatment, it has proposed the use of bisphosphonate as zoledronic acid. Objective: to describe the effect of treatment with intravenous zoledronic acid in of pediatric patients diagnosed with osteogenesis imperfecta attended at the Hospital Universitario San José (Popayán Colombia) between 2013 and 2014. Material and methods: an observational cohort study, closed and without comparison group was conducted. The zoledronic acid treatment was conducted quarterly for one year and during this time the positive and adverse effects of treatment were determined. Results: six patients had a diagnosis of osteogenesis imperfecta, of which one was excluded because it began surgical treatment, and five of them started treatment with zoledronic acid; subsequently, one patient voluntarily withdrew from the study found. From the four patients who completed one year of treatment with zoledronic acid, two not showed fractures during it and the other two each presented one fracture. Bone mineral density of the lumbar spine and femoral showed improvement; having two patients in the normal range at three months of treatment ends. According to the visual analogue scale, bone pain intensity at baseline ranged between 5 and 8, and at the end between 0 and 2. Regarding functional limitation were not found significant changes nor adverse effects were found throughout follow-up...

Effect of Teriparatide on Healing of Atypical Femoral Fractures: A Systemic Review

BACKGROUND: Bisphosphonates (BPs) are the most commonly used anti-osteoporotic drugs, which have been proven to reduce the risk of osteoporotic fractures. However, use of BPs, particularly for long periods of time, is associated with an increased risk of atypical femoral fracture (AFF). Healing of BP-associated AFF is usually delayed because of suppressed bone turnover. Teriparatide (TPTD), a recombinant form of parathyroid hormone (PTH), enhances bone healing in patients with delayed healing or non-union. METHODS: In this study, we summarized and performed a systemic review of the published literature on treatment of AFF using TPTD. RESULTS: Although there is a lack of level 1 studies on the evidence of TPTD in promoting bone union in AFFs, this systemic review of the available literature revealed that TPTD works positively in AFFs, and we put together the evidence that TPTD is a viable treatment option for enhancing fracture healing in AFFs. CONCLUSIONS: While anecdotal evidence of beneficial effects of TPTD on fracture healing offer limited guidance for clinical decision making, a better understanding of the role of TPTD in fracture healing may be elucidated with future prospective trials.

Association between the efficacy of alendronate and serum level of vitamin D in patients with osteoporosis / 中华内分泌代谢杂志

Objective To examine the association between vitamin D and alendronate response,and to investigate the proper vitamin D levels for the efficacy of alendronate treatment of osteoporosis.Methods In this retrospective study,559 post-menopausal women with osteoporosis were devided into two groups:non-responders and responders,based on the European Study of Forsteo (EUROFORS).Demographic and clinical data including mean 25-hydroxy vitamin D (25-OHD) levels between dual-energy X-ray absorptiometry (DEXA) scans were obtained.Mean 25-OHD levels were compared between responders and non-responders and multiple logistic regression analysis was performed to identify factors associated with non-response.Results There were 437 (75.5％) responsers to alendronate therapy and 142 (24.5％) non-responders.Responders with a mean serum 25-OHD level of (59.96 ±12.56) nmol/L,obtained a more favorable result than non-responders,whose serum 25-OHD level was (47.50 ±9.92) nmol/L (P＜0.01).25-OHD level was significantly associated with response.Conclusion Patients with a mean 25-OHD ≥50 nmol/L had a substantially greater likelihood of maintaining bisphosphonate response.

Significance of prostate specific antigen and markers of bone formation and resorption in evaluation of efficacy of bone metastasis treatment in prostate cancer patients / 中华老年医学杂志

Objective To evaluate the significances of prostate specific antigen (PSA)and alkaline phosphatase(ALP) as a marker of bone formation and tartrate-resistant acid phosphatase 5b (TRACP5b)and pyridinoline cross-linked carboxy-terminal telopeptide of type Ⅰ collagen(ICTP)as markers of bone resorption in predicting therapeutic effect of bone metastasis of prostate cancer patients.Methods Serum levels of PSA,tALP,TRACP5b and ICTP in 57 elderly patients aged 61-90 years with prostate cancer were determined by electrochemiluminescence,colorimetric assay,enzyme linked immunosorbent assays(ELISA)respectively.The correlation between the duration of ADT and the concentrations of each marker index (ln-transformed) was analyzed by Pearson correlation analysis.All prostate cancer patients with bone metastasis were divided into group A (patients without bisphosphonates,n =13),group B (patients with stable bone metastasis and bisphosphonates,n=6) and group C (patients with severe bone metastasis and bisphosphonates,n=8).The concentration of each bone metabolic marker was compared between the three groups.Results Pearson correlation analysis showed that serum concentrations of PSA,ALP and ICTP had no significant correlations with the duration of ADT,but TRACP5b concentration (ln transformed) had a significant positive correlation with the duration of ADT (ln transformed) (R =0.421,P＜ 0.01).The concentrations of PSA,TRACP5b and tALP were increased in group C as compared with group A,but only TRACP5b concentration had a significant difference between group A and C (P＜ 0.05).The concentrations of PSA,tALP,ICTP and TRACP5b were significantly increased in group C as compared with group B (all P＜0.05).Conclusions PSA and bone resorption and formation markers can be excellent monitors of therapeutic effect-relating bone metabolism changes during castration and bisphosphonate treatment in prostate cancer patients with bone metastasis,and TRACP5b may be more sensitive.

The use of bisphosphonates in dental clinic: a review of the last five years / O uso de bisfosfonatos na clinica dentária: uma revisão dos últimos cinco anos

The bisphosphonates are synthetic drugs used for treatment of neoplasms and bone, Paget’s disease and more reason for excitement in cases of postmenopausal osteoporosis. These drugs present some known side effects, however, a new complication with oral manifestation was recently identified, called Osteonecrosis. When this necrosis of the bone bases is associated to the use of Bisphosphonates, it is named Osteonecrosis by Bisphosphonates. The type of bisphosphonate, route of administration, and duration of treatment with these drugs seem to have direct relation with the incidence of osteonecrosis associated with bisphosphonates. The aim of this work was to present a review of the last five years about the use of bisphosphonates, the available bisphosphonate groups in the Brazilian market emphasizing those used in the treatment of Osteonecrosis, and exploring possible diagnostic aspects of the disease from image Diagnostics. It is concluded the impact of current world life stimulates new research areas focusing on important illnesses, their manifestations, and on searching for better treatment protocols and faster diagnosis protocols, aiming reduce possible treatment unwanted side effects

Os bisfosfonatos são drogas sintéticas usadas no tratamento de neoplasias de osso, doença de Paget e nos casos de osteoporose pós-menopáusica. Estas drogas apresentam alguns efeitos colaterais conhecidos, no entanto, uma nova complicação com manifestação oral foi recentemente identificada, chamada osteonecrose. Quando a necrose das bases ósseas está associada à utilização de bisfosfonatos, é nomeada osteonecrose por bisfosfonatos. O tipo de Bisfosfonato, a via de administração e duração do tratamento com estes medicamentos parecem ter uma relação direta com a incidência da osteonecrose. O objetivo deste trabalho foi apresentar uma revisão dos últimos cinco anos sobre o uso de Bisfosfonatos e os grupos de Bifosfonatos disponíveis no mercado brasileiro, enfatizando aqueles usados no tratamento da osteonecrose, além de explorar possíveis aspectos de diagnóstico da doença por meio de imagem. Conclui-se que novas áreas de pesquisa, com foco em doenças importantes e as suas manifestações, estão buscando melhores protocolos no tratamento e diagnóstico rápido, visando reduzir possíveis efeitos colaterais indesejados

Osteonecrose mandibular associada ao uso de bifosfonato: relato de caso / Biphosphonate related osteonecrosis of the jaw: case report

Introdução: os bifosfonatos são um grupo de medicamentos utilizados no tratamento de doenças malignas metastáticas e em outras doenças ósseas como osteoporose e doença de Paget. Seu mecanismo de ação reduz a reabsorção óssea, a inibição do recrutamento e promoção da apoptose de osteoclastos. Apesar dos grandes benefícios para pacientes nestas condições, uma complicação associada ao seu uso é aosteonecrose dos maxilares. Objetivo: relatar um caso clínico envolvendo um paciente do sexo masculino de 72anos, sob tratamento endovenoso mensal com ácido zoledrônico, que evoluiu com osteonecrose espontânea bilateral em região posterior mandibular após um ano sob uso desta medicação. Conclusão: a conscientização dos Cirurgiões Dentistas quanto à etiologia da osteonecrosee a manutenção de ótima higiene oral nos pacientes sob uso destes medicamentos são fundamentais na prevenção da ocorrência desta condição.

Introduction: Biphosphonates are a group of drugs used to treat metástases associated with breast or prostate cancer and other bone diseases, including osteoporosis and Paget disease. They inhibit bone resorption through na action on osteoclasts slowing their activity and inducing apoptosis. Despite the benefits of biphosphonates, osteonecrosis of the jaw (ONJ) has emerged as a serious complication in some patients treated with these drugs. Aim: a case report of a 72-year-old male treated with zoledronic acid for one year that presented spontaneous bilateral ONJ is presented. Conclusion: the awareness of the dentists regarding the etiology of the ONJ and the maintenance of a great oral hygine by the patients under these medications are essencial for preventing this condition.

Osteonecrosis maxilar: una problemática onco-odontológica / Maxillary osteonecrosis: an onco-odontologic problematic

Los bifosfonatos fueron sintetizados en el siglo XIX por químicos alemanes, los cuales buscaban prevenir el depósito industrial de carbonato de calcio en sus chimeneas. Más tarde se observó la gran afinidad de la droga con el tejido óseo y que además inhibía la conversión de fosfato de calcio amorfo a hidroxiapatita (HA), lo cual reducía la velocidad de disolución de los cristales óseos. Por lo antedicho, estos compuestos sintéticos son utilizados hace más de tres décadas para el tratamiento de desórdenes esqueletales: osteoporosis, enfermedad de Paget, hipercalcemia asociada a mieloma múltiple y metástasis óseas propias de cáncer de próstata y mama, osteogénesis imperfecta y displasia fibrosa. Recientemente se han descripto algunos casos de osteonecrosis maxilar a causa de tratamiento crónico con bifosfonatos, a altas dosis en la prescripción de dichas drogas utilizadas como terapéutica oncológica.

Biphosphonates, synthesized in the mid 19th century by German chemists, were initially used in industry due to their capacity to prevent the deposits of calcium carbonate, which made them especially useful in avoiding the deposit of calcium salt in pipes. Later it was shown that they had great affinity with osseous tissue, where they inhibitedthe conversion of amorphous calcium phosphate in hydroxyapatite and they reduced the dissolution speed o the later. Biphosphonates are synthetics compounds used in the treatment of various metabolic and malignant bone diseases: Osteoporosis, Paget Disease, Hypercalcemia, Multiple Mieloma, Metastatic breast cancer and Metastatic prostate cancer, Osteogenesis Imperfecta, Fibrous Dysplasia. Recently, have been described some cases of Osteonecrosis of the jaw because of biphosphonate treatment in high doses for oncology administration.

Evaluación del uso de ácido zoledrónico en pacientes con cáncer de mama metastásico a hueso / Assessment on zoledronic acid use in patients with bone metastatic breast cancer

OBJETIVO: Los bifosfonatos constituyen una piedra angular en el tratamiento de las metástasis óseas. En este trabajo se evalúa la eficacia y seguridad del uso del ácido zoledrónico (AZ) en pacientes con cáncer de mama metastásico (CMM) a hueso. MÉTODOS: Se realizó un estudio retrospectivo y descriptivo de pacientes tratadas en el Servicio de Oncología del Hospital "Hermanos Ameijeiras" (HHA), desde octubre del 2006 hasta diciembre del 2007, con confirmación histológica de CMM óseo y tratadas con AZ. La supervivencia (SV) global y el tiempo para la aparición de nuevos eventos esqueléticos (EER) fue estimada usando el método de Kaplan-Meier. Para la comparación de las medias se utilizó el test de comparación (Wilcoxon) para muestras relacionadas. Para la evaluación de la respuesta al dolor se utilizó la escala visual analgésica (EVA). RESULTADOS: Las medianas de SV y del tiempo para la aparición de algún EER fueron de 33,82 meses y de 27,82 meses, respectivamente. El 50 por ciento de las pacientes presentaban dolor severo (EVA ³ 7), al inicio del tratamiento, y a los 12 meses, el 66,6 por ciento obtuvieron EVA=0 (p=0,021). En el 42,3 por ciento se reportó un síndrome pseudogripal luego de la primera infusión. No hubo toxicidad hematológica, ni variaciones significativas de los valores de fosfatasa alcalina, LDH, y creatinina. No se reportó ningún caso de insuficiencia renal. CONCLUSIONES: Este estudio constituye el primer reporte en Cuba de la utilización del AZ en cáncer. Se demostró la eficacia del AZ en reducir los EER, el tiempo de aparición de estos, incremento de la SV, así como la reducción del dolor e incremento de la calidad de vida. El AZ tiene un buen perfil de seguridad

OBJECTIVE: the biphosphonates are the cornerstone in the bone metastases treatment. In present paper the effectiveness and safety of the zoledronic acid (ZA) use in patients with bone metastatic breast cancer (MBC). METHODS: a descriptive and retrospective study was conducted in patients seen in Oncology Service of the ½Hermanos Ameijeiras» Clinical Surgical Hospital from October, 2006 to December, 2007 with histological confirmation of MBC treated with ZA. Global survival and appearance time of new skeletal events (SE) was estimated using the Kaplan-Meier method. For means comparison we used the comparison test (Wilcoxon) in related samples. To assessment of pain response the analgesic visual scale (AVS). RESULTS: the survival means and the appearance time of some SE were of 33.82 months and of 27.72 months, respectively. The 50 percent of patients showed AVS ³ 7 at treatment onset, and at 12 months, the 66.6 percent had AVS =0 (p=0.021). In the 42.3 percent was present a flu-like syndrome after the first infusion. There was not hematologic toxicity or significant variations of alkaline phosphatase values, LDH and creatinine. No case of renal failure. CONCLUSIONS: present paper is the first report in Cuba on use of ZA in cancer cases. The ZA effectiveness to reduce the SEs was demonstrated, as well as the appearance time of such events, the survival rise, the pain decrease and the quality of life increase. ZA has a good safety profile