4.19.23_Hoda Antiresorptives, radiation

Question 1

What is the incidence of ONJ from osteoporosis?

Answer 1

The incidence of ONJ in the setting of osteoporosis treatment is substantially lower, at around 1 in 10,000 to 100,000 patient-years compared to 1 to 10 per 100 in patients receiving high-dose regimens.

Question 2

Which is more powerful: Nitrogen-containing or non-nitrogen-containing bisphosphonates?

Answer 2

1- Nitrogen containing.
2- Non-Nitrogen containing (100 - 10.000 X more potent)

Question 3

How do bisphosphonates work?

Answer 3

1- Inhibit development of osteoclasts (Hughes et. Al. 1995)
2- Induction of osteoclast apoptosis (Sato et. Al. 1990)
3- Reduction of osteoclast activity (Hughes et. Al. 1989)
4- Prevent the development of osteoclasts from hematopoietic precursors (Vitte et. Al. 1996)
5- Stimulates the production of an osteoclast inhibitory factor (Coluccis et. Al. 1998)

Question 4

What is MRONJ?

Answer 4

Definition: Exposed bone that has persisted for >8 weeks, with current or previous treatment with antiresorptive medication and no history of radiation therapy to the jaws or metastatic disease to the jaws.

Question 5

What is the incidence of MRONJ?

Answer 5

Duration of Tx.:
Zoledronate: After 2 years: 1.6–4.0%
Over 2 years: 3.8-18.0%
Denosumab: After 2 years: 1.6–4.0%
Over 2 years: 3.8-18.0%