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1.
Medicina (B.Aires) ; 81(5): 767-773, oct. 2021. graf
Article in Spanish | LILACS | ID: biblio-1351049

ABSTRACT

Resumen El tumor de células gigantes óseo es una neoplasia de agresividad local intermedia, que raramente metastatiza. En los últimos años el denosumab, anticuerpo monoclonal humano, surgió como una alternativa de tratamiento para esta enfermedad, al bloquear el comportamiento lítico tumoral. El objetivo de este trabajo fue determinar sus indicaciones y efectos adversos, analizando también los resultados oncológicos, y las tasas de recurrencia local en pacientes con diagnóstico de tumor de células gigantes óseo que recibieron denosumab como tratamiento neoadyuvante. Entre 2010 y 2018 se analizaron 80 pacientes con tumor de células gigantes, de los cuales 14 recibieron denosumab como tratamiento neoadyuvante. El seguimiento mínimo fue 12 meses. En 8 pacientes se trató de un tumor primario, mientras que 6 fueron pacientes con recidiva tumoral. En todos los casos se evidenció una mejoría clínica. Trece presentaron cambios radiográficos, y 11 respuesta histológica completa. En 6 de 14 pacientes se evidenció una recurrencia local y en 7 se identificó al menos un efecto adverso relacionado con el denosumab (incluyendo una malignización tumoral). A pesar de ser una herramienta útil para el tratamiento del tumor de células gigantes, el uso de denosumab está asociado a mayor tasa de recurrencias locales y no está exento de efectos adversos.


Abstract Giant cell tumor of bone is an intermediate, locally aggressive and rarely metastasiz ing, primary bone neoplasia. In recent years denosumab emerged as a treatment alternative for this pathology. The objective of this work was to analyze its indications as well as the clinical outcomes, side effects and local recurrence rates in patients diagnosed with giant cell tumor of bone, who received denosumab as neoadjuvant treatment. Between 2010 and 2018, 80 patients with giant cell tumor were analyzed, of whom 14 received deno sumab as a neoadjuvant treatment. The minimum follow-up was 12 months. In 8 patients it was a primary tumor, while 6 showed tumor recurrence. In all cases, clinical improvement was evident. Thirteen patients presented radiographic changes, and 11 showed complete histological response. A local recurrence was evidenced in 6 of 14 patients, and at least one adverse effect related to denosumab (including tumor malignancy) was identified in 7. Despite being a useful tool for treating giant cell tumor, the use of denosumab is associated with a higher rate of local recurrences and is not free of adverse effects.


Subject(s)
Humans , Bone Neoplasms/drug therapy , Bone Neoplasms/diagnostic imaging , Giant Cell Tumor of Bone/drug therapy , Giant Cell Tumor of Bone/diagnostic imaging , Bone Density Conservation Agents/adverse effects , Denosumab/adverse effects , Neoplasm Recurrence, Local/drug therapy
2.
Medicina (B.Aires) ; 81(5): 749-753, oct. 2021. graf
Article in English | LILACS | ID: biblio-1351046

ABSTRACT

Abstract Anabolic drugs are the treatment of choice for osteoporotic patients with very high risk of fractures. Post anabolic treatment with an antiresorptive drug maintains the bone mineral density (BMD) gained. The recommendations regarding the ideal antiresorptive drug are not precise. The aim of this paper is to compare the usefulness of zoledronate and denosumab in a group of 28 women with very high risk of fractures. All of them completed at least one year of treatment with teripatide and latter 14 received zolendronate and 14 denosumab for another year. We retrospectively review their biochemical and densitometric changes. Both treat ment groups experienced a reduction in bone turnover markers of the same magnitude at the end of the second year. In Lumbar Spine BMD increase of 3.96 ± 8.56% Median (Me) 2.54 p = 0.21 in zolendronate group and 3.55 ± 5.36% (Me 5.14) p = 0.07 in denosumab group. Femoral Neck BMD changed -0.09 ± 6.50% (Me 0.29) p = 0.85 in zolendronate group, and - 3.41 ± 5.08% (Me 5.35) p = 0.59 in denosumab group, with no difference between both groups. In Total Hip BMD an increase of 0.55 ± 4.20% (Me 0.43) p = 0.70 in zoledronate group, and 4.53 ± 5.13% (Me 0.64) p = 0.04 with denosumab. We conclude that both antiresortive treatments have a similar effect in biochemical markers after one year of treatment. BMD increase significantly in total hip and changed with a trend toward in lumbar spine with denosumab, but without differences between both groups of treatment.


Resumen Los anabólicos son el tratamiento de elección en la osteoporosis con muy alto riesgo de fracturas. Después del tratamiento anabólico un fármaco antirresortivo mantiene la densidad mineral ósea (DMO) ganada. Las reco mendaciones sobre el fármaco antirresortivo ideal no son precisas. El objetivo de este trabajo es comparar la utilidad de zoledronato y denosumab en un grupo de 28 mujeres con muy alto riesgo de fracturas. Todas ellas completaron al menos un año de tratamiento con teripatide y luego 14 recibieron zolendronato y 14 denosumab durante un año. Revisamos retrospectivamente sus cambios bioquímicos y densitométricos. Ambos grupos de tratamiento experimentaron una reducción de los marcadores de recambio óseo de la misma magnitud al final del segundo año. En columna lumbar la DMO aumentó 3.96 ± 8.56% Mediana (Me) 2.54, p = 0.21 en el grupo zolendronato y 3.55 ± 5.36% (Me 5.14) p = 0.07 en el grupo denosumab. La DMO del cuello femoral cambió -0.09 ± 6.50% (Me 0.29) p = 0.85 en el grupo zolendronato y - 3.41 ± 5.08% (Me 5.35) p = 0.59 en el grupo de denosumab, sin diferencias entre ambos grupos. En la Cadera Total la DMO aumentó 0.55 ± 4.20% (Me 0.43) p = 0.70 con zoledronato y 4.53 ± 5.13% (Me 0.64) p = 0.04 con denosumab. Concluimos que ambos tratamien tos antiresortivos tuvieron un efecto similar en los marcadores bioquímicos después de un año de tratamiento. La DMO aumentó significativamente en la cadera total y mostró una tendencia similar en columna lumbar con denosumab, sin diferencias entre ambos tratamientos.


Subject(s)
Humans , Female , Teriparatide/therapeutic use , Bone Density Conservation Agents/therapeutic use , Bone Density , Retrospective Studies , Denosumab/therapeutic use
3.
Rev. Ateneo Argent. Odontol ; 64(1): 22-27, 2021. ilus, tab
Article in Spanish | LILACS | ID: biblio-1248381

ABSTRACT

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)


Subject(s)
Humans , Female , Diphosphonates/adverse effects , Bone Density Conservation Agents/adverse effects , Bisphosphonate-Associated Osteonecrosis of the Jaw , Radiotherapy/adverse effects , Breast Neoplasms/complications , Risk Factors , Diphosphonates/pharmacokinetics , Interprofessional Relations
4.
Article in English | WPRIM | ID: wpr-878439

ABSTRACT

The morbidity rate of medication-related osteonecrosis of the jaws (MRONJ) increased rapidly in recent years. Thusfar, the mechanism of MRONJ has no consensus. The possible mechanisms may include bone remodeling inhibition theory, angiogenesis inhibition theory, oral microorganism infection theory, immunosuppression theory, cytotoxicity-targeted oral epithelial cells, microcrack formation of maxillary or mandibular bone, and single nucleotide polymorphism. However, the efficacy of prevention and treatment based on a single mechanism is not ideal. Routine oral examination before MRONJ-related drug treatment, treatment of related dental diseases, and regular oral follow-up during drug treatment are of great significance for the prevention of MRONJ. During the treatment of MRONJ, the stage of MRONJ must be determined accurately, treatment must be standardized in accordance with the guidelines, and personalized adjustments must be made considering the specific conditions of patients. This review aimed to combine the latest research and guidelines for MRONJ and the experiences on the treatment of MRONJ in the Maxillofacial Surgery Department of West China Hospital of Stomatology, Sichuan University, and discuss the strategies to improve the clinical process.


Subject(s)
Bisphosphonate-Associated Osteonecrosis of the Jaw/prevention & control , Bone Density Conservation Agents , Bone Remodeling , China , Humans , Jaw
5.
Rev. Ateneo Argent. Odontol ; 63(2): 13-17, nov. 2020. ilus
Article in Spanish | LILACS | ID: biblio-1150415

ABSTRACT

La acción terapéutica favorable que los antirresortivos (bifosfonatos BPs, denosumab DS) y drogas antiangiogénicas ocasionan en el tejido óseo en aquellos pacientes que presentan como causa etiológica cáncer o discrasias óseas incluyen hipercalcemias malignas o ­si requieren el consumo de dicha droga a baja concentración­ como ser: osteoporosis, osteopenia, enfermedad de Paget, displasia fibrosa, Osteogénesis Imperfecta. (1) La presente actualización pretende relacionar el tratamiento odontológico con prescripción crónica y drogas antirresortivas, para lo cual 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. La AAOMS estableció los siguientes grupos de acuerdo con sus características clínicas en 4 estadios (0, 1 ,2 y 3) de acuerdo con el aspecto clínico y radiológico de la lesión osteonecrótica. Estadío 0: lesión osteonecrótica sin evidencia de hueso necrótico en pacientes bajo consumo de drogas antirresortivas. Estadío 1: lesión osteonecrótica con signos clínicos y ausencia de sintomatología clínica. Estadío 2: lesión osteonecrótica con signo y sintomatología clínica evidente. Estadío 3: lesión osteonecrótica con signo y sintomatología evidente que compromete a estructuras nobles: fracturas patológicas, anestesia del nervio dentario inferior, comunicación buco-nasal, comunicación buco-sinusal, fístulas cutáneas (2) (AU)


It is known the favourable action which antiresorptive (Bisphosphonates BPs, Denosumab: DS) and Antiangiogenic drugs produce in bone tissue. High concentrations are primarily used as an effective treatment in the management of cancer-related disorders, including hypercalcemia of malignant. Besides, low concentrations are used for other metabolic bone diseases including Osteoporosis, Osteopenia, Paget's Disease, Fibrous Dysplasia, Imperfect Osteogenesis. (1) The update relate relationship between dentistry and chronic treatment with antiresorptive drugs. According to the American Association of Oral and Maxillofacial Surgeons (AAOMS), MRONJ is defined as exposed or necrotic bone in the maxillofacial region that has persisted for more than 8 weeks in association with current or previous BPs or DS therapy and with a lack of head and neck radiotherapy. AAOMS divided the MRONJ into 4 stages (0,1, 2 and 3) according to the clinical and radiological aspect of the osteonecrotic lesion: Stage 0: osteonecrotic lesion without sign-pathognomonic evidence of osteonecrosis. Stage 1: osteonecrotic lesion with clinical signs and absence of clinical symptoms. Stage 2: osteonecrotic lesion with sign and evident clinical symptoms. Stage 3: osteonecrotic lesion with signs and evident symptoms that involve noble structures: pathological fractures, anaesthesia of the lower dental nerve, oral-nasal communication, oral-sinus communication, skin fistulas (2) (AU)


Subject(s)
Humans , Female , Aged , Bone Resorption , Diphosphonates/adverse effects , Bone Density Conservation Agents , Bisphosphonate-Associated Osteonecrosis of the Jaw , Bone Diseases , Dental Care for Chronically Ill , Angiogenesis Inhibitors , Denosumab , Mouthwashes/therapeutic use
6.
Säo Paulo med. j ; 138(4): 326-335, July-Aug. 2020. tab, graf
Article in English | LILACS, SES-SP | ID: biblio-1139704

ABSTRACT

ABSTRACT BACKGROUND: Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is still the most prevalent type of osteonecrosis with clinical relevance. In Brazil, bisphosphonate use is high but there is a lack of epidemiological studies on BRONJ. OBJECTIVE: To determine the clinical profile of BRONJ in a Brazilian population through an integrative review. DESIGN AND SETTING: Integrative review of BRONJ in a Brazilian population. METHODS: Cases and clinical research on Brazilians with BRONJ between 2010 and 2019, indexed in PubMed/MEDLINE, Scopus, Web of Science and LILACS were reviewed. Age, sex, type and time of bisphosphonate intake, administration route, related diseases, region of the BRONJ, diagnostic criteria, staging, triggering factor and type of treatment were analyzed. RESULTS: Fifteen articles on 128 subjects were included. Most patients were women (82.03%); the mean age was 63 years. Intravenous zoledronic acid was mostly used (62.50%), for breast cancer treatment (46.87%). The main localization of BRONJ was the mandible (54.68%), associated mainly with tooth extractions (45.98%). The diagnostic criteria were clinical (100%) and radiographic (89.06%), mostly in stage II (68.08%). The surgical treatments were sequestrectomy (37.50%) and platelet-rich plasma (PRP) (36.71%). Microbial control was done using chlorhexidine (93.75%) and infection control using clindamycin (53.90%). CONCLUSIONS: BRONJ had higher prevalence in Brazilian women receiving treatment for breast cancer and osteoporosis. The mandible was the region most affected with a moderate stage of BRONJ, particularly when there were histories of tooth extraction and peri-implant surgery. Sequestrectomy with additional drugs and surgical therapy was the treatment most accomplished.


Subject(s)
Humans , Female , Middle Aged , Tooth Extraction , Diphosphonates/adverse effects , Bone Density Conservation Agents/adverse effects , Bisphosphonate-Associated Osteonecrosis of the Jaw/surgery , Osteoporosis/drug therapy , Brazil , Breast Neoplasms/drug therapy , Dental Care , Treatment Outcome , Angiogenesis Inhibitors , Diphosphonates/administration & dosage , Bone Density Conservation Agents/administration & dosage , Bisphosphonate-Associated Osteonecrosis of the Jaw/etiology , Bisphosphonate-Associated Osteonecrosis of the Jaw/diagnostic imaging
7.
Article in Portuguese | LILACS, ColecionaSUS, CONASS, SES-GO | ID: biblio-1118551

ABSTRACT

Tecnologia: Denosumabe e bifosfonados. Indicação: tratamento de osteoporose para prevenção de fraturas. Pergunta: O denosumabe é mais eficaz e seguro que os bifosfonados orais para tratamento da osteoporose e prevenção de fraturas secundárias à osteoporose? Métodos: Levantamento bibliográfico realizado na PUBMED seguindo estratégia de busca predefinida. Avaliação da qualidade metodológica das revisões sistemáticas com a ferramenta AMSTAR (Assessing the Methodological Quality of Systematic Reviews). Resultados: Foram selecionadas e incluídas 3 revisões sistemáticas, com pontuação de 9 a 11 no AMSTAR. Conclusão: Denosumabe tem menor risco relativo que alendronato e risedronato de sódio para fraturas vertebrais e maior efeito sobre densidade óssea mineral femoral, com risco similar de outros tipos de fratura e eventos adversos (infecções, transtornos cardiovasculares, óbito por infecção, morte cardiovascular ou por qualquer causa). Denosumabe evita 0,00154 fraturas, previne 0,00025 institucionalizações (ou cuidados permanentes de enfermagem no domicílio) e promove um ganho de 0,0018 anos de vida a mais que o alendronato de sódio por paciente tratado. Denosumabe é um pouco mais eficaz e tão seguro quanto os bifosfonados, mas a diferença de eficácia é mínima


Technology: Denosumab and bisphosphonates. Indication: osteoporosis treatment for fracture prevention. Question: Denosumab is more effective and safer than oral bisphosphonates for treating osteoporosis and preventing fractures related to osteoporosis? Methods: Bibliographic search was performed on PUBMED, following predefined search strategies. Evaluation of the methodological quality of systematic reviews was carried out using the AMSTAR (Assessing the Methodological Quality of Systematic Reviews) tool. Results: We selected and included 3 systematic reviews. Their scores ranged from 9 to 11 on AMSTAR. Conclusion: Denosumab has a lower relative risk than sodium alendronate and risedronate for vertebral fractures and greater effect on femoral mineral bone density, with a similar risk for non-vertebral fractures and adverse events (infections, cardiovascular disorders, death caused by infection, cardiovascular death or any cause mortality). Denosumab avoids 0.00154 fractures, prevents 0.00025 nursing home/ residential care admissions and get 0.0018 years of life gained per treated patient more than sodium alendronate. Denosumab is slightly more effective and as safe as bisphosphonates, but the effectiveness difference is minimal


Subject(s)
Humans , Osteoporosis/drug therapy , Alendronate/therapeutic use , Bone Density Conservation Agents/therapeutic use , Osteoporotic Fractures/prevention & control , Risedronic Acid/therapeutic use , Denosumab/therapeutic use , Treatment Outcome , Alendronate/adverse effects , Evidence-Based Medicine , Risedronic Acid/adverse effects , Denosumab/adverse effects
8.
J. appl. oral sci ; 28: e20200204, 2020. tab, graf
Article in English | LILACS, BBO | ID: biblio-1134802

ABSTRACT

Abstract Objective This study aims to evaluate bone repair and the development of the medication related osteonecrosis of the jaw (MRONJ) associated with the use of zoledronic acid in Wistar rats. Methodology 48 male Wistar rats were divided into four groups: ZA, treated with intraperitoneal zoledronic acid, 0.6 mg/kg every 28 days, totaling five doses; control (C), treated with 0.9% sodium chloride; ZA-surgical (SZA) and C-surgical (SC), submitted to extraction of the right upper molars 45 days after the first application. Alveolar bone repair was evaluated by macroscopic and histological analysis. Protein expression evaluations were performed by qPCR. Results Macroscopic evaluation showed that 91.66% (11) of the animals in the SZA group and 41.66% (5) from the SC group presented solution of epithelium continuity (P<0.05). All animals in the SZA group and none in the SC group had bone sequestration. The area of osteonecrosis was higher in the SZA group than in the SC group (P<0.05). In molecular evaluation, the SZA group presented changes in the expression of markers for osteoclasts, with increased RANK and RANKL, and a decrease in OPG. Conclusion The results highlighted strong and evident interference of zoledronic acid in bone repair of the socket, causing osteonecrosis and delayed bone remodeling.


Subject(s)
Animals , Male , Rats , Bone Density Conservation Agents/adverse effects , Bisphosphonate-Associated Osteonecrosis of the Jaw/physiopathology , Zoledronic Acid/adverse effects , Tooth Extraction/adverse effects , Rats, Wistar
9.
Article in English | WPRIM | ID: wpr-880846

ABSTRACT

Medication-related osteonecrosis of the jaw (MRONJ) is a serious side effect of bone-modifying agents and inhibits angiogenesis agents. Although the pathogenesis of MRONJ is not entirely clear, multiple factors may be involved in specific microenvironments. The TGF-β1 signalling pathway may have a key role in the development of MRONJ. According to the clinical stage, multiple variables should be considered when selecting the most appropriate treatment. Therefore, the prevention and management of treatment of MRONJ should be conducted in patient-centred multidisciplinary team collaborative networks with oncologists, dentists and dental specialists. This would comprise a closed responsibility treatment loop with all benefits directed to the patient. Thus, in the present review, we aimed to summarise the pathogenesis, risk factors, imaging features, clinical staging, therapeutic methods, prevention and treatment strategies associated with MRONJ, which may provide a reference that can inform preventive strategies and improve the quality of life for patients in the future.


Subject(s)
Bisphosphonate-Associated Osteonecrosis of the Jaw/prevention & control , Bone Density Conservation Agents/adverse effects , Humans , Quality of Life , Risk Factors
10.
Article in English | WPRIM | ID: wpr-811185

ABSTRACT

BACKGROUND: Adequate suppression of bone turnover rate is important to decrease fracture risk without mineralization defect due to oversuppression. This study was performed to determine reference intervals (RIs) for 2 bone turnover markers, serum C-terminal telopeptide of type I collagen (CTX) and osteocalcin, in Korean women.METHODS: A total of 461 Korean women (287 premenopausal and 174 postmenopausal) without any disease or drug history affecting bone metabolism was included. Serum CTX and osteocalcin were measured after overnight fasting. Bone mineral density (BMD) was measured at the 1st to 4th lumbar vertebra using dual energy X-ray absorptiometry. Subjects with normal spinal BMD (T-score ≥−1.0) were included in this study.RESULTS: After stable concentrations were maintained, both CTX and osteocalcin were abruptly increased in 50 to 59 years, and then decreased with increasing age. Median levels and interquartile range of serum CTX and osteocalcin in all subjects were 0.322 (0.212–0.461) ng/mL and 15.68 (11.38–19.91) ng/mL. RIs for serum CTX and osteocalcin in all subjects were 0.115 to 0.861 ng/mL and 6.46 to 36.76 ng/mL. Those were higher in postmenopausal women (CTX, 0.124–1.020 ng/mL, osteocalcin, 5.42–41.57 ng/mL) than in premenopausal women (CTX, 0.101–0.632 ng/mL, osteocalcin, 6.73–24.27 ng/mL). If we use target reference levels as lower half of premenopausal 30 to 45 years in patients with antiresorptive drugs, those were 0.101 to 0.251 ng/mL and 6.40 to 13.36 ng/mL.CONCLUSIONS: We established RIs for serum CTX and osteocalcin in healthy Korean women with normal lumbar spine BMD. Premenopausal RIs for serum CTX and osteocalcin would be useful to monitor patients with low bone mass using osteoporosis drugs.


Subject(s)
Absorptiometry, Photon , Biomarkers , Bone Density , Bone Density Conservation Agents , Bone Remodeling , Collagen Type I , Fasting , Female , Humans , Metabolism , Miners , Osteocalcin , Osteoporosis , Reference Values , Spine
11.
Article in Chinese | WPRIM | ID: wpr-827513

ABSTRACT

Osteonecrosis of the jaw could occur after intake of bisphosphonate drugs, which are widely used to treat osteoporosis and bone metastasis of malignant tumors. This effect has aroused concern among dentists. In this paper, a case of bisphosphonate-related osteonecrosis caused by implant is reported, and the pathogenesis, diagnosis, prevention, and treatment of bisphosphonate drug-induced osteonecrosis are described through a literature review. The effects of bisphosphonate drug treatment on dental implants are also discussed.


Subject(s)
Bisphosphonate-Associated Osteonecrosis of the Jaw , Bone Density Conservation Agents , Dental Implants , Diphosphonates , Humans , Osteoporosis
12.
J. bras. nefrol ; 41(2): 304-305, Apr.-June 2019. graf
Article in English | LILACS | ID: biblio-1012531

ABSTRACT

Abstract Mineral bone disorder is a common feature of chronic kidney disease. Lion face syndrome is rare complication of severe hyperparathyroidism in end-stage renal disease patients, which has been less commonly reported due to dialysis and medical treatment advances in the last decade. The early recognition of the characteristic facial deformity is crucial to prompt management and prevent severe disfigurement. The authors present a rare case of severe hyperparathyroidism presenting with lion face syndrome and bone fractures.


Resumo O distúrbio mineral e ósseo é uma característica comum da doença renal crônica. A síndrome da face leonina é uma complicação rara do hiperparatireoidismo grave em pacientes com doença renal terminal, que tem sido menos relatada devido aos avanços na diálise e tratamento médico na última década. O reconhecimento precoce da deformidade facial característica é crucial para estimular o tratamento precoce e prevenir a desfiguração severa. Os autores apresentam um caso raro de hiperparatireoidismo grave, apresentando síndrome da face leonina e fraturas ósseas.


Subject(s)
Humans , Female , Adult , Chronic Kidney Disease-Mineral and Bone Disorder/complications , Hyperostosis Frontalis Interna/diagnosis , Hyperostosis Frontalis Interna/etiology , Kidney Failure, Chronic/complications , Postoperative Complications/drug therapy , Bone Density , Hyperostosis Frontalis Interna/surgery , Ergocalciferols/therapeutic use , Calcium/therapeutic use , Parathyroidectomy/adverse effects , Renal Dialysis , Treatment Outcome , Teriparatide/therapeutic use , Fractures, Bone/diagnosis , Bone Density Conservation Agents/therapeutic use , Hypocalcemia/etiology , Hypocalcemia/drug therapy
13.
Article in Chinese | WPRIM | ID: wpr-773883

ABSTRACT

OBJECTIVE@#To study and compare the clinical effects of Rehmannia Decoction and alendronate sodium for the treatment of primary osteoporosis.@*METHODS@#From January 2016 to December 2017, 72 patients with primary osteoporosis who took Dihuang Decoction(DHD) orally and alendronate regularly for more than one year were randomly divided into 2 groups:experimental group and control group. The experimental group consisted of 14 males and 22 females, with an average age of(63.97±3.70) years old. The patients in the experimental group took Chinese medicine DHD, one dose each time, one time in the morning and one time in the evening, twice a week. The control group consisted of 16 males and 20 females with an average age of(63.36±3.07) years old. Patients in the control group were given alendronate 70 mg orally once a week. The basic treatment for osteoporosis remained unchanged in both groups(600 mg of calcium carbonate D3 and 0.5 μg of calcitriol capsules were taken daily). Bone mineral density (BMD) of femoral neck and lumbar vertebrae was measured by dual energy X-ray absorptiometry before and after treatment for one year. The levels of serum collagen type I C-terminal peptide (beta-CTX) and serum osteoclast (SOST) were measured before and after treatment for two groups.@*RESULTS@#The age, bone mineral density, SOST and beta-CTX baseline values between the two groups before and after anti-osteoporosis treatment were compared. The difference was not statistically significant(>0.05). Compared with the two groups, the BMD of femoral neck and lumbar vertebrae were increased after 1 year of anti-osteoporosis treatment. The differences were statistically significant (0.05). The serum beta-CTX values were compared between the two groups after treatment. The value was 0.908. The serum SOST values were compared between the two groups after treatment. The value was 0.888. The difference was not statistically significant (>0.05).@*CONCLUSIONS@#In this study, traditional Chinese medicine DHD is used to treat osteoporosis. It is found that DHD and alendronate have a good effect. The DHD can be used as a choice of Chinese medicine in the treatment of primary osteoporosis.


Subject(s)
Absorptiometry, Photon , Aged , Alendronate , Therapeutic Uses , Bone Density , Bone Density Conservation Agents , Therapeutic Uses , Female , Humans , Male , Middle Aged , Osteoporosis , Drug Therapy
14.
Article in Chinese | WPRIM | ID: wpr-773486

ABSTRACT

OBJECTIVE@#To investigate the effects of continuous pumping of teriparatide (TPTD) on bone metabolism in ovariectomized and normal mice and provide experimental evidence for the selection of animal models for studying the effects of TPTD and its related peptides on osteoclasts.@*METHODS@#Twenty-four female C57BL mice (6-weeks old) were subjected to ovariectomy (OVX) or sham operation followed 7 days later by continuous pumping of TPTD or the solvent vehicle (VEH) a micropump (SHAM-VEH, SHAM-TPTD, OVX-VEH, and OVX-TPTD groups; =6). Two weeks later, the tibial and femoral bones were harvested for micro-CT scanning to measure the parameters of the tibia and the femoral cortical bone. Histopathological examinations of the tibial tissue were conducted using HE staining and TRAP staining and the number of osteoclasts and the growth plate thickness were determined. The serum Ca2 + levels of the mice were measured. The primary osteoblasts from the cranial bone were treated with estradiol (E2) and TPTD for 48 h, and the expressions of β-catenin and RANKL protein in the cells were analyzed.@*RESULTS@#The trabecular bone mass of OVX mice was significantly lower than that of sham-operated mice ( < 0.05). Continuous TPTD pumping significantly reduced tibial cancellous bone mass and femoral cortical bone area in the sham-operated mice, while in the castrated mice, TPTD pumping increased the cancellous bone mass without changing the cortical bone area. TRAP staining showed that cancellous osteoblasts in the tibia increased significantly in the castrated mice as compared with the sham-operated mice, and TPTD pumping significantly increased the number of cancellous osteoblasts in the sham-operated mice ( < 0.05). In the primary cultured osteoblasts, treatment with both E2 and TPTD obviously lowered the expression of β-catenin and increased the expression of RANKL as compared with TPTD treatment alone.@*CONCLUSIONS@#Continuous pumping of TPTD promotes bone resorption in normal mice but does not produce obvious bone resorption effect in the ovariectomized mice, suggesting that castrated mice are not suitable models for studying the effect of TPTD and the related peptides on the osteoclasts.


Subject(s)
Animals , Bone Density , Bone Density Conservation Agents , Pharmacology , Bone Resorption , Drug Therapy , Bone and Bones , Metabolism , Female , Growth Plate , Mice , Mice, Inbred C57BL , Osteoclasts , Ovariectomy , RANK Ligand , Metabolism , Teriparatide , Pharmacology , beta Catenin , Metabolism
15.
Article in Chinese | WPRIM | ID: wpr-772671

ABSTRACT

Bisphosphonates can directly inhibit osteoclasts, which may lead to increased bone density, reduced blood flow, and osteonecrosis of the jaw. Bisphosphonate-related osteonecrosis is usually observed in the jaw bone. In this article, we report a patient with bisphosphonate-related osteonecrosis of the jaw (BRONJ) complicated with wrist scaphoid osteomyelitis. Furthermore, we introduce the pathogenesis, treatment, and prevention of BRONJ.


Subject(s)
Bisphosphonate-Associated Osteonecrosis of the Jaw , Bone Density Conservation Agents , Diphosphonates , Humans , Osteomyelitis , Wrist , Pathology
16.
Braz. oral res. (Online) ; 33: e086, 2019. tab, graf
Article in English | LILACS | ID: biblio-1019605

ABSTRACT

Abstract Treatment of patients with bisphosphonate usage is a significant concern for oral surgeons because it interferes with jaw bone turnover and regeneration. In case of adverse effects manifesting related to bisphosphonate use, oral surgeons are usually treating and keep the patient's symptoms under control. In this study, we aimed to investigate a new treatment protocol for medication-related osteonecrosis of the jaw (MRONJ). This treatment protocol consisted of administering human parathyroid hormone (hPTH) loaded chitosan microspheres which were prepared by ionotropic gelation method or/and the prepared microspheres were suspended in a poloxamer gel. After in-vitro optimization studies, the efficacy of the chosen formulations was evaluated in-vivo studies. Zoledronic acid was administered daily to forty-eight adult female Sprague-Dawley rats, divided into four experimental groups, at a daily concentration of 0.11 mg/kg over three weeks to induce the MRONJ model. At the end of this period, maxillary left molar teeth were extracted. In the first group, the subjects received no treatment. In the negative control group, poloxamer hydrogel containing empty microspheres were immediately applied to the soft tissues surrounding the extraction socket. The treatment group-1 was treated with local injections of poloxamer hydrogel containing hPTH. The treatment group-2 was treated with a single local injection of poloxamer hydrogel containing hPTH-loaded chitosan microspheres. Both treatment groups received a total of 7 µg of hPTH at the end of the treatment protocol. Our study demonstrates successful attenuation of MRONJ through a local drug delivery system combined with hPTH, as opposed to previously attempted treatment strategies.


Subject(s)
Humans , Animals , Female , Parathyroid Hormone/pharmacology , Chitosan/pharmacology , Bone Density Conservation Agents/pharmacology , Maxilla/drug effects , Parathyroid Hormone/therapeutic use , Rats, Sprague-Dawley , Poloxamer/administration & dosage , Poloxamer/chemistry , Models, Animal , Delayed-Action Preparations , Chitosan/therapeutic use , Bone Density Conservation Agents/adverse effects , Bone Density Conservation Agents/therapeutic use , Bisphosphonate-Associated Osteonecrosis of the Jaw , Bisphosphonate-Associated Osteonecrosis of the Jaw/drug therapy , Zoledronic Acid/adverse effects , Maxilla/pathology , Microspheres
17.
Braz. oral res. (Online) ; 33: e050, 2019. tab, graf
Article in English | LILACS | ID: biblio-1011654

ABSTRACT

Abstract The present study aimed to investigate the use of platelet-rich plasma (PRP) on tooth extraction sites in rats treated with bisphosphonates. Thirty Albinus Wistar male rats were administered 0.035 mg/kg zoledronic acid intravenously for 8 weeks, divided into four administrations with a 2-week interval between each application, after which their upper right central incisors were extracted to induce the development of bisphosphonate-related osteonecrosis of the jaw (BRONJ). The samples were divided into the following two groups: Group 1 (G1) underwent marginal resection of BRONJ followed by the use of PRP, while Group 2 (G2) underwent resection of BRONJ but without the use of PRP. The treatment groups were evaluated after 14, 28, and 42 days. Clinical, microtomographic, microscopic, and immunohistochemical (IHC) evaluations were performed. Microtomography results revealed no significant difference between the groups (p <0.05) in any time period. Histomorphometric analysis showed increased bone formation over time for both groups (p < 0.001). G1 demonstrated a greater amount of new bone formation than G2 at 28 and 42 days (p < 0.001), with G1 presenting greater vascularization and a slightly higher VEGF expression. For both groups, RANKL/OPG expression levels were sufficient as a parameter for indicating the rate of bone remodeling in a previously treated area of osteonecrosis groups. Taken together, our findings indicated that the use of PRP improves the resolution process of BRONJ.


Subject(s)
Animals , Male , Rats , Diphosphonates/therapeutic use , Bone Density Conservation Agents/therapeutic use , Platelet-Rich Plasma , Bisphosphonate-Associated Osteonecrosis of the Jaw/therapy , Osteoclasts/drug effects , Tooth Extraction/adverse effects , Wound Healing , Rats, Wistar , Disease Models, Animal , Bisphosphonate-Associated Osteonecrosis of the Jaw/physiopathology , Bisphosphonate-Associated Osteonecrosis of the Jaw/pathology
18.
Rev. Fac. Odontol. (B.Aires) ; 34(76): 7-15, 2019. ilus, tab
Article in Spanish | LILACS | ID: biblio-1102379

ABSTRACT

La osteonecrosis asociada a medicamentos (ONAM) es un efecto adverso poco frecuente pero potencialmente serio que afecta a pacientes que reciben o recibieron tratamiento con drogas antirresortivas o antiangiogénicas. A partir de una revisión narrativa de la literatura, el presente artículo aporta conceptos básicos e información actualizada acerca de incidencia, factores de riesgo y prevención de ONAM desde la perspectiva de la Práctica Basada en la Evidencia. Además pone en conocimiento a la comunidad profesional de la Facultad de Odontología de la Universidad de Buenos Aires acerca de las actividades de investigación clínica llevadas a cabo en este área en la Cátedra de Cirugía y Traumatología Buco-Máxilo-Facial I de nuestra casa de estudios (AU)


Medicine related osteonecrosis of the jaws (MRONJ) is a rare but potentially serious side effect experienced by patients receiving treatment with antiresorptive or antiangiogenic drugs. Through a narrative review of the literature, this paper provides basic concepts and updated data about incidence, risk factors and prevention of MRONJ from the Evidence Based Practice perspective. It also informs the professional community of the School of Dentistry of the University of Buenos Aires about the clinical research activities carried out in this area in the Oral and Maxillofacial Surgery I Department (AU)


Subject(s)
Humans , Male , Female , Risk Factors , Angiogenesis Inhibitors/adverse effects , Bone Density Conservation Agents/adverse effects , Bisphosphonate-Associated Osteonecrosis of the Jaw/prevention & control , Argentina , Schools, Dental , Societies, Dental/standards , Comprehensive Dental Care , Dental Research , Oral Surgical Procedures , Evidence-Based Dentistry , Bisphosphonate-Associated Osteonecrosis of the Jaw/epidemiology , Platelet-Rich Fibrin
19.
J. appl. oral sci ; 27: e20180150, 2019. graf
Article in English | LILACS | ID: biblio-975883

ABSTRACT

Abstract Objectives This investigation aimed to assess the differentiation inhibitory effects of ProRoot MTA® (PMTA) and Biodentine® (BIOD) on osteoclasts originated from murine bone marrow macrophages (BMMs) and compare these effects with those of alendronate (ALD). Materials and Methods Mouse BMMs were cultured to differentiate into osteoclasts with macrophage colony-stimulating factor and receptor activator of NF-κB (RANKL), treated with lipopolysaccharide. After application with PMTA, BIOD, or ALD, cell toxicities were examined using WST-1 assay kit, and RANKL-induced osteoclast differentiation and activities were determined by resorption pit formation assay and tartrate-resistant acid phosphate (TRAP) staining. The mRNA levels of osteoclast activity-related genes were detected with quantitative real time polymerase chain reaction. Expressions of molecular signaling pathways were assessed by western blot. All data were statistically analyzed with one-way ANOVA and Tukey's post-hoc test (p<0.05). Results Mouse BMMs applied with PMTA, BIOD, or ALD showed highly reduced levels of TRAP-positive osteoclasts. The BIOD treated specimens suppressed mRNA expressions of cathepsin K, TRAP, and c-Fos. Nonetheless, it showed a lower effect than PMTA or ALD applications. Compared with ALD, PMTA and BIOD decreased RANKL-mediated phosphorylation of ERK1/2 and IκBα. Conclusions PMTA and BIOD showed the inhibitory effect on osteoclast differentiation and activities similar to that of ALD through IκB phosphorylation and suppression of ERK signaling pathways.


Subject(s)
Animals , Mice , Osteoclasts/drug effects , Root Canal Filling Materials/pharmacology , Bone Marrow Cells/drug effects , Cell Differentiation/drug effects , Silicates/pharmacology , Calcium Compounds/pharmacology , Alendronate/pharmacology , Bone Density Conservation Agents/pharmacology , Osteoclasts/physiology , Osteogenesis/drug effects , Phosphorylation/drug effects , Root Resorption/prevention & control , Time Factors , Bone Marrow Cells/cytology , Cell Survival/drug effects , Cells, Cultured , Blotting, Western , Reproducibility of Results , MAP Kinase Signaling System/drug effects , I-kappa B Proteins/drug effects , RANK Ligand/analysis , RANK Ligand/drug effects , Real-Time Polymerase Chain Reaction , Tartrate-Resistant Acid Phosphatase
20.
J. appl. oral sci ; 27: e20180713, 2019. tab, graf
Article in English | LILACS, BBO | ID: biblio-1040234

ABSTRACT

Abstract Vitamin D has been known to have important regulatory functions in inflammation and immune response and shows inhibitory effects on experimental periodontitis in animal models. However, the potential mechanism has yet to be clarified. Recent studies have highlighted Aryl hydrocarbon receptor (AhR) and its downstream signaling as a crucial regulator of immune homeostasis and inflammatory regulation. Objective: This study aimed to clarify the effect of 1,25-dihydroxyvitamin D3 (VD3) on experimental periodontitis and AhR/nuclear factor-κB (NF-κB)/NLR pyrin domain-containing 3 (NLRP3) inflammasome pathway in the gingival epithelium in a murine model. Methodology: We induced periodontitis in male C57BL/6 wild-type mice by oral inoculation of Porphyromonas gingivalis (P. gingivalis), and subsequently gave intraperitoneal VD3 injection to the mice every other day for 8 weeks. Afterwards, we examined the alveolar bone using scanning electron microscopy (SEM) and detected the gingival epithelial protein using western blot analysis and immunohistochemical staining. Results: SEM images demonstrated that alveolar bone loss was reduced in the periodontitis mouse model after VD3 supplementation. Western blot analyses and immunohistochemical staining of the gingival epithelium showed that the expression of vitamin D receptor, AhR and its downstream cytochrome P450 1A1 were enhanced upon VD3 application. Additionally, VD3 decreased NF-κB p65 phosphorylation, and NLRP3, apoptosis-associated speck-like protein, caspase-1, interleukin-1β (IL-1β) and IL-6 protein expression. Conclusions: These results implicate the alleviation of periodontitis and the alteration of AhR/NF-κB/NLRP3 inflammasome pathway by VD3 in the mouse model. The attenuation of this periodontal disease may correlate with the regulation of AhR/NF-κB/NLRP3 inflammasome pathway by VD3.


Subject(s)
Animals , Male , Periodontitis/metabolism , Periodontitis/drug therapy , Calcitriol/pharmacology , NF-kappa B/drug effects , Bone Density Conservation Agents/pharmacology , NLR Family, Pyrin Domain-Containing 3 Protein/drug effects , Periodontitis/pathology , Reference Values , Calcitriol/analysis , Immunohistochemistry , Blotting, Western , Reproducibility of Results , Alveolar Bone Loss , NF-kappa B/analysis , Interleukin-6/analysis , Treatment Outcome , Receptors, Aryl Hydrocarbon/analysis , Receptors, Aryl Hydrocarbon/drug effects , Porphyromonas gingivalis , Caspase 1/analysis , Bone Density Conservation Agents/analysis , Interleukin-1beta/analysis , NLR Family, Pyrin Domain-Containing 3 Protein/analysis , Gingiva/drug effects , Gingiva/metabolism , Gingiva/pathology , Mice, Inbred C57BL
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