Newsgroup: it.scienza.medicina
Titolo: bifosfonati

ciao a tutti
Ad un congresso č stato detto che la terapia dell'osteoporosi con 
bifosfonati controindica l'uso di impianti perchč ci possono essere come 
effetto collaterale delle necrosi localizzate dei mascellari.
Qualcuno mi puň dare notizie piů precise?
Grazie. 

effetto collaterale delle necrosi localizzate dei mascellari.
si , e' cosi' :
Osteonecrosis of the jaws is seen mainly with drugs such as Zometa or
Aredia which are  bisphosphonates given to reduce hypercalcemia seen
in certain cancers. 
A recent study done by UCLA/VA indicates that patients getting IV
Fosamax have a higher  incidence of failure to achieve integration
with dental implants than patients who are  not taking bisphosphonates
or are taking them orally. 
One problem with the bisphosphonates is that they persist in bone for
very long periods  of time, so discontinuing use may not be effective.
 
vedi anche da medline :
J Oral Maxillofac Surg. 2005 Nov;63(11):1567-75. Related Articles,
Links  
 
Bisphosphonate-induced exposed bone (osteonecrosis/osteopetrosis) of
the jaws: risk factors, recognition, prevention, and treatment.
Marx RE, Sawatari Y, Fortin M, Broumand V.
Miller School of Medicine, Division of Oral and Maxillofacial Surgery,
University of Miami, 9380 SW 150th Street, Miami, FL 33157, USA.
rm...@med.miami.edu
PURPOSE: Bisphosphonates inhibit bone resorption and thus bone renewal
by suppressing the recruitment and activity of osteoclasts thus
shortening their life span. Recently three bisphosphonates,
Pamidronate (Aredia; Novartis Pharmaceuticals, East Haven, NJ),
Zoledronate (Zometa; Novartis Pharmaceuticals), and Alendronate
(Fosamax; Merck Co, West Point, VA) have been linked to painful
refractory bone exposures in the jaws. 
MATERIALS AND METHODS: One hundred-nineteen total cases of
bisphosphonate-related bone exposure were reviewed. RESULTS:
Thirty-two of 119 patients (26%) received Aredia, 48 (40.3%) received
Zometa, 36 (30.2%) received Aredia later changed to Zometa, and 3
(2.5%) received Fosamax. The mean induction time for clinical bone
exposure and symptoms was 14.3 months for those who received Aredia,
12.1 months for those who received both, 9.4 months for those who
received Zometa, and 3 years for those who received Fosamax. Sixty-two
(52.1%) were treated for multiple myeloma, 50 (42%) for metastatic
breast cancer, 4 (3.4%) for metastatic prostate cancer and 3 (2.5%)
for osteoporosis. Presenting findings in addition to exposed bone were
37 (31.1%) asymptomatic, 82 (68.9%) with pain, 28 (23.5%) mobile
teeth, and 21 (17.6%) with nonhealing fistulas. Eighty-one (68.1%)
bone exposures occurred in the mandible alone, 33 (27.7%) in the
maxilla, and 5 (4.2%) occurred in both jaws. Medical comorbidities
included the malignancy itself 97.5%, previous and/or maintenance
chemotherapy 97.5%, Dexamethasone 59.7%. Dental comorbidities included
the presence of periodontitis 84%, dental caries 28.6%, abscessed
teeth 13.4% root canal treatments 10.9%, and the presence of
mandibular tori 9.2%. The precipitating event that produced the bone
exposures were spontaneous 25.2%, tooth removals 37.8%, advanced
periodontitis 28.6%, periodontal surgery 11.2%, dental implants 3.4%
and root canal surgery 0.8%. 
CONCLUSIONS: Complete prevention of this complication in not currently
possible. However, pre-therapy dental care reduces this incidence, and
non-surgical dental procedures can prevent new cases. For those who
present with painful exposed bone, effective control to a pain free
state without resolution of the exposed bone is 90.1% effective using
a regimen of antibiotics along with 0.12% chlorohexidine antiseptic
mouth.
-- 
sgas ® UIN 69225877 co-moderatore di ISciMed 
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