Exam 1

Question 1

Antiresorptive medications

Answer 1

IV Bisphosphonates and Oral Bisphosphonates

Question 2

IV bisphosphonates

Answer 2

• tx of cancer-related conditons
• hypercalcemia of malignancy
• skeletal related events assocated with solid tumors
• postive effect on QOL, no effect on cancer-specific survival

Medications: Aretia, Zometa

Question 3

Oral bisphosphonates

Answer 3

Tx of osteoporosis and osteopenia, paget’s disease of bone, and osteogenesis imperfecta

Medications: fosomax, boniva, actonel

Question 4

mechanism of action of bisphosphonates

Answer 4

1) attach to hydroxyapatitie binding sites on bony surfaces (especially areas undergoing resorption)
2) inhibit osteoclast activity
3) decreases osteoclast progenitor development/recruitments and promotes osteoclast apoptosis

Question 5

RANK ligand inhibitors

Answer 5

Denosumab, Prolia, Xgeva

• Ab against RANK ligand which inhibits osteoclast function
• Tx of osteoporosis

Question 6

Medication related osteonecrosis of the jaw (MRONJ) case definition

Answer 6

• current or previous treatment w/ antiresorptive or antiangiogenic agents
• exposed bone or bone that can be probed through an intraoral or extraoral fistula that persisted for >8 weeks
• no history or radiation therapy to the jaws or obvious metastatic disease to the jaws

Question 7

pathophisiology of MRONJ

Answer 7

• increased remodeling rate of jaws
• inflammation and infection
• inhibition of angiogenesis
• soft tissue toxicity
• innate or acquired immune dysfunction

Question 8

Pts with cancer that are taking antiresorptive medication have 100x (larger/smaller) risk of developing ONJ than osteonecrosis pts taking the same medication.

Answer 8

cancer patients taking anti-resorptive tx are at 100x greater risk of developing ONJ than osteonecrosis pts

Question 9

Risk facts of MRONJ