SDCEP Bisphosphonates guidelines Flashcards
What is the MOA of bisphosphonates ?
- hinder the formation, recruitment and function of osteoclasts
What is the most common use of bisphosphonates?
Osteoporosis
How are bisphosphonate drugs used in the management of malignant or non-malignant conditions ?
they can delay the onset of treatment (e.g. chemo) complications such as bone fractures and bone pain
Why is the jaw at risk of otseonecrosis when taking bisphosphonates ?
this is because bisphosphonates accumulates at sites of high bone turnover. Here, they reduce bone turn over and blood supply leading to the death of the bone (osteonecrosis)
Give examples of non-malignant conditions that can be treated with bisphosphonates
- osteoporosis
- pagets disease
- fibrous dysplasia
- osteogenesis imperfecta
- primary hyperparathyroidism
- cystic fibrosis
Give examples of malignant conditions that can be treated with bisphosphonates
- myeloma
- prostate cancer
- breast cancer
- hypercalcaemia of metastasis
- bone metstatic lesions
What is the postulated reason for the lack of a true incidence of BONJ?
too few cases are reported
It is possible to develop BONJ spontaneously (in the absence of trauma or injury?). True or false
true
The duration of the effect of bisphosphonates may extend beyond the duration of the treatment. Why is this?
This is because bisphosphonates stay in the skeletal system/base for years
Half life of 10 years
Current evidence supports assessing the risk of the development of BONJ on …
the condition which the bisphosphonate was prescribed for
high risk… for malignant conditions
low risk… for non-malignant conditions
What should prescribers and dispensers of bisphosphonates advise patients?
- that the medication they have been given is associated with a very small risk of BONJ
- to make an appointment with a dentist A.S.A.P. to ensure they are dentally fit
- to inform their dentist of their bisphosphonate use
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What signs and symptoms should a patient at risk of developing BONJ look out for?
- feeling of numbness, heaviness or unusual sensation in the jaw
- pain in jaw and bad taste
- swelling of jaw
- loose teeth
- exposed bone
What patients are at low risk of developing BONJ?
- patients about to start bisphoshonate therapy for any condition
- patient taking bisphosphonate to manage or prevent osteoporosis (without higher risk factors)
What is the guidance for dentists for the management of patients with low risk of developing BONJ ?
- perform extractions/oral surgery/procedures that may impact bone in primary care as atraumatically as possoible; avoid raising flaps and achieve good haemostasis
- review healing at 4 weeks after carrying out any invasive treatment
- if surgery sites failr to heal within 4-6 weeks refer to OS/OMFS specialist
What patients are considered to be at high risk of developing BONJ?
- previous diagnosis of BONJ
- on bisphosphonates to manage a malignant condition
- on bisphosphonates to manage systemic non-malignant conditions (pagets disease)
- under care of specialist for rare medical condition such as osteogenesis imperfecta
- concurrent use of corticosteroids and immunosuppressants
- coagulopathy, chemotherapu or radiotherapy
What is the guidance for dentists regarding the management of patients with high risk of developing BONJ?
Seek advice from an OS/OMFS specialist (preferrably by letter) about whether treatment can be carried out in primary care for extraction, oral surgery or procedure which may impact bone or whether to refer
What is the primary indication for alendronic acid?
osteoporosis
What is the primary indication of risedronate sodium?
- osteoporosis
- pagets disease
What is the primary indication for zoledronic acid?
- Pagets disease
- skeletal events associated with bone metastases
- hypercalemia
What is the primary indication of etidronate disodium?
- osteoporosis
- pagets disease
What is the primary indication for tiludronic acid?
pagets disease
What is the primary indication for ibandronic acid?
- osteoporosis
- bone metastasis
- hypercalcaemia
What is the primary indication for pamidronate disodium ?
- pagets disease
- bone pain
- skeletal events associated with bone metastases
- hypercalcaemia
What is the primary indication for sodium clodronate?
- bone pain
- skeletal events associated with bone metastases
- hypercalcaemia
What are the most commonly prescribed bisphosnonates?
- alendronic acid
- risedronate sodium
- zoledronic acid
There is no evidence supporting the use of antibiotic or topical antiseptic prophylaxis in reducing the risk of BONJ. True or false
True
You should not bother allocating a patient that has completed bisphosphonate therapy into a risk group. True or false
False
They should still be allocated into a risk group
Before the commencement of bisphoshonate therapy, what dental care should be received by a patient?
- care that will reduce mucosal trauma/help avoid subsequent extraction or oral surgery e.g.
- remedial dental work
- reduction of periodontal/dental infection
- adjuse or replace ill fitting dentures to minimise mucosal trauma
What preventive advice should be given to patients prescribed bisphosphonates?
- maintain good OH
- healthy diet; reduce sugary snacks and drinks
- stop smoking
- limit alcohol intake
- regular dental checks
- report following symptoms: loose teeth, pain, swelling A.S.A.P.
