SPECIAL CARE MRONJ Flashcards
What is MRONJ?
exposed bone in the maxilla or mandible that has persisted for more than 8 weeks in pts taking anti-resorptive or anti-angiogenic drugs and where there is no history of radiation or no obvious metastatic disease to the jaw
what are symptoms of MRONJ?
delayed healing post xla or trauma
sometimes spontaneous
pain
soft tissue infection and swelling
numbness
exposed bone - sometimes absent
risk factors of MRONJ?
underlying medical condition
cumulative drug dose
concurrent tx with steroids
surgery/ trauma
what drugs put you at risk of MRONJ?
bisphosphonates
RANKL inhibitors
anti-angiogenic drugs
what are bisphosphonates?
drugs that reduce bone resorption by hindering formation, recruitment and function of osteoclasts
what are bisphosphonates used for?
osteoporosis
also non-malignant and malignant conditions
what is the positive effect of bisphosphonates for patients?
reduce or delay onset of disease or tx complications such as bone fractures and pain
what is the half life of alendronate?
10 years
how may bisphosphonates lead to osteonecrosis?
they accumulate at sites of high bone turnover. this may reduce bone turnover, bone blood supply and lead to death of bone
what are the oral bisphosphonates?
alendronic acid
risendronate sodium
what are the IV bisphosphonates?
pamidronate
zolendronic acid
what are RANKL inhibitors?
anti-resorptive drugs
inhibit osteoclast function and bone resorption
why do pts use RANKL inhibitors?
reduce risk of fracture and chronic pain in osteoporosis
cancer
name a RANKL inhibitor?
denosumab
how is denosumab administered?
6 monthly for osteoporosis
monthly for cancer
