Management of patients at Risk of Medication-Related Osteonecrosis of Jaw Flashcards
1
Q
What does MRONJ stand for?
A
- Medication related osteonecrosis of the jaw
2
Q
What is MRONJ?
A
- Rare side effect of anti-resorptive and anti-angiogenic drugs
- Exposed bone or bone that can be probed through an intraoral or extraoral fistula in maxillofacial region that has persisted more than 8 weeks
3
Q
What are the signs and symptoms of MRONJ?
A
- Delayed healing following dental extraction or other oral surgery
- Pain
- Soft tissue infection or swelling
- Numbness
- Paraesthesia
- Exposed bone
4
Q
What are the current hypotheses of MRONJ mechanisms?
A
- Suppression of bone turnover
- Inhibition of angiogenesis
- Toxic effects on soft tissues, inflammation or infection
- Likely cause is multifactorial with both genetic and immunological elements
5
Q
What are the risk factors for MRONJ?
A
- Underlying medical condition :
- cancer
- osteoporosis
- Cumulative drug dose (and duration of drug treatment)
- Concurrent treatment with systemic glucocorticoids
- Dentoalveolar surgery and mucosal trauma
6
Q
How do anti-resorptive drugs work?
A
- Osteoclasts break down (resorb) bone tissue
- Inhibit osteoclast differentiation and function
- Leads to decreased bone resorption and remodelling
7
Q
What anti-resorptive drugs have been linked to MRONJ and what are they used for?
A
- Bisphosphonates
- Denosumab
- Used for management of osteoporosis and other non malignant and malignant conditions
8
Q
How do bisphosphonates work?
A
- Reduce bone resorption
/ - high affinity for hydroxyapatite of bone and persist in skeletal tissue for a long time
- ingested by osteoclast
- inhibiting enzymes essential to formation, recruitment and function of osteoclasts
9
Q
What is the half life of alendronate?
A
- Approx 10 years
10
Q
What are bisphosphonates used for(conditions)?
A
- Reduce symptoms and complications of metastatic bone disease (breast cancer, prostate cancer and multiple myeloma) - high dose Intravenous
- Osteoporosis
- Paget’s disease
- Osteogenesis imperfecta
- Fibrous dysplasia
11
Q
What is denosumab?
A
-
Human monoclonal antibody
/ - Acts like OPG- RANKL inhibitor
- Binds to RANKL
- So that it can’t bind to RANK
- Inhibits osteoclast function and associated bone resorption
( RANKL binding to RANK on osteoclast precursor to promotes the differentiation and maturation of osteoclast)
12
Q
What is denosumab used for?
A
- Prophylaxis and treatment of osteoporosis
- Subcutaneously every 6 months for osteoporosis
/ - Reduce SKE skeletal -related events related to metastasis ( breast cancer etc)
- Higher dose monthly in metastatic disease
/ - Effects on bone turnover diminish within 9months after treatment completion
13
Q
What are anti-angiogenic drugs?
A
- Target the processes by which new blood vessels formed
- Used in cancer treatment to restrict tumour revascularisation
14
Q
what are some types anti-angiogenic drugs related to MRONJ?
A
- Vascular endothelial growth factor (VEGF) inhibitors:
- bevacizumab
- and aflibercept
/ - Receptor tyrosine kinase inhibitor
- sunitinib
15
Q
What are bisphosphonates used for in children?
A
- Osteogenesis imperfecta
- Fibrous dysplasia
- Neuromuscular disorders
- Bone dysplasia
- Idiopathic juvenile osteoporosis
- Rheumatologic disorders
- Crohn’s disease