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1.
Actual. osteol ; 17(2): 104-111, 2021. ilus, tab
Article in Spanish | LILACS, BINACIS, UNISALUD | ID: biblio-1370318

ABSTRACT

El síndrome de dolor regional complejo (SDRC) es una patología poco frecuente, caracterizada por dolor crónico y cambios locales del sitio afectado. Ocurre en forma posterior a un traumatismo, o, menos frecuentemente, sin desencadenante claro. El diagnóstico se realiza de forma clínica, evaluando la presencia de hallazgos típicos detallados en los criterios de Budapest, como el dolor continuo y desproporcionado, y síntomas y signos típicos, como edema, asimetría térmica y disminución del rango de movilidad. Los estudios por imágenes, así como la radiografía, la resonancia magnética o el centellograma óseo de 3 fases, también brindan información valiosa, sobre todo en los casos que se presentan con más dudas, y para realizar diagnóstico diferencial de otras patologías. En este sentido, la medición de la densidad mineral ósea por absorciometría dual de rayos X (DXA) se presenta también como herramienta de utilidad, no solo en la fase diagnóstica, al evidenciar la mayor desmineralización del miembro afectado, sino también en la evaluación de la respuesta terapéutica a bifosfonatos. Presentamos el caso de una paciente con SDRC del miembro inferior, donde la densitometría ósea resultó de gran utilidad en su manejo clínico. (AU)


Complex regional pain syndrome (CRPS) is a rare pathology, characterized by chronic pain and local changes of the affected site. It occurs after trauma or, less frequently, without a clear trigger. The diagnosis is made clinically, evaluating the presence of typical findings detailed in the Budapest criteria, such as continuous and disproportionate pain, and typical signs and symptoms, like edema, thermal asymmetry, and decreased range of motion. Imaging studies, such as radiography, magnetic resonance imaging, or 3-phase bone scintigraphy also provide valuable information, especially in cases that present with more doubts, and to make a differential diagnosis with other pathologies. In this regard, the measurement of bone mineral density by dual X-ray absorptiometry (DXA) is also a useful tool, not only in the diagnostic phase, by showing the greater demineralization of the affected limb, but also in the evaluation of the therapeutic response to bisphosphonates. We present the case of a patient with CRPS of the lower limb, where bone densitometry was very useful in her clinical management. (AU)


Subject(s)
Humans , Female , Middle Aged , Complex Regional Pain Syndromes/diagnosis , Complex Regional Pain Syndromes/pathology , Complex Regional Pain Syndromes/drug therapy , Densitometry , Bone Density , Complex Regional Pain Syndromes/diagnostic imaging , Diagnosis, Differential , Diphosphonates/administration & dosage , Chronic Pain/etiology
2.
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
3.
Int. j. morphol ; 38(3): 683-688, June 2020. graf
Article in English | LILACS | ID: biblio-1098307

ABSTRACT

The aim was to evaluate bone repair and gingival tissue repair in osteopenic rats. Fifteen female wistar rats were included; in all of them ovariectomy was realized to induce osteopenia; after 45 days, the animals were submitted to 2 surgical techinques 1) dental extraction of the upper central incisor with no socket preservation and 2) 5 mm cranial defect in the calvarium; 5 rats were included in the control group (G1) withput alendronate application; in the group 2 (G2) was used subcutenous alendronate (0.5 mg/kg) once for three weeks and then was realizd the both surgical techniques. In group 3 (G3), after ovariectomy was realized the both dental extraction and the calvarium defect and after that was realized the alendronate protocol. In each group, after six week was realized euthanasia and descriptive histological analysis of the surgical areas involved. In bone formation of the 5 mm cranial defect was observed with good progression in the 3 experimental models and no modification in quality of bone repair was observed. For the gingival tissue in the extraction socket, no differences were observed between G1 and G3. On other hand, in G2 a thinner and reduced gingival epithelium was found. Our results showed that alendronate was not an obstacle for bone repair; deficiencies in re-epithelialization of oral mucosa show the impact of alendronate before dental extraction.


El objetivo fue evaluar la reparación ósea y gingival en ratas con osteopenia. Quince ratas wistar hembras fueron incluidas; en todas ellas se realizo ovarectomia y fue realizada la inducción de osteopenia; después de 45 días, los animales fueron sometidos a dos técnicas quirúrgicas 1) extracciones dentales del incisivo central superior sin preservación alveolar y 2) creación de un defecto craneano de 5 mm en la calota; 5 animales fueron incluidos como grupo control (G1) sin la aplicación de alendronato; en el grupo 2 (G2) se utilizó alendronato subcutáneo (0,5 mg/kg) una vez a la semana durante 3 semanas. En el grupo 3 (G3), después de la ovarectomia se realizó la exodoncia y el defecto en el cráneo y después de ello se inicio el protocolo con alendronato. En cada grupo, después de seis semanas se realizó la eutanasia con descripción histológica de los hallazgos. En el hueso formado en el defecto craneano de 5 mm se observó una adecuada progresión de reparación en los 3 modelos experimentales y no se observó cambios importantes en el modelo de reparación. Para el tejido gingival en el sitio de extracción, no se observaron diferencias entre el grupo G1 y G3. Por otra parte, el G2 presentó un tejido mas delgado con reducción del epitelio gingival; nuestros resultados demuestran que el alendronato no fue un obstáculo en la reparación ósea; deficiencias en la re epitelización de la mucosa oral muestran el impacto del alendronato después de la exodoncia.


Subject(s)
Animals , Female , Rats , Bone Diseases, Metabolic/drug therapy , Bone Regeneration/drug effects , Alendronate/administration & dosage , Gingiva/drug effects , Osteonecrosis/drug therapy , Osteoporosis/drug therapy , Bone Diseases, Metabolic/complications , Ovariectomy , Rats, Wistar , Diphosphonates/administration & dosage
5.
Actual. osteol ; 15(2): 94-102, mayo - ago. 2019. tab.
Article in Spanish | LILACS | ID: biblio-1048478

ABSTRACT

El propósito de la terapia en el desorden del metabolismo óseo mineral asociado a la enfermedad renal crónica (IRC) consiste en restaurar el balance mineral, y, en la osteoporosis, mantener o aumentar la masa ósea. Ambas terapias tratan de evitar la fractura ósea. La mayoría de los osteoactivos están contraindicados en la insuficiencia renal crónica avanzada (estadios 4 y 5), y las terapias son empíricas. Algunos autores opinan que sin anomalías bioquímicas del desorden del metabolismo óseo mineral asociado a la enfermedad renal crónica avanzada se podría intentar el tratamiento estándar para la osteoporosis. Antes de intentar la terapia osteoactiva se debe corregir el desorden mineral óseo que pudiera presentarse asociado a la IRC, y en la indicación del tipo de osteoactivo se sugiere seleccionar al paciente según su estado óseo. Se aconseja que la administración de los antirresortivos se realice a dosis menores con respecto a los que tienen mejor función renal junto con aportes adecuados de calcio y vitamina D, antes y durante el tratamiento para prevenir el riesgo de severas hipocalcemias y un efecto óseo excesivo. Se presenta el caso clínico de una mujer de 65 años, con diagnóstico de osteoporosis de etiología multifactorial, fractura de pelvis, múltiples fracturas vertebrales e insuficiencia renal crónica avanzada, entre otras comorbilidades, y probable enfermedad ósea adinámica. Recibió inicialmente terapia con teriparatide y luego con denosumab, complicándose con hipocalcemia asintomática. (AU)


The purpose of therapy for the bone mineral metabolism disorder associated with chronic kidney disease is to restore the mineral balance; and to maintain or increase bone mass in osteoporosis. The goal of both types of therapy is to avoid bone fractures. Most antiosteoporotic drugs are contraindicated in advanced chronic renal failure (CRF) stages 4 and 5, and the therapies are empirical. Some authors believe that without biochemical abnormalities of the mineral bone metabolism disorder associated with advanced chronic kidney disease, standard treatment for osteoporosis could be attempted. Before attempting antiosteoporotic therapy, the bone mineral disorder that may be associated with CRF must be corrected, and in the indication of the type drug it is suggested that the patient be selected according to their bone status. It is advised that the administration of anti-resorptives be performed at lower doses in individuals with poor renal function compared to those with better renal function together with adequate calcium and vitamin D, before and during treatment to prevent the risk of severe hypocalcemia, and an excessive bone effect. We present the clinical case of a 65-year-old woman with a diagnosis of osteoporosis of multifactorial etiology, pelvic fracture, multiple vertebral fractures and advanced chronic renal failure, among other comorbidities and probable adynamic bone disease. The patient received initial therapy with teriparatide and followed by denosumab administration and exhibited asymptomatic hypocalcemia. (AU)


Subject(s)
Humans , Female , Aged , Chronic Kidney Disease-Mineral and Bone Disorder/drug therapy , Fractures, Bone/prevention & control , Osteoporosis/therapy , Chronic Kidney Disease-Mineral and Bone Disorder/complications , Chronic Kidney Disease-Mineral and Bone Disorder/metabolism , Chronic Kidney Disease-Mineral and Bone Disorder/therapy , Vitamin D/administration & dosage , Vitamin D/therapeutic use , Calcium/administration & dosage , Calcium/therapeutic use , Alendronate/therapeutic use , Teriparatide/administration & dosage , Teriparatide/adverse effects , Teriparatide/therapeutic use , Diphosphonates/administration & dosage , Diphosphonates/adverse effects , Diphosphonates/therapeutic use , Cinacalcet/therapeutic use , Risedronic Acid/therapeutic use , Denosumab/administration & dosage , Denosumab/adverse effects , Denosumab/therapeutic use , Hypocalcemia/prevention & control
6.
Int. j. odontostomatol. (Print) ; 13(2): 137-141, jun. 2019. graf
Article in Spanish | LILACS | ID: biblio-1002296

ABSTRACT

RESUMEN: El balance óseo está mediado por una regulación inmunoendócrina, siendo éste un complejo proceso. Entre las acciones llevadas a cabo para mantener la densidad y estructura del esqueleto son variadas las farmacoterapias utilizadas. Diversos estudios han demostrado que tanto Alendronato (AL) y Vitamina E (E) contribuyen a la inhibición de la reabsorción ósea. El objectivo de este trabajo fue estudiar el efecto de la administración combinada de (AL) por vía subcutánea y (E) se administró tres veces por semana también por vía subcutánea con una dosificación de 20 mg/kg de peso corporal. La fórmula farmacéutica fue de 0,5 mg/kg de peso corporal para AL, y 20 mg/kg de vitamina E. El efecto se evaluó en ratas machos Wistar (n=108), de 90 ± 20 g, divididas en 4 grupos. Se realizó la exodoncia de los primeros molares inferiores. La droga se inyectó en forma subcutánea en tiempos 0, 7, 15 y 30 días post cirugía. Las imágenes de las mandíbulas fueron adquiridas mediante radiovisiógrafo, en cada tiempo experimental y fueron analizadas con el Software Image ProPlus versión 4,1 de Media Cibernetics. Estudios estadísticos: no paramétrico: prueba de Kruskal-Wallis Resultados: El grupo C (que registró la media de intensidad más baja), se diferenció significativamente de los grupos E y A-E (p<0,001), no así del grupo que utilizó únicamente Al (p=0,070; p>0,05). Los grupos Al, E y el combinado Al-E no se diferenciaron significativamente entre sí (p>0,05 en todos los casos). Los datos evaluados sirven para mostrar una tendencia favorable en relación al efecto beneficioso de la combinación de AL y vitamina E.


ABSTRACT: The bone balance is mediated by an immunoendocrine regulation, this being a complex process. A number of pharmacotherapies are used among the actions taken to maintain the density and structure of the skeleton. Several studies have shown that both Alendronate (AL) and Vitamin E (E) contribute to the inhibition of bone resorption. Objective: To study the effect of combined administration of (LA) subcutaneously and (E) was administered three times per week also subcutaneously with a dosage of 20 mg / kg body weight. The pharmaceutical formulation was 0.5 mg / kg body weight for AL and 20 mg / kg vitamin E. The effect was evaluated in male Wistar rats (n = 108), 90 ± 20 g, divided into 4 groups. Extraction of the first lower molars was performed. The drug was injected subcutaneously at time 0, 7, 15 and 30 days post-surgery. The images of the jaws were acquired by radiovisiography, at each experimental time and were analyzed with Image ProPlus Software version 4.1 of Media Cibernetics. Statistical studies: non-parametric: Kruskal-Wallis test Group C (which recorded the lowest mean intensity) was significantly different from the E and AE groups (p <0.001), but not from the group that used only Al (P = 0.070, p> 0.05). The Al, E and combined Al-E groups did not differ significantly from each other (p> 0.05 in all cases). The data evaluated serve to show a favorable trend in relation to the beneficial effect of the combination of AL and vitamin E.


Subject(s)
Animals , Rats , Vitamin E/administration & dosage , Bone Remodeling/drug effects , Alendronate/administration & dosage , Radiography, Dental , Analysis of Variance , Animal Experimentation , Diphosphonates/administration & dosage
9.
Actual. osteol ; 13(3): 233-242, Sept - DIc. 2017. ilus, tab
Article in Spanish | LILACS | ID: biblio-1117496

ABSTRACT

La displasia fibrosa ósea es un trastorno no hereditario del desarrollo esquelético caracterizado por una proliferación anormal de fibroblastos y diferenciación deficiente de osteoblastos que conduce a un reemplazo del tejido óseo esponjoso por tejido conectivo fibroso. Es producida por una mutación somática activadora del gen GNAS1 que induce una activación y proliferación de células mesenquimales indiferenciadas con formación de tejido fibroso y trabéculas óseas anómalas. Existen formas monostóticas, poliostóticas y craneofaciales con diversos grados de dolor, deformidades y fracturas óseas, aunque muchos casos son asintomáticos. En ocasiones se producen quistes óseos aneurismáticos, hemorragias, compromisos neurológicos y raramente osteosarcomas. Algunos casos se asocian a síndrome de McCune-Albright, síndrome de Mazabraud y a osteomalacia por hipofosfatemia por pérdida tubular renal inducida por el FGF23 producido por el tejido displásico. Los hallazgos en las radiografías convencionales son característicos, aunque variables y de carácter evolutivo. La gammagrafía ósea es la técnica de imagen con mayor sensibilidad para determinar la extensión de la enfermedad. El diagnóstico diferencial incluye múltiples lesiones óseas de características similares y en raras ocasiones se requiere biopsia ósea o estudio genético para confirmarlo. No existe un consenso unánime acerca del abordaje terapéutico de estos pacientes, razón por la cual es necesario un enfoque multidisciplinario. La conducta puede ser expectante o quirúrgica según el tipo de lesiones y es importante el manejo del dolor y de las endocrinopatías asociadas. La mayor experiencia publicada se refiere al uso de bifosfonatos y, más recientemente, denosumab. Los tratamientos actuales son insuficientes para modificar el curso de la enfermedad y es necesario el desarrollo de nuevas moléculas que actúen específicamente en el gen GNAS1 o sobre las células mesenquimales afectadas. (AU)


Fibrous dysplasia of bone is a noninherited developmental anomaly of bone characterized by abnormal proliferation of fibroblasts and differentiation of osteoblasts that cause a replacement of trabeculous bone by fibrous connective tissue. It is caused by a somatic mutation in the GNAS1 gene, which induces an undifferentiated mesenquimal cells activation and proliferation with formation of fibrous tissue and abnormal osseous trabeculae. There are monostotic, polyostotic and craniofacial variants with different grades of bone pain, deformities and fractures, although many cases remain asymptomatic. Aneurysmal bone cysts, bleeding, neurological compromise and infrequently osteosarcoma are possible complications. Some cases are associated to McCune-Albright syndrome, Mazabraud syndrome or hypophosphatemia and osteomalacia due to to renal tubular loss induced by FGF23 produced by dysplastic tissue. The findings on conventional radiography are characteristic although variable and evlolve with time. Bone scintigraphy is the most sensitive technique to evaluate the extent of disease. Differential diagnosis include several osseous lesions of similar appearance and, in some cases, bone biopsy or genetic testing may be necessary. Today, there is no consensus regarding the therapeutic approach for these patients and it is necessary a multidisciplinary medical team. Watchful waiting or surgical interventions can be indicated, depending on the type of bone lesions. Bone pain and associated endocrinopathies management are very important. Most published experience refers to the use of bisphosphonates and, more recently, denosumab. Current treatments are insufficient to modify the natural curse of the disease and therefore, new molecules with specific action on GNAS1 gene or affected mesenchymal cells are necessary. (AU)


Subject(s)
Humans , Male , Female , Child, Preschool , Child , Adolescent , Adult , Young Adult , Fibrous Dysplasia of Bone/etiology , Fibrous Dysplasia of Bone/drug therapy , Osteogenesis/genetics , Osteomalacia/complications , Congenital Abnormalities , Vitamin D/therapeutic use , Osteosarcoma/etiology , Calcium/therapeutic use , Hypophosphatemia/blood , Bone Cysts, Aneurysmal/etiology , Diagnosis, Differential , Diphosphonates/administration & dosage , Diphosphonates/adverse effects , Fractures, Bone/pathology , Mesenchymal Stem Cells/pathology , Pain Management , Fibrous Dysplasia, Monostotic/etiology , Fibrous Dysplasia of Bone/genetics , Fibrous Dysplasia of Bone/blood , Fibrous Dysplasia of Bone/diagnostic imaging , Fibrous Dysplasia, Polyostotic/etiology , Fibrous Dysplasia, Polyostotic/diagnostic imaging , Craniofacial Fibrous Dysplasia/etiology , Mutation/genetics
11.
Int. j. odontostomatol. (Print) ; 11(1): 19-24, abr. 2017. ilus
Article in Spanish | LILACS | ID: biblio-841011

ABSTRACT

Estudios han demostrado que el aceite de oliva (O) con sus compuestos fenólicos tienen efectos positivos en diversos biomarcadores fisiológicos. Análisis previos han demostrado que los bisfosfonatos, son potentes inhibidores de la resorción ósea. Estudiar el efecto del tratamiento combinado de alendronato (AL) y pamidronato (PA) y de O sobre la regeneración ósea. Las fórmulas se dosificaron 0,5 mg/kg de peso para AL, y de 0,6 mg/kg de peso para PA. El O se administró en la dieta, 50 g/Kg. Cincuenta y cuatro ratas macho de la línea Wistar se dividieron en 6 grupos. El grupo control (C), recibió semanalmente 0,3 ml/100 g de solución salina vía subcutánea. El grupo (AL) recibió semanalmente por vía subcutánea en el miembro posterior izquierdo. El grupo (PA) se colocó igual que el grupo anterior. El grupo (O) fue tratado en la alimentación y en las áreas de la cirugía recibieron inyección subcutánea con solución fisiológica. El grupo (ALO) recibió tratamiento combinado con AL y O. El grupo (PAO) se trató igual al anterior. Se obtuvieron muestras de fémur en tiempos 15, 30, 60 y 90 días, que se incluyeron en solución fisiológica y mantenidos a -20 C. Los estudios estadísticos se realizaron a través del análisis de la variancia a dos y tres criterios de clasificación. Sólo el factor días influye significativamente sobre los valores. Las diferencias entre drogas no resultaron estadísticamente significativas. Tampoco se verificó interacción significativa entre los factores Droga y etapa. Los valores más elevados de fuerza de ruptura aplicada, se registraron a los 90 días. No se encontraron diferencias significativas en los ensayos biomecánicos, poniendo de manifiesto la acción sistémica de los fármacos. Estas acciones fueron benéficas al aumentar la rigidez.


Studies have shown that olive oil (O) with its phenolic compounds have positive effects on various physiological biomarkers. Previous analyzes have shown that bisphosphonates are potent inhibitors of bone resorption. The objective of this work was to study the effect of combined treatment with alendronate (AL) and pamidronate (PA) and O on bone regeneration. Formulas 0.5 mg/kg for AL dosed, and 0.6 mg/kg for PA. O was administered in the diet, 50 g/kg. Fifty-four male Wistar rats were divided into 6 groups. The control group (C) received weekly 0.3 mL/100 g of saline subcutaneously. Group (AL) received weekly subcutaneously in the left posterior limb. Group (PA) was placed as the previous group. Group (O) was treated in food and in the areas of surgery received subcutaneous injection with saline. The (ALO) group received combined treatment with Al and O. The group (PAO) was treated the same as before. Femur samples at times 15, 30, 60 and 90 days, were included in physiological solution and maintained at -20 °C were obtained. Statistical studies were conducted through analysis of variance to two and three classification criteria. The ANOVA showed that only days factor significantly influences the values of the variables (p <0.05). The differences between drugs were not statistically significant (p> 0.05). Nor was there significant drug interaction between factors and stage (p> 0.05) was verified. The highest values of force rupture applied occurred at 90 days. No significant differences were found in the biomechanical testing, demonstrating the systemic action of drugs. These actions were beneficial to increase rigidity.


Subject(s)
Animals , Male , Rats , Bone Regeneration/drug effects , Diphosphonates/administration & dosage , Olive Oil/chemistry , Alendronate/administration & dosage , Biomechanical Phenomena , Rats, Wistar
12.
Bauru; s.n; 2017. 89 p. ilus, tab, graf.
Thesis in Portuguese | LILACS, BBO | ID: biblio-883240

ABSTRACT

Os bisfosfonatos (BF) são amplamente utilizados no tratamento de doenças osteolíticas como metástases ósseas e osteoporose. A osteonecrose dos maxilares associada ao uso de BF (OMAB) é caracterizada pela presença de osso exposto ou que pode ser sondado através de uma fístula que persiste por mais de oito semanas em pacientes com história de terapia de BF e sem história de radioterapia na região de cabeça e pescoço e/ou sem doença metastática nos maxilares. A incidência de OMAB aumenta com a potência, duração do tratamento e dose de BF recebida. Até o presente momento, a fisiopatologia da OMAB não está clara, dificultando a prevenção e o tratamento. O objetivo deste estudo foi avaliar o efeito da administração de altas doses Ácido Zoledrônico (AZ) por período prolongado no osso esponjoso da mandíbula e da metáfise proximal do fêmur de ratos Wistar. Para relacionar as descobertas à fisiopatologia da OMAB, o regime de administração de BF de um modelo animal relevante desta lesão foi reproduzido. Seis animais receberam AZ (0,6 mg / kg) e seis receberam solução salina no mesmo volume (Controles). Os compostos foram administrados por via intraperitoneal em cinco doses a cada 28 dias. A eutanásia dos animais ocorreu após 150 dias de início da terapia. As hemimandíbulas e fêmures direitos foram escaneados usando Micro-tomografia computadorizada (Micro-CT) de alta resolução (14 m). Para a primeira análise realizada neste estudo, os dados morfométricos do osso esponjoso foram calculados na região do segundo e primeiro molar na mandíbula e na metáfise do fêmur usando CTAnalyzer (Bruker, Bélgica). Para a segunda análise, cinco amostras de hemimandíbulas de cada grupo foram cortadas em lâminas histológicas (5 m) e coradas com Hematoxilina e Eosina. Para comparar os parâmetros morfométricos na Micro-CT e histologia, as imagens de Micro-CT foram espacialmente alinhadas à histologia. Os dados morfométricos do osso alveolar foram calculados usando o software CTAnalyzer (Bruker, Bélgica) na região entre as raízes mesial e distal do primeiro molar. A densidade da área vascular (área vascular/área total; VA/TA) e os dados histomorfométricos ósseos foram estimados usando Axiovision na mesma região (entre as raízes mesial e distal do primeiro molar). Foi adotada significância estatística de 5% ( = 0,05). Os animais tratados com AZ apresentaram aumento significativo na porcentagem de volume ósseo (p <0,05) com trabéculas mais espessas, osso mais compacto com menor separação trabecular na mandíbula e no fêmur. Na mandíbula, o aumento da densidade óssea e diminuição da separação trabecular foram fortemente correlacionados com a diminuição da área vascular observada no grupo AZ (p <0,05). Em conclusão, o tratamento de longa duração com altas doses de AZ foi significativamente associado ao aumento na densidade óssea e à diminuição dos espaços medulares, canais nutritivos e vasculatura do osso alveolar. A análise com Micro-CT revelou alterações semelhantes na estrutura óssea tanto na mandíbula quanto no fêmur do grupo AZ.(AU)


Bisphosphonates (BFs) are widely used in the treatment of osteolytic diseases such as bone metastases and osteoporosis. The osteonecrosis of the jaws related to BF (ONB) is characterized by the presence of exposed bone or bone that can be probed through a fistula that persists for more than eight weeks in patients with a history of BF therapy and without history of head and neck radiotherapy and / or without metastatic disease in the jaws. The incidence of ONB increases with potency, duration of treatment and dose of BF received. Thus far, the pathophysiology of ONB is unclear, hampering prevention and treatment. The aim of this study was to objectively assess the effect of long-term high-dose Zoledronic Acid (ZA) on cancellous bone in the jaw and femur of Wistar rats. In order to link our findings to the physiopathology of ONB, the therapeutic regiment of a relevant ONB animal model was reproduced. Twelve Wistar rats were randomly divided in two groups: six received Zoledronic acid (ZA; 0.6 mg / kg) and six (Controls) received saline solution in the same volume. The compounds were administrated intraperitoneally in five doses each 28 days. The rats were killed after 150 days of the therapy onset. Mandibles and femurs were scanned using a high-resolution (14m) micro-computerized tomography (Micro-CT). For the first analysis carried in this study, cancellous bone morphometric data were calculates in the region of the second and first molar in the mandible and in the proximal femur using CTAnalyzer (Bruker, Belgium). For the second analysis five samples were cut into histological slices (5m) and stained with Hematoxylin and Eosin. In order to compare the same morphological structures in Micro-CT and histology, the Micro-CT images were aligned to histology. Alveolar bone morphometric data (Micro-CT) was calculated using CTAnalyzer (Bruker, Belgium) in the region between the mesial and distal roots of the first molar. Blood vessels density and bone histomorphometric data were calculated using Axiovision (Carl Zeiss, Germany) in the same region used for Micro-CT evaluation. Statistical significance of 5% (=0.05) was adopted. ZA treated rats presented significant increase in the percentage of bone volume (p<0.05) with thicker trabeculae and more compact bone with smaller marrow spaces in the mandible and femur. In the mandible, the increase in bone density and decrease of marrow spaces size was strongly correlated with the decrease in the vascular area noticed in the ZA group (p<0.05). In conclusion, long-term high-dose ZA treatment was significant associated with the increase of bone density and the diminution of medullary spaces and nutritive canals size as well as decrease in vascularity of the alveolar bone. Micro-CT investigation showed similar changes in bone structure in the mandible and femur in the ZA group.(AU)


Subject(s)
Animals , Rats , Bisphosphonate-Associated Osteonecrosis of the Jaw/drug therapy , Bone Density Conservation Agents/administration & dosage , Cancellous Bone/drug effects , Diphosphonates/administration & dosage , Femur/drug effects , Imidazoles/administration & dosage , Mandibular Diseases/drug therapy , Bisphosphonate-Associated Osteonecrosis of the Jaw/physiopathology , Bone Density , Random Allocation , Rats, Wistar , Reproducibility of Results , Time Factors , Treatment Outcome , X-Ray Microtomography
13.
Acta cir. bras ; 31(5): 308-313, May 2016. tab, graf
Article in English | LILACS | ID: lil-783798

ABSTRACT

ABSTRACT PURPOSE : To evaluate a modified experimental model for medication-related osteonecrosis of the jaw (MRONJ) through the upper right central incisor extraction followed by intravenous bisphosphonate administration. METHODS: Forty five rats underwent the upper right central incisor tooth extraction were divided in 2 groups: Group I - experimental group, 30 rats received an intravenous administration protocol of zoledronic acid 35μg/kg into the tail vein every two weeks, totalizing four administrations, during eight weeks of administration, previously the extraction, and Group II - control group, 15 rats didn't received any medication before extraction. The groups were subdivided in postoperative periods: 14/28/42 days. Clinical analysis and microtomography were performed to verify the presence of osteonecrosis. In addition, descritive histological analysis of hematoxylin-eosin stained sections was performed to evaluate the presence of osteonecrosis or necrotic foci. RESULTS: Twelve (40%) rats, from experimental group, showed clinical signs of MRONJ (p=0.005), however, all samples showed imaginologic findings like osteolysis and loss of integrity of the cellular walls (p≤0.001). Microscopic evaluation revealed osteonecrosis areas with microbial colonies and inflammatory infiltrate (p≤0.001). In the control group, all animals presented the chronology of a normal wound healing. CONCLUSIONS: The presence of medication-related osteonecrosis of the jaw after maxillary central incisor extraction in rats. This new experimental model may be considered an option for the study of MRONJ.


Subject(s)
Animals , Male , Models, Animal , Diphosphonates/administration & dosage , Bisphosphonate-Associated Osteonecrosis of the Jaw/pathology , Imidazoles/administration & dosage , Osteitis/pathology , Osteolysis/chemically induced , Osteolysis/diagnostic imaging , Tooth Extraction/adverse effects , Tooth Extraction/methods , Maxillary Diseases/diagnostic imaging , Alveolar Bone Loss/diagnostic imaging , Rats, Wistar , Diphosphonates/adverse effects , X-Ray Microtomography/instrumentation , Bisphosphonate-Associated Osteonecrosis of the Jaw/diagnostic imaging , Administration, Intravenous/methods , Imidazoles/adverse effects , Incisor/surgery
14.
Int. j. morphol ; 34(1): 291-297, Mar. 2016. ilus
Article in English | LILACS | ID: lil-780508

ABSTRACT

This study aims to observe the 3-D structural changes in subchondral bone and the effects of bisphosphonate intervention in the early unsteady stage of the knee joint. Sixty healthy male New Zealand white rabbits were divided into the model group (n= 24), the bisphosphonate (Bis) group (n= 24), and the control group (n= 12). The rabbits' right knees were used to evaluate the structural changes. The Bis group received subcutaneous injections of bisphosphonate, while the model and control groups received subcutaneous injections of isotonic saline solution. After surgical preparation, the knee joint was dissected for Micro-CT examination, and the Micro-CT results were compared using ANOVA. In the fourth postoperative week, the bone volume fraction (BVF), trabecular number (Tb.N), and trabecular thickness (Tb.Th) of the model group were significantly lower than those of the control group (P<0.01). There was no significant difference between the Bis and control groups. In the twelfth postoperative week, BVF, Tb.Th, and Tb.N of the model group were significantly higher than those of the control and Bis groups (P <0.05). Similarly, bone mineral density was higher in the model group (P <0.01), while the trabecular spacing was significantly lower (P <0.05). In the early unsteady stage of the knee joint, the subchondral bone had markedly decreased, while obvious bone formation was visible in the late stage. Bisphosphonates could protect the subchondral bone structure by inhibiting bone absorption.


El objetivo fue observar los cambios estructurales en 3-D del hueso subcondral y los efectos de la intervención con bifosfonatos en la etapa temprana de la inestabilidad de la articulación de la rodilla. Sesenta conejos blancos New Zealand machos sanos se dividieron en tres grupos: modelo (n= 24), bisfosfonato (Bis) (n= 24) y control (n= 12). Las rodillas derechas de los conejos se utilizaron para evaluar los cambios estructurales. El grupo Bis recibió inyecciones subcutáneas de bisfosfonato, mientras que los grupos modelo y control recibieron inyecciones subcutáneas de solución salina isotónica. Después de la preparación quirúrgica, la articulación de la rodilla fue disecada para su análisis mediante micro-TC, y los resultados se compararon mediante ANOVA. En la cuarta semana postoperatoria, la fracción del volumen óseo (GVF), el número trabecular (Tb.N) y el espesor trabecular (Tb.Th) del grupo modelo fueron significativamente más bajos que los del grupo control (P <0,01). No hubo diferencia significativa entre los grupos control y Bis. En la semana 12 postoperatoria, BVF, Tb.Th, y Tb.N del grupo modelo fueron significativamente mayores que los del grupo control y Bis (P <0,05). Del mismo modo, la densidad mineral ósea fue mayor en el grupo modelo (P <0,01), mientras que la separación trabecular fue significativamente menor (<0,05 P). En la etapa inestable temprana de la articulación de la rodilla, el hueso subcondral disminuyó notablemente, mientras que la formación ósea obvia fue visible en la etapa tardía. Los bisfosfonatos podrían proteger la estructura ósea subcondral mediante la inhibición de la absorción ósea.


Subject(s)
Animals , Male , Rabbits , Bone and Bones/diagnostic imaging , Bone and Bones/drug effects , Diphosphonates/administration & dosage , Osteoarthritis/diagnostic imaging , Osteoarthritis/drug therapy , X-Ray Microtomography/methods , Bone and Bones/pathology , Imaging, Three-Dimensional , Osteoarthritis/pathology
15.
Actual. osteol ; 12(2): 107-125, 2016. tab
Article in Spanish | LILACS, BINACIS, UNISALUD | ID: biblio-1372377

ABSTRACT

La osteoporosis inducida por glucocorticoides (OIC) es la causa más común de osteoporosis secundaria. La pérdida ósea se produce en forma temprana, en los primeros meses siguientes a la introducción de los glucocorticoides (GC), dependiendo de la dosis diaria. La patogénesis es multifactorial y el principal efecto deletéreo es la inhibición de la formación ósea. Los GC inducen fracturas por fragilidad ósea, especialmente en la columna vertebral, y esto genera incapacidad funcional. En los últimos años se han publicado algunas guías internacionales elaboradas por consenso para la prevención y el tratamiento de la OIC. La Sociedad Argentina de Osteoporosis designó a un grupo de trabajo para elaborar una guía propia y actualizada para el diagnóstico, la prevención y el tratamiento de la OIC (GE-OIC-SAO). (AU)


Glucocorticoid-induced osteoporosis (GIO) is the most common cause of secondary osteoporosis. It occurs early, with rapid bone loss in the first few weeks after the initiation of the treatment, with a rate that is dependent mainly on the daily dose. While the pathogenesis is multifactorial, the highest inhibitory effect occurs on bone formation. Glucocorticoids induce fragility fractures, especially in spine, generating functional disability. In recent years, there have been some international guidelines developed by consensus for the prevention and treatment of GIO. The Argentinean Osteoporosis Society appointed a working group to prepare a national guide updating the diagnosis, prevention and treatment of GIO. (AU)


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Osteoporosis/diagnosis , Osteoporosis/chemically induced , Osteoporosis/prevention & control , Osteoporosis/drug therapy , Osteoporosis/therapy , Glucocorticoids/adverse effects , Osteogenesis Imperfecta/chemically induced , Osteoporosis/physiopathology , Osteoporosis/epidemiology , Vitamin D/administration & dosage , Calcium/administration & dosage , Practice Guidelines as Topic , Teriparatide/administration & dosage , Densitometry , Diphosphonates/administration & dosage , Vertebroplasty , Osteoporotic Fractures/chemically induced , Glucocorticoids/administration & dosage
16.
J. bras. nefrol ; 36(4): 529-534, Oct-Dec/2014. graf
Article in English | LILACS | ID: lil-731146

ABSTRACT

BK polyomavirus (BKPyV) is a causal agent of nephropathy, ureteral stenosis and hemorrhagic cystitis in kidney transplant recipients, and is considered an important emerging disease in transplantation. Regular screening for BKPyV reactivation mainly during the first 2 years posttransplant, with subsequent pre-emptive reduction of immunosuppression is considered the best option to avoid disease progression, since successful clearance or reduction of viremia is achieved in the vast majority of patients within 6 months. The use of drugs with antiviral properties for patients with persistent viremia has been attempted despite unclear benefits. Clinical manifestations of BKPyV nephropathy, current strategies for diagnosis and monitoring of BKPyV infection, management of immunosuppressive regimen after detection of BKPyV reactivation and the use of antiviral drugs are discussed in this review.


BK Poliomavírus (BKPyV) é um agente causal de nefropatia, estenose ureteral e cistite hemorrágica em receptores de transplante renal, sendo considerado uma importante doença emergente na transplantação. Rastreamento regular para reativação do BKPyV, principalmente nos dois primeiros anos pós-transplante, com subsequente redução preemptiva da imunossupressão é considerada a melhor conduta para evitar a progressão da doença, já que a eliminação ou redução da viremia é alcançada na grande maioria dos pacientes dentro de 6 meses. O uso de drogas com propriedades antivirais para os pacientes com viremia persistente tem sido tentado, embora sem benefícios claros. As manifestações clínicas da nefropatia por BKPyV, as estratégias para o diagnóstico e monitoramento da infecção por BKPyV, o manejo do regime de imunossupressão após a detecção da reativação do BKPyV e o uso de drogas antivirais são discutidas nesta revisão.


Subject(s)
Female , Humans , Middle Aged , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Bone Neoplasms/drug therapy , Bone Neoplasms/secondary , Breast Neoplasms/drug therapy , Breast Neoplasms/pathology , Breast Neoplasms/surgery , Cyclophosphamide/administration & dosage , Drug Administration Schedule , Diphosphonates/administration & dosage , Floxuridine/administration & dosage , Medroxyprogesterone Acetate/administration & dosage , Quality of Life
17.
Bogotá; IETS; dic. 2014. ilus.
Monography in Spanish | LILACS, BRISA | ID: biblio-847134

ABSTRACT

Introducción: La osteoporosis es definida en la literatura como una enfermedad sistémica caracterizada por el deterioro del tejido óseo, medido por la disminución de la masa ósea, con la consecuente alteración de la arquitectura ósea. Lo anterior altera la resistencia ósea y esto da como resultado mayor fragilidad y aumento en el riesgo de fracturas (8). Objetivo: evaluar los beneficios y riesgos del uso del ácido ibandrónico en el tratamiento de la osteoporosis, como uno de los criterios para informar la toma de decisiones relacionada con la posible inclusión de tecnologías en el Plan Obligatorio de Salud, en el marco de su actualización integral para el siguiente periodo. Metodología: la evaluación fue realizada de acuerdo al protocolo definido previamente por el grupo desarrollador. Se realizó una búsqueda sistemática en MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects y LILACS, sin restricciones de idioma y limitada a revisiones sistemáticas publicadas en los últimos cinco años. Las búsquedas electrónicas fueron hechas entre octubre y noviembre de 2014 y se complementaron mediante búsqueda manual en bola de nieve y una consulta con expertos temáticos. La tamización de referencias se realizó por dos revisores de forma independiente y los desacuerdos fueron resueltos por consenso. La selección de estudios fue realizada mediante la revisión en texto completo de las referencias preseleccionadas, verificando los criterios de elegibilidad. La calidad de los estudios fue valorada con las herramientas AMSTAR e ISPOR. Las características de los estudios fueron extraídas a partir de las publicaciones originales. Se realizó una síntesis narrativa de las estimaciones del efecto para las comparaciones y desenlaces de interés a partir de los estudios de mejor calidad. Resultados: El estudio de Jansen 2011 reportó para el desenlace de reducción de fracturas vertebrales, al zoledronato comparado con ibandronato como superior con un RR de 0.58 (IC 95% 0.37-0.92), estadísticamente significativo. El estudio de Migliore 2013 reportó para el desenlace de riesgo de nuevas fracturas vertebrales, en la comparación risedronato versus ibandronato un OR de 1.17 (IC 95% 1.37-1.91) a favor de ibandronato, diferencia que no es estadísticamente significativa. Para el desenlace de riesgo de nuevas fracturas vertebrales, en la comparación de ibandronato vs denosumab, el ibandronato muestra inferioridad en cuanto a la efectividad comparado con el denosumab con un OR de 1.56 (IC95% 0.97-2.53) pero esta diferencia no es estadísticamente significativa, también se reporta para la comparación ibandronato versus zolendronato un OR de 1.58 (IC95% 1 a 2.50). Para el desenlace de reducción de fracturas de cadera el estudio de Jansen 2011 reportó para la comparación de risedronato vs ibandronato un RR de 0.52 (IC95% 0.12 a 2.15) resultado no estadísticamente significativo, y para la comparación de zoledronato versus ibandronato se reportó un RR de 0.38 (IC 95% 0.09 a 1.43) diferencia no estadísticamente significativo. Para la comparación alendronato versus ibandronato se reportó un RR de 0.40 (IC95% 0.09 a 1.55), no estadísticamente significativo. Para el desenlace de reducción de fractura no vertebra/no cadera en el estudio Jansen 2011, se evidencia un resultado estadísticamente significativo en la comparación de risedronato versus ibandronato RR 0.5 (IC95% 0.35 a 0.90), a favor del risedronato. Respecto a la seguridad el estudio de Young Ho Lee compara el ibandronato versus alendronato con una frecuencia de eventos adversos menor para el ibandronato, con un RR de 0.989 (IC95% 0.913 a 1.071 p=0.77) resultado no estadísticamente significativo. Respecto a los eventos adversos gastrointestinales se encontró una diferencia no estadísticamente significativa favor del alendronato con un RR de 1.059 (IC95% 0.937 a 1.198 p=0.357). La diferencia en retiros a causa de eventos adversos fue mayor en el grupo de pacientes tratado con ibandronato comparado con alendronato (RR 1.044 IC95% 0.787 a 1.386 p =0.76), resultado no estadísticamente significativo. Conclusiones: Efectividad: Fracturas vertebrales: de acuerdo con los hallazgos la revisión de comparaciones indirectas se puede concluir que el ácido ibandrónico es inferior en efectividad comparado con el ácido zoledrónico en la reducción de fracturas vertebrales. Comparando el risedronato con el ibandronato no se encuentra diferencias estadísticamente significativas en la reducción de fracturas vertebrales ni tampoco en el riesgo de nuevas fracturas vertebrales. En la comparación entre ibandronato y denosumab el riesgo de nuevas fracturas no muestra diferencias estadísticamente significativas. Fractura de cadera: No hay diferencias estadísticamente significativas para el desenlace que mide la reducción de fracturas de cadera en las comparaciones de ácido risedrónico versus ácido ibandrónico y ácido zoledrónico versus ácido ibandrónico. Fractura no vertebra/no cadera: Se evidencia que el ácido ibandronico es inferior al ácido risedronico en la reducción de fracturas no vertebra-no cadera. Seguridad: El ácido ibandronico reporta un perfil de seguridad a favor respecto al alendronato, sin embargo las diferencias encontradas no fueron estadísticamente significativas respecto al reporte de eventos adversos, a la presencia de síntomas gastrointestinales secundarios secundarios a la administración del medicamento y al retiro de pacientes a causa de eventos adversos.(AU)


Subject(s)
Humans , Diphosphonates/administration & dosage , Osteoporosis/drug therapy , Biomedical Technology , Colombia , Treatment Outcome
18.
J. bras. med ; 102(3)jul. 2014.
Article in Portuguese | LILACS | ID: lil-719971

ABSTRACT

Vários estudos têm avaliado o risco de fraturas futuras associado a diversas fraturas, em vários sítios esqueléticos; uma fratura prévia em qualquer sítio duplica o risco de fraturas futuras. Aparentemente ocorrem fraturas secundárias rapidamente após a primeira fratura. O risco de fraturas subsequentes parece ser maior logo após o primeiro episódio, especialmente no primeiro ano. Tem-se como objetivo reduzir o número de fraturas de quadril em 20% até 2020...


Many scientific studies have been evaluated the risk of future fractures related to multiple fractures, at several skeletal sites; one previous fracture at any site it doubles the risk of future fractures. Seemingly many secondary fractures ocurr quickly thereupon the first fracture. The risk of subsequent fractures it seems to be higher thereupon the first episode, especially in the first year. The goal is to decrease the amount of hip fractures by 20% until 2020...


Subject(s)
Humans , Male , Female , Osteoporotic Fractures/prevention & control , Osteoporosis/complications , Bone Density Conservation Agents , Drug Administration Schedule , Diphosphonates/administration & dosage , Fractures, Bone/prevention & control , Hip Fractures/prevention & control , Bone and Bones/injuries , Primary Prevention , Secondary Prevention , Preventive Health Services
19.
Article in Spanish | LILACS | ID: lil-778004

ABSTRACT

La Osteonecrosis de los maxilares relacionada a los bifosfonatos puede ser definida como una condición patológica caracterizada por la presencia de un área de hueso necrótico expuesto por más de 8 semanas, en pacientes que se encuentran bajo tratamiento con Bifosfonatos y que no han sido sometidos a radioterapia. Los Bifosfonatos son fármacos utilizados ampliamente en la prevención y tratamiento de una variedad de enfermedades metabólicas, como la osteoporosis, cáncer óseo, hipocalcemia asociada a cáncer y para prevenir el desarrollo de metástasis ósea. Los pacientes bajo tratamiento con este fármaco se caracterizan por presentar un remodelado óseo deficiente con una pobre actividad de las células claves para el desarrollo de tal proceso, que son: los osteoblastos, los osteoclastos y osteocitos. La incidencia de esta patología depende de dos factores, que son la potencia y la duración del tratamiento bajo BFF. Por lo cual, aquellos casos donde se administran estos fármacos de manera intravenosa, tienen una incidencia más elevada debido al mayor efecto que se obtiene por esta vía. Es de suma importancia que el especialista y el odontólogo estén conscientes de los riesgos que conllevan la administración de estos fármacos y la prevención y el manejo de la Osteonecrosis. Igualmente informar a los pacientes que van a iniciar una terapia con BFF sobre los beneficios y riesgos que conllevan la administración de estos fármacos, haciendo énfasis en el alto riesgo de Osteonecrosis...


Bisphosphonates induced osteonecrosis of the maxilla can be defined as a pathologic condition characterized by the presence of necrotic exposed bone for more than eight weeks, in patients under BFF treatment without radiotherapy. Bisphosphonates are drugs used widely to prevent and treat a variety of metabolic disorders such as osteoporosis, bone cancer, cancer associated hypocalcaemia and to prevent bony metastasis. Patients treated with this kind of drugs, are characterized for deficient bone remodeling with low activity of key cells involved in the development of such process, they are: o and osteoblast, osteoclast and osteocyst. Incidence of this pathology depends on two factors, they are: the potency and the duration of the treatment. There for, those cases where BFF are administered intravenously, has higher incidence due to the higher effect. It is very important that the specialist and the dentist are aware of the risk related to administration of BFF and the prevention and management of Osteonecrosis. Inform the patients about to initiate BFF therapy regarding the benefits and risk related to the use of BFF and associated osteonecrosis...


Subject(s)
Humans , Male , Female , Bisphosphonate-Associated Osteonecrosis of the Jaw , Diphosphonates/administration & dosage , Diphosphonates , Diphosphonates/pharmacokinetics , Administration, Intravenous/adverse effects , Osteomyelitis , Pharmacology , Tumor Necrosis Factors
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