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2.
Hematol Oncol ; 25(4): 164-9, 2007 Dec.
Article in English | MEDLINE | ID: mdl-17577204

ABSTRACT

Osteonecrosis of the jaws (ONJ) associated with the use of bisphosphonates is a newly described entity. To elucidate the mechanism leading to ONJ and to test the hypothesis that in patients with ONJ the bisphosphonates may interfere with endothelial cell proliferation, using flow cytometric analysis we evaluated the number of circulating endothelial progenitor cells (EPCs) and circulating endothelial cells (CECs) in eight patients with bisphosphonate treatment and osteonecrosis, eight multiple myeloma (MM) patients with bisphosphonates treatment without ONJ and five normal subjects. MM patients showed an increase of CD34+ cells with respect the control subjects and ONJ subjects. EPCs and CECs were higher in MM patients compared to controls and ONJ patients. ONJ patients showed a decrease of EPCs compared to control subjects while CECs were similar to the controls group. Our results seem to show the possibility that bisphosphonates could have a antiangiogenic effect and a suppressive effect on CECs of patients with ONJ.


Subject(s)
Diphosphonates/adverse effects , Endothelial Cells/pathology , Jaw Diseases/chemically induced , Osteonecrosis/chemically induced , Aged , Aged, 80 and over , Angiogenesis Inhibitors , Blood , Case-Control Studies , Cell Count , Female , Flow Cytometry , Humans , Male , Middle Aged , Stem Cells/pathology
3.
Acta Haematol ; 117(3): 181-7, 2007.
Article in English | MEDLINE | ID: mdl-17164581

ABSTRACT

Osteonecrosis of the jaw is an unremitting adverse outcome associated with bisphosphonate therapy in patients with multiple myeloma or bone metastases from solid tumors. Twelve patients who presented with exposed bone associated with bisphosphonates were reviewed to determine the type, dosage and duration of their bisphosphonate therapy, presenting findings, comorbidities and the event that incited the bone exposure. The discontinuation of bisphosphonate therapy has not helped reverse the presence of osteonecrosis, and the surgical manipulation of the involved site appears to worsen the underlying bone pathology. Hyperbaric oxygen, which has proven efficacious in other forms of osteonecrosis by establishing an oxygen gradient, is of no definitive benefit to patients with bisphosphonate-induced exposed bone. Antibiotic therapy is useful in controlling pain and swelling but ineffective in preventing the progression of the exposed bone. To date, prevention is the only currently possible therapeutic approach to the management of this complication.


Subject(s)
Bone Density Conservation Agents/adverse effects , Breast Neoplasms/complications , Diphosphonates/adverse effects , Imidazoles/adverse effects , Multiple Myeloma/complications , Osteonecrosis/chemically induced , Osteonecrosis/etiology , Alendronate/adverse effects , Bone Neoplasms/secondary , Breast Neoplasms/pathology , Female , Humans , Jaw Diseases/chemically induced , Jaw Diseases/etiology , Jaw Diseases/pathology , Male , Mandible/diagnostic imaging , Mandible/pathology , Maxilla/diagnostic imaging , Maxilla/pathology , Middle Aged , Necrosis , Osteonecrosis/pathology , Pamidronate , Tomography, X-Ray Computed , Zoledronic Acid
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