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Interventions for treating osteonecrosis of the jaw bones associated with bisphosphonate drugs

Bisphosphonates are drugs very similar to pyrophosphate (a normal substance found in bone). They are used to lessen symptoms and complications due to the spread of cancer to the bones, and to prevent and treat fragile bones in osteoporosis (a conditon where tiny holes in the bones makes them brittle). These drugs can cause a rare but serious condition called bisphosphonate‐related osteonecrosis of the jaw or 'BRONJ'. BRONJ affects the healing of bone damage by interrupting the process of removing dead bone and laying down new bone. When this happens, parts or all of the jaw bone becomes friable (a bit like chalk), and eventually this dead bone can be exposed. This makes it difficult for people to eat, speak or brush their teeth, and it often causes severe pain.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

A systematic review of therapeutical approaches in bisphosphonates-related osteonecrosis of the jaw (BRONJ)

OBJECTIVES: The clinical management of bisphosphonate-related osteonecrosis of the jaw (BRONJ) remains controversial. Since universally accepted guidelines have not been released yet, clinicians usually chose the type of treatment according to position papers based on expert opinion, or on empirical experience. The aim of this systematic review is to identify different therapeutical approaches for BRONJ that have been described in literature and to describe their effectiveness.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2014

[Osteonecrosis of the jaw associated with bisphosphonate therapy in primary osteoporosis: review of the literature]

BACKGROUND: The aim of this review was to study risk factors involved in osteonecrosis of the jaw after oral surgery in patients treated with bisphosphonates due to primary osteoporosis.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2013

Defining the epidemiology of bisphosphonate-associated osteonecrosis of the jaw: prior work and current challenges

Bisphosphonate-related osteonecrosis of the jaw (BONJ) is an adverse effect of bisphosphonate use with a poorly described epidemiology in osteoporosis patients. We examined the literature and two new cohorts for BONJ. The literature suggests an incidence rate of 0.028 % to 4.3 %. Our cohort studies found an incidence of 0.02 % (95 % CI 0.004 %-0.11 %).

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2013

Risk of osteonecrosis of the jaw in cancer patients receiving denosumab: a meta-analysis of seven randomized controlled trials

AIMS: The aim of this study is to gain a better understanding of the overall incidence and risk of osteonecrosis of the jaw (ONJ) in cancer patients receiving denosumab.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2014

A systematic review of microsurgical reconstruction of the jaws using vascularized fibula flap technique in patients with bisphosphonate-related osteonecrosis

OBJECTIVE: The aim of this systematic review was to assess the role of microsurgical reconstruction of the jaws in patients with bisphosphonate-related osteonecrosis, and biological complications after an observation period of at least 12 months.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2011

Association between CYP2C8 (rs1934951) polymorphism and bisphosphonate-related osteonecrosis of the jaws in patients on bisphosphonate therapy: a meta-analysis

AIMS: Bisphosphonate-related osteonecrosis of the jaws (BONJ) is a severe complication in patients on bisphosphonate therapy. The study was conducted to verify the association between CYP2C8 (rs1934951) polymorphism and BONJ predisposition.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2013

Risk of osteonecrosis in patients taking bisphosphonates for prevention of osteoporosis: a systematic review and meta-analysis

SUMMARY: We aimed to systematically review observational studies evaluating use of bisphosphonates (BPs) and risk of osteonecrosis of jaw (ONJ) or other sites among non-cancer patients.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2014

An evidence-based review of risk-reductive strategies for osteonecrosis of the jaws among cancer patients

PURPOSE: Bone antiresorptive treatment is associated with osteonecrosis of the jaws. Interventions used to treat this complication are diverse, controversial, and largely empirical but certain risk factors could help in its avoidance. The aim of this evidence-based review is to elucidate any interventions that are effective in reducing the risk for development of ONJ in cancer patients receiving bone antiresorptive therapy and to quantify the effectiveness of such interventions.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2013

Use of bisphosphonates and the risk of osteonecrosis among cancer patients: a systemic review and meta-analysis of the observational studies

PURPOSE: This study aims to systematically review observational studies evaluating the use of bisphosphonates (BPs) and risk of osteonecrosis of the jaw (ONJ) among cancer patients.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2014

Osteonecrosis of the jaw and use of bisphosphonates in adjuvant breast cancer treatment: a meta-analysis

The authors concluded that jaw osteonecrosis was rare after adjuvant biphosphonate treatment in women with breast cancer. It was associated with biphosphonates (in particular zoledronic acid). Overall, biphosphonates were a safe adjuvant treatment. The review was generally well-conducted, but the conclusion that biphosphonates were safe may be optimistic given that zoledronic acid was associated with increased risk.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2009

Narrative [corrected] review: bisphosphonates and osteonecrosis of the jaws

This review reported on cases of osteonecrosis of the jaws following treatment with bisphosphonates. The authors concluded that most reported cases have been in patients with multiple myeloma or metastatic cancer and, to a lesser extent, osteoporosis. The conclusions seem reasonable, though they are based on case series and prospective studies are required to reliably identify risk factors.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2006

What is the impact of bisphosphonate therapy upon dental implant survival? A systematic review and meta-analysis

OBJECTIVE: A systematic review and meta-analysis are carried out to assess the scientific evidence that bisphosphonate therapy can decrease the success rate of dental implants.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2014

Metastatic breast cancer: Treatments and possible consequences

When breast cancer is diagnosed, the aim of treatment is usually to remove all of the tumor. But this is no longer possible if it has spread to other parts of the body. Then the aim of treatment is to keep your overall health and quality of life as good as possible for as long as possible.The goal of treatment for metastatic breast cancer is to stop or slow down the growth of the tumor. It is also possible to reduce the symptoms and possible side effects of treatment and to treat associated medical conditions. Cancer-related pain can be treated with well-managed pain relief therapy. If treatment is carefully planned and tailored to a person's specific situation, and if their overall health is good, it is often possible to keep the disease under control for years, even if they have metastatic tumors, and have a good quality of life despite the symptoms.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: April 7, 2016

Bisphosphonates in multiple myeloma

Multiple myeloma (also known as myeloma or plasma cell myeloma) is a B‐cell malignancy or, more precisely, plasma cell neoplasm. This cancer grows inside or outside of bones. The bone damage, or osteolytic lesions, may lead to fractures of the long bones or compression fractures in the spine. The mechanism of bone destruction appears to be related to increased bone resorption by cells called osteoclasts. Bisphosphonates are drugs that can inhibit bone resorption by reducing the number and activity of osteoclasts. This updated review of 20 trials enrolling 6692 patients shows that adding bisphosphonates to myeloma treatment reduces fractures of the vertebra and bone pain. Zoledronate is better than etidronate and placebo alone, but not superior to pamidronate or clodronate for improving overall survival and any other outcomes such as vertebral and nonvertebral fractures.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Interventions for replacing missing teeth: hyperbaric oxygen therapy for irradiated patients who require dental implants

This review, carried out by authors of the Cochrane Oral Health Group, was produced to compare the success of dental implant treatment carried out with and without hyperbaric oxygen therapy (HBO) in patients who had previously had radiation treatment.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Bone agents for breast cancer

When breast cancer (BC) has spread to the bones (bone metastases, BM), bone agents (added to anti‐cancer treatment for breast cancer) can reduce pain, fractures and other bone problems. Women and men with advanced breast cancer (ABC) commonly develop bone metastases. Cancer in bones can cause pain, fractures, hypercalcaemia (too much calcium in the blood) and tumour compression of the spinal cord, resulting in serious and permanent nerve damage. This is because cancer deposits can erode into bone using bone‐absorbing cells. Bisphosphonates, and the more recent novel targeted‐therapy denosumab, are drugs that reduce the activity of these bone‐absorbing cells. This review of trials in women with advanced BCBM found that the use of bisphosphonates or denosumab (in addition to their other cancer treatments), can reduce these serious bone problems. It is of great interest to see if bisphosphonates prevent recurrence and improve survival for patients who have been treated for early breast cancer (EBC). However, this review of trials in women with EBC has not identified a benefit of bisphosphonates as an adjuvant therapy at this stage. We have to wait for the reporting of a number of large clinical trials before firm conclusions can be made. Adverse effects are not common for bisphosphonates and include mild gut reactions, transient fever, hypocalcaemia and a small risk of osteonecrosis of the jaw (ONJ), depending on which drug is used. Denosumab appears to be at least as well tolerated as the bisphosphonates.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Risedronate for preventing fractures caused by osteoporosis in postmenopausal women

This summary of a Cochrane review, presents what we know from research about the effect of Risedronate for preventing fractures (broken bones) caused by osteoporosis.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

Alendronate for preventing fractures caused by osteoporosis in postmenopausal women

This summary of a Cochrane review presents what we know from research about the effect of alendronate for preventing fractures (broken bones) caused by osteoporosis.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Oral Complications of Chemotherapy and Head/Neck Radiation (PDQ®): Patient Version

Expert-reviewed information summary about oral complications, such as mucositis and salivary gland dysfunction, that occur in cancer patients treated with chemotherapy or radiation therapy to the head and neck.

PDQ Cancer Information Summaries [Internet] - National Cancer Institute (US).

Version: December 16, 2016

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