JVD 2011 #4 - Bisphosphonate Related Osteonecrosis of the Jaws: A Review FOUNDATIONS Flashcards
According to Kevin Stepaniuk, DVM
in
Bisphosphonate Related Osteonecrosis of the Jaws: A Review FOUNDATIONS
What formulations of bisphosphonates are more potent?
nitrogenous formulations
According to Kevin Stepaniuk, DVM
in
Bisphosphonate Related Osteonecrosis of the Jaws: A Review FOUNDATIONS
What are the plasma half life and bone halflife for bisphosphonates?
plasma 1-2 hours
bone 3+ years
According to Kevin Stepaniuk, DVM
in
Bisphosphonate Related Osteonecrosis of the Jaws: A Review FOUNDATIONS
What are the most common side effects of bisphosphonate administration?
GI side effects, diarrea, esophagitis
less common, risk of esophageal cancer
concern for acute renal tubular necrosis
According to Kevin Stepaniuk, DVM
in
Bisphosphonate Related Osteonecrosis of the Jaws: A Review FOUNDATIONS
how common is BRONJ in dogs treated with bisphosphonates for clinically occurring diseases?
never reported
According to Kevin Stepaniuk, DVM
in
Bisphosphonate Related Osteonecrosis of the Jaws: A Review FOUNDATIONS
What is the best treatment for BRONJ?
Prevention
no known effective treatment. benefits of debridement are debated
According to Kevin Stepaniuk, DVM
in
Bisphosphonate Related Osteonecrosis of the Jaws: A Review FOUNDATIONS
in experimental model of BRONJ in dogs treated with aledronate and zoledronate, what percentage in each group developed histologic and clinical necrosis?
no dog developed clinical necrosis
17-25% in oral aledronate group
25-33% in in injectible zoledronate group
According to Kevin Stepaniuk, DVM
in
Bisphosphonate Related Osteonecrosis of the Jaws: A Review FOUNDATIONS
What is RANK and what does it do?
receptor-activated nuclear factor kb
key regulator of bone metabolism
expressed on plasma membrane of of osteoclasts and osteoclast precursors
stimulation of RANK by RANKL upregulates bone destruction
According to Kevin Stepaniuk, DVM
in
Bisphosphonate Related Osteonecrosis of the Jaws: A Review FOUNDATIONS
What is RANKL and why is it important?
receptor-activated nuclear factor-kb ligand
RANKL expressed on plasma membrane of osteoblasts
Stimulation of RANK by RANKL leads to increased bone resorption and turnover
According to Kevin Stepaniuk, DVM
in
Bisphosphonate Related Osteonecrosis of the Jaws: A Review FOUNDATIONS
What is OPG and why is it important?
Osteoprotegrin
binds to RANK as a decoy and prevents activation and thus decreases bone resorption
According to Kevin Stepaniuk, DVM
in
Bisphosphonate Related Osteonecrosis of the Jaws: A Review FOUNDATIONS
What are risk factors identified in people for BRONJ (8)?
IV use,
long-term oral use,
use of concurrent corticosteroids,
use of concurrent chemotherapeutic agents,
dental disease, and
dental/oral surgery.
poor oral hygiene
diabetes mellitus
According to Kevin Stepaniuk, DVM
in
Bisphosphonate Related Osteonecrosis of the Jaws: A Review FOUNDATIONS
which 2 drugs alone or in combination are responsible for most of the human cases?
zoledronate 43 % of the cases,
pamidronate 27 %, and
zoledronate plus pamidronate 23 % of the cases
According to Kevin Stepaniuk, DVM
in
Bisphosphonate Related Osteonecrosis of the Jaws: A Review FOUNDATIONS
What are the known inciting events for human cases (6)?
extraction (37.8 %),
active periodontitis (28.6 %),
spontaneous (25.2 %),
periodontal surgery (11.2 %),
dental implant (3.4 %), and
apicoectomy (0.8 %)
essentially iatrogenic disruption or infection
According to Kevin Stepaniuk, DVM
in
Bisphosphonate Related Osteonecrosis of the Jaws: A Review FOUNDATIONS
in humans which jaw is most affected?
mandible 67%,
maxilla 26%,
both mandible and maxilla 8%
