Preventing and Treating Dental Implant Complications from Drugs Known to Cause Osteonecrosis of the Jaws
- 27 Downloads
The prevention and management of Drug Induced Osteonecrosis of the Jaws (DIONJ) is different from the osteoporosis patient compared to the metastatic cancer patient.
The drugs at greatest risk for DIONJ in the osteoporosis patients are alendronate and denosumab where as residronate and ibandronate patients are at minimal risk and raloxifene, rhPTH1–34, strontium renelate, and vitamin D3 with calcium pose no risk. In patients on bisphosphonates, a presurgical drug holiday of 9 months followed by a postsurgical drug holiday of 3 months reduces the risk for clinical DIONJ to the lowest possible and is useful when treating the exposed necrotic bone in established DIONJ in this patient group.
The drugs at greatest risk for DIONJ in the metastatic cancer patients are Zoledronate and denosumab. This risk is even higher if Zoledronate was begun and was followed by denosumab. In patients who have received Zoledronate alone or initially received Zoledronate followed by denosumab, implant placement is very risky to develop DIONJ due to the 11.2 year half-life of bisphosphonates. If the patient has received only denosumab its short half-life of 26 days lends itself to implant placement and/or surgical debridement of existing DIONJ using a 4 months drug holiday before the procedure and 3 month drug holiday after the procedure.
KeywordsDrug-induced osteonecrosis Drug holidays Osteoporosis Metastatic cancer
- 4.Marx RE. Oral & intravenous bisphosphonate induced osteonecrosis of the jaws, history, etiology, prevention, and treatment. 2nd ed. Tokyo: Quintessence Publishing Company; 2011.Google Scholar
- 5.Food and Drug Administration. Background document for meeting of Advisory Committee for reproductive health drug and drug safety and Risk Management Advisory Committee. FDA, September 9, 2011. http://wwwfda.gov/downloads/advisorycommittees/committeesmeetings.
- 6.Rosen HN, Moses AC, Garber J, Iloputaife ID, Ross DS, Lee SL, Greenspan SL. Serum CTX: a new marker of bone resorption that shows treatment effect more often than other markers because of low coefficient of variability and large changes with bisphosphonate therapy. Calcif Tissue Int. 2000;66(2):100–3.CrossRefGoogle Scholar
- 10.Black DM, Schwartz AV, Ensrud KE, Cauley JA, Levis S, Quandt SA, Satterfield S, Wallace RB, Bauer DC, Palermo L, Wehren LE, Lombardi A, Santora AC, Cummings SR, FLEX Research Group. Effects of continuing or stopping alendronate after 5 years of treatment: the Fracture Intervention Trial Long-term Extension (FLEX): a randomized trial. JAMA. 2006;296(24):2927–38.CrossRefGoogle Scholar
- 11.Khosla S, Burr D, Cauley J, Dempster DW, Ebeling PR, Felsenberg D, Gagel RF, Gilsanz V, Guise T, Koka S, McCauley LK, McGowan J, McKee MD, Mohla S, Pendrys DG, Raisz LG, Ruggiero SL, Shafer DM, Shum L, Silverman SL, Van Poznak CH, Watts N, Woo SB, Shane E, American Society for Bone and Mineral Research. Bisphosphonate-associated osteonecrosis of the jaw: report of a task force of the American Society for Bone and Mineral Research. J Bone Miner Res. 2007;22(10):1479–91.CrossRefGoogle Scholar
- 13.Ruggiero SL, Dodson TB, Assael LA, Marx RE, Mehrotra B. American Association of Oral and Maxillofacial Surgeons Position Paper on bisphosphonate-related osteonecrosis of the jaws. 2009, update. J Oral Maxillo Surg. 2009;67(5 Suppl):2–12.Google Scholar
- 15.Novartis AG. Zometa. Zoledronic acid injection. Produce information sheet. Novartis AG; 2004.Google Scholar
- 18.Motzer RJ, Hutson TE, Tomczak P, Michaelson MD, Bukowski RM, Oudard S, Negrier S, Szczylik C, Pili R, Bjarnason GA, Garcia-del-Muro X, Sosman JA, Solska E, Wilding G, Thompson JA, Kim ST, Chen I, Huang X, Figlin RA. Overall survival and updated results for sunitinib compared with interferon alfa in patients with metastatic renal cell carcinoma. J Clin Oncol. 2009;27(22):3584–90.CrossRefGoogle Scholar