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ONJ ( Osteonecrosis of the Jaw) in Bisphosphonate -Treated Cancer Patients

ONJ ( Osteonecrosis of the Jaw) in Bisphosphonate -Treated Cancer Patients. Bisphosphonates effectively manage bone complications from cancer Approved for treatment of malignant bone disease from solid tumors and multiple myeloma

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ONJ ( Osteonecrosis of the Jaw) in Bisphosphonate -Treated Cancer Patients

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  1. ONJ (Osteonecrosis of the Jaw) in Bisphosphonate-Treated Cancer Patients

  2. Bisphosphonates effectively manage bone complications from cancer • Approved for treatment of malignant bone disease from solid tumors and multiple myeloma • Zoledronic acid (Zometa) is approved for the treatment of any advanced malignancy involving bone

  3. ● Common adverse events - Flu-like symptoms - Fever - Myalgias/ Arthralgias ● Uncommon adverse events: - Renal-function effects - Osteonecrosis of the jaw

  4. ONJ • Etiology and pathogenesis are not well characterized • The clinical identification of ONJ is usually made on the basis of visual inspection and/or radiographic appearance

  5. Risk Factors for ONJ •Periodontal disease •Dento-alveolar surgery •Oral trauma •Corticosteroid therapy •Immuno-compromised state

  6. Recommendations for the Management of ONJ • Prevention of ONJ • Prior to treatment with bisphosphonates: – Dental exam with appropriate preventive dentistry – Remove abscessed teeth, and teeth with poor long-term prognosis – Educate patients on oral hygiene and signs and symptoms of ONJ

  7. • During bisphosphonate treatment – Seek dental maintenance care at least every 6 months – Avoid invasive dental procedures if possible

  8. • In case of ONJ – Refer to dental professional as soon as possible – Reassess benefit/risk of continued bisphosphonate therapy • No prospective data exist to withhold therapy–Conservative management

  9. ONJ Outcomes • Emerging data indicate that stability / improvement of lesions occurs in the majority of patients with conservative management – With preventive measures and conservative management, deterioration occurs only in a minority of patients

  10. ONJ : personal clinical case V.H.52 year old man receiving IV Biphosphonate as maintenance therapy for Multiple Myeloma ONJ healing after 3 months ONJ after two years of Biphosphonate therapy

  11. Summary - ONJ is an uncommon event - Most patients can be managed conservatively according to guidelines with minimal impact on quality of life - Ongoing studies will increase the understanding of ONJ…

  12. THANK YOU

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