Patients' Awareness of the Complications of Bisphosphonate Therapy

Authors

  • Meri Hristamyan Department of Epidemiology and DM, Faculty of Public Health, Medical University – Plovdiv, Bulgaria
  • Ralista Raycheva Department of Social Medicine and Public Health, Faculty of Public Health, Medical University – Plovdiv, Bulgaria
  • Veselka Hristamyan Clinic of Oral and Maxillofacial Surgery, University Hospital "St. George" – Plovdiv, Bulgaria

DOI:

https://doi.org/10.5195/d3000.2022.362

Keywords:

bisphosphonates, osteonecrosis, prevention, awareness, patients

Abstract

INTRODUCTION: Bisphosphonate-associated osteonecrosis of the jaws (BAONJ) is a serious complication that has been reported predominantly in cancer patients treated with Bisphosphonate (BP). The level of knowledge of dental and medical practitioners, as well as patients, is crucial for its prevention.

OBJECTIVES: To investigate patients’ awareness of BAONJ in order to evaluate some problems of the prevention, prophylaxis and diagnosis.        

MATERIALS AND METHODS: A prospective epidemiological study of 112 oncology patients diagnosed with Bisphosphonate-associated osteonecrosis of the jaw was conducted in the Clinic of maxillo-facial surgery of university multiprofile hospital for active treatment (UMHAT) “St. George”, Plovdiv, Bulgaria, based on anamnesis, clinical examination, hospital documentation, and imaging studies. SPSS Statistics v.24 was used for statistical analysis, at a significance level p<0.05.

RESULTS: Before initiation of therapy, only 17.86% of the patients were consulted by a medical practitioner about the risk of jaw complications associated with the use of Bisphosphonates, 9.82% knew about the need for regular dental check-ups after the initiation of therapy and 4.46% had a dental examination and oral sanation. By the time of diagnosis, 61.61% of the patients remained unaware, with the last dental manipulation being most often extraction (52.68%) and removable dentures (21.42%) considered risky by experts. Diagnosed by a general dental practitioner or oncologist were 6.74% of the respondents – the medical practitioners who usually monitor the condition of these patients. Over 2/3 of the patients were diagnosed at a more advanced stage (II/III).

CONCLUSION: The lack of patient awareness leads to omissions and errors in their prophylaxis, and to the diagnosis of BAONJ at a more advanced stage.

References

A Review of Literature on Updates of Bisphosphonates Administration, Cancer Biomarkers for Bisphosphonate Therapy, and Bisphosphonate-related Osteonecrosis of the Jaw in Breast Cancer. Khayamzadeh M, Razmara F, Asad A, Shabankare G. International Journal of Cancer Management. 2021;14(3); e102733. doi: 10.5812/ijcm.102733

Understanding bisphosphonates and osteonecrosis of the jaw: uses and risks. Rosini S, Rosini S, Bertoldi I, Frediani B. Eur Rev Med Pharmacol Sci. 2015 Sep;19(17):3309-17. PMID: 26400539.

Bisphosphonate-associated Osteonecrosis of the Jaws: a Survey of the Level of Knowledge of Dentists about the Risks of Bisphosphonate Therapy. Hristamyan-Cilev MA, Pechalova PP, Raycheva RD, Hristamyan VP, Kevorkyan AK, Stoilova YD. Folia Med (Plovdiv). 2019 Jun 1;61(2):303-311. doi: 10.2478/folmed-2018-0075. PMID: 31301653.

Knowledge, practices, and opinions of ontario dentists when treating patients receiving bisphosphonates. Alhussain A, Peel S, Dempster L, Clokie C, Azarpazhooh A. J Oral Maxillofac Surg. 2015 Jun;73(6):1095-105. doi: 10.1016/j.joms.2014.12.040. Epub 2015 Jan 12. PMID: 25843818.

Bisphosphonates, healthcare professionals and oral health. Raj DV, Abuzar M, Borromeo GL. Gerodontology. 2016 Mar;33(1):135-43. doi: 10.1111/ger.12141. Epub 2014 Jul 15. PMID: 25039439.

Survey of Korean dentists on the awareness on bisphosphonate-related osteonecrosis of the jaws. Yoo JY, Park YD, Kwon YD, Kim DY, Ohe JY. J Investig Clin Dent. 2010 Nov;1(2):90-5. doi: 10.1111/j.2041-1626.2010.00024.x. PMID: 25427263.

Knowledge and attitudes of French dentists on bone resorption inhibitors (bisphosphonates and denosumab): A cross-sectional study. Arnaud MP, Talibi S, Lejeune-Cairon S. J Stomatol Oral Maxillofac Surg. 2022 Apr;123(2):163-170. doi: 10.1016/j.jormas.2021.04.010. Epub 2021 Apr 27. PMID: 33930600.

Bisphosphonate-related osteonecrosis of the jaw: awareness and level of knowledge of Lebanese physicians. El Osta L, El Osta B, Lakiss S, Hennequin M, El Osta N. Support Care Cancer. 2015 Sep;23(9):2825-31. doi: 10.1007/s00520-015-2649-1. Epub 2015 Feb 13. PMID: 25672288.

Physicians' awareness of bisphosphonates-related osteonecrosis of the jaw. Al-Mohaya MA, Al-Khashan HI, Mishriky AM, Al-Otaibi LM. Saudi Med J. 2011 Aug;32(8):830-5. PMID: 21858393.

Perceptions of medical doctors on bisphosphonate-related osteonecrosis of the jaw. Kim JW, Jeong SR, Kim SJ, Kim Y. BMC Oral Health. 2016 Sep 7;16(1):92. doi: 10.1186/s12903-016-0290-0. PMID: 27604159; PMCID: PMC5015333.

Intervention to improve awareness of the risk factors for osteonecrosis of the jaw in patients under treatment with bisphosponates. Randomised clinical trial. García-Martínez L, Martín-Payo R, Pelaz-García A, Sierra-Vega M, Junquera-Gutiérrez LM. Enferm Clin. 2017 Nov-Dec;27(6):352-360. English, Spanish. doi: 10.1016/j.enfcli.2017.04.001. Epub 2017 Jun 2. PMID: 28583834.

Awareness of the risk of developing medication-related osteonecrosis of the jaw among bisphosphonate users. El-Ma'aita A, Da'as N, Al-Hattab M, Hassona Y, Al-Rabab'ah M, Al-Kayed MA. J Int Med Res. 2020 Sep;48(9):300060520955066. doi: 10.1177/0300060520955066. PMID: 32924697; PMCID: PMC7493245.

Awareness among patient at risk of developing Medication Related Osteonecrosis of the Jaw (MRONJ) - A primary prevention strategy. Al Abdullateef A, Alhareky MS. Saudi Pharm J. 2020 Jun;28(6):771-778. doi: 10.1016/j.jsps.2020.05.004. Epub 2020 May 15. PMID: 32550810; PMCID: PMC7292880.

Narrative [corrected] review: bisphosphonates and osteonecrosis of the jaws. Woo SB, Hellstein JW, Kalmar JR. Ann Intern Med. 2006 May 16;144(10):753-61. doi: 10.7326/0003-4819-144-10-200605160-00009. Erratum in: Ann Intern Med. 2006 Aug 1;145(3):235. PMID: 16702591.

Epidemiology, clinical manifestations, risk reduction and treatment strategies of jaw osteonecrosis in cancer patients exposed to antiresorptive agents. Campisi G, Fedele S, Fusco V, Pizzo G, Di Fede O, Bedogni A. Future Oncol. 2014 Feb;10(2):257-75. doi: 10.2217/fon.13.211. PMID: 24490612.

Medication-related osteonecrosis of the jaw in patients with cancer. Berenson J.R. Stopeck A.T. ©2015 UpToDate. https://www.uptodate.com/contents/medication-relatedosteonecrosis-of-the-jaw-in-patients-with-cancer (Accesed on September 04, 2021)

Appropriate and necessary oral care for people with cancer: guidance to obtain the right oral and dental care at the right time. Epstein JB, Güneri P, Barasch A. Support Care Cancer. 2014 Jul;22(7):1981-8. doi: 10.1007/s00520-014-2228-x. Epub 2014 Mar 28. PMID: 24676676.

How patients' lack of knowledge about oral bisphosphonates can interfere with medical and dental care. Migliorati CA, Mattos K, Palazzolo MJ. J Am Dent Assoc. 2010 May;141(5):562-6. doi: 10.14219/jada.archive.2010.0229. PMID: 20436104.

American Association of Oral and Maxillofacial Surgeons position paper on medication-related osteonecrosis of the jaw--2014 update. Ruggiero SL, Dodson TB, Fantasia J, Goodday R, Aghaloo T, Mehrotra B, O'Ryan F; American Association of Oral and Maxillofacial Surgeons. J Oral Maxillofac Surg. 2014 Oct;72(10):1938-56. doi: 10.1016/j.joms.2014.04.031. Epub 2014 May 5. Erratum in: J Oral Maxillofac Surg. 2015 Jul;73(7):1440. Erratum in: J Oral Maxillofac Surg. 2015 Sep;73(9):1879. PMID: 25234529.

International Task Force on Osteonecrosis of the Jaw. Diagnosis and management of osteonecrosis of the jaw: a systematic review and international consensus. Khan AA, Morrison A, Hanley DA, Felsenberg D, McCauley LK, O'Ryan F, et al. J Bone Miner Res. 2015 Jan;30(1):3-23. doi: 10.1002/jbmr.2405. PMID: 25414052.

Canadian consensus practice guidelines for bisphosphonate associated osteonecrosis of the jaw. Khan AA, Sándor GK, Dore E, Morrison AD, Alsahli M, Amin F, et al. Canadian Association of Oral and Maxillofacial Surgeons. J Rheumatol. 2008 Jul;35(7):1391-7. Epub 2008 Jun 1. Erratum in: J Rheumatol. 2008 Aug;35(8):1688. Erratum in: J Rheumatol. 2008 Oct;35(10):2084. PMID: 18528958.

American Society of Clinical Oncology executive summary of the clinical practice guideline update on the role of bone-modifying agents in metastatic breast cancer. Van Poznak CH, Temin S, Yee GC, Janjan NA, Barlow WE, Biermann JS, et al. American Society of Clinical Oncology. J Clin Oncol. 2011 Mar 20;29(9):1221-7. PMID: 21343561.

CHMP Assessment Report on Bisphosphonates and Osteonecrosis of the Jaw. European Medicines Agency. London: EMA/CHMP 2011. http://www.ema.europa.eu/docs/en_GB/document_library/Other/2010/01/WC500051383.pdf (Accessed on December 05, 2021).

Decreased occurrence of osteonecrosis of the jaw after implementation of dental preventive measures in solid tumour patients with bone metastases treated with bisphosphonates. The experience of the National Cancer Institute of Milan. Ripamonti CI, Maniezzo M, Campa T, Fagnoni E, Brunelli C, Saibene G, et al. Ann Oncol. 2009 Jan;20(1):137-45. doi: 10.1093/annonc/mdn526. Epub 2008 Jul 22. PMID: 18647964.

Reduction of osteonecrosis of the jaw (ONJ) after implementation of preventive measures in patients with multiple myeloma treated with zoledronic acid. Dimopoulos MA, Kastritis E, Bamia C, Melakopoulos I, Gika D, Roussou M, et al. Ann Oncol. 2009 Jan;20(1):117-20. doi: 10.1093/annonc/mdn554. Epub 2008 Aug 9. PMID: 18689864.

Preventive strategies and clinical implications for bisphosphonate-related osteonecrosis of the jaw: a review of 282 patients. Bonacina R, Mariani U, Villa F, Villa A. J Can Dent Assoc 2011; 77:b147. PMID: 22129778.

Chapter 10 Bisphosphonate – Related Osteonecrosis of the Jaws – Diagnosis and Management. Pechalova P, Poriazova E, Pavlov N, Bakardjiev A. Textbook of Advanced Oral and Maxillofacial Surgery, edited by Mohammad Hosein Kalantar Motamedi, ISBN 978-953-51- 1146-7. Published: June 26, 2013

Bisphosphonate-induced exposed bone (osteonecrosis/osteopetrosis) of the jaws: risk factors, recognition, prevention, and treatment. Marx RE, Sawatari Y, Fortin M, Broumand V. J Oral Maxillofac Surg. 2005 Nov;63(11):1567-75. doi: 10.1016/j.joms.2005.07.010. PMID: 16243172.

A different schedule of zoledronic acid can reduce the risk of the osteonecrosis of the jaw in patients with multiple myeloma. Corso A, Varettoni M, Zappasodi P, Klersy C, Mangiacavalli S, Pica G, Lazzarino M. Leukemia. 2007 Jul;21(7):1545-8. doi: 10.1038/sj.leu.2404682. Epub 2007 Apr 5. PMID: 17410188.

Osteonecrosis of the jaw and bisphosphonates. Durie BG, Katz M, Crowley J. N Engl J Med. 2005 Jul 7;353(1):99-102; discussion 99-102. doi: 10.1056/NEJM200507073530120. PMID: 16000365.

Downloads

Published

2022-08-19

Issue

Vol. 10 No. 1 (2022)

Section

Adults & the Elderly

License

Authors who publish with this journal agree to the following terms:

  1. The Author retains copyright in the Work, where the term “Work” shall include all digital objects that may result in subsequent electronic publication or distribution.
  2. Upon acceptance of the Work, the author shall grant to the Publisher the right of first publication of the Work.
  3. The Author shall grant to the Publisher and its agents the nonexclusive perpetual right and license to publish, archive, and make accessible the Work in whole or in part in all forms of media now or hereafter known under a Creative Commons Attribution 4.0 International License or its equivalent, which, for the avoidance of doubt, allows others to copy, distribute, and transmit the Work under the following conditions:
    1. Attribution—other users must attribute the Work in the manner specified by the author as indicated on the journal Web site;
    with the understanding that the above condition can be waived with permission from the Author and that where the Work or any of its elements is in the public domain under applicable law, that status is in no way affected by the license.
  4. The Author is able to enter into separate, additional contractual arrangements for the nonexclusive distribution of the journal's published version of the Work (e.g., post it to an institutional repository or publish it in a book), as long as there is provided in the document an acknowledgement of its initial publication in this journal.
  5. Authors are permitted and encouraged to post online a prepublication manuscript (but not the Publisher’s final formatted PDF version of the Work) in institutional repositories or on their Websites prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work. Any such posting made before acceptance and publication of the Work shall be updated upon publication to include a reference to the Publisher-assigned DOI (Digital Object Identifier) and a link to the online abstract for the final published Work in the Journal.
  6. Upon Publisher’s request, the Author agrees to furnish promptly to Publisher, at the Author’s own expense, written evidence of the permissions, licenses, and consents for use of third-party material included within the Work, except as determined by Publisher to be covered by the principles of Fair Use.
  7. The Author represents and warrants that:
    1. the Work is the Author’s original work;
    2. the Author has not transferred, and will not transfer, exclusive rights in the Work to any third party;
    3. the Work is not pending review or under consideration by another publisher;
    4. the Work has not previously been published;
    5. the Work contains no misrepresentation or infringement of the Work or property of other authors or third parties; and
    6. the Work contains no libel, invasion of privacy, or other unlawful matter.
  8. The Author agrees to indemnify and hold Publisher harmless from Author’s breach of the representations and warranties contained in Paragraph 6 above, as well as any claim or proceeding relating to Publisher’s use and publication of any content contained in the Work, including third-party content.

Revised 7/16/2018. Revision Description: Removed outdated link.