Evaluation of Early-Stage Osteonecrosis Findings and Oral Health in Patients Using Biphosphonate for Osteoporosis

Year 2023, Volume: 7 Issue: 2, 270 - 280, 31.05.2023

Özlem Yarbaşı , Esin Bozdemir (haştar)

https://doi.org/10.46237/amusbfd.1141019

Abstract

Objective: The aim of study is to evaluate the oral health status and early osteonecrosis findings in patients using bisphosphonates for osteoporosis.
Methods: 110 postmenopausal female patients who were using bisphosphonates for osteoporosis were included to this study. Oral health status was evaluated with the oral index including caries, vertical and horizontal bone loss, tooth loss, and periapical lesion on panoramic radiographs. Early-stage bisphosphonate-related osteonecrosis findings of the jaws to be evaluated are as follows; lamina dura thickening, focal or diffuse bone sclerosis, widening of the periodontal space, persistent alveolar socket, thickening of the external oblique line.
Results: Early-stage MRONJ findings were determined in 68.2% of the patients. Thickening of the external oblique line (33.6%), thickening of the lamina dura (28.2%), and focal/diffuse bone sclerosis (23.6%) were the most common findings. It was determined that 30.9% of the patients did not have caries, 88.2% had horizontal bone loss, 49.1% had more than 10 missing teeth, and 36.3% had a periapical lesion.
Conclusion: It was determined that most of the participants had more dental problems and the presence of early stage MRONJ sign.The patients in need of dental treatment can be determined with the cooperation of medical doctors and dentists. Additionally, signs of osteonecrosis can be noticed at an early stage. This is important in terms of monitoring and treatment of the patients.

Keywords

Bisphosphonate, Osteonecrosis, Osteoporosis, Oral health

Osteoporoz Nedeniyle Bifosfonat Kullanan Hastalarda Erken Evre Osteonekroz Bulgularının ve Ağız Sağlığının Değerlendirilmesi

Abstract

Amaç: Çalışmanın amacı osteoporoz nedeniyle bifosfonat kullanan hastalarda oral sağlık durumunun ve erken dönem osteonekroz bulgularının değerlendirilmesidir.
Yöntem: Çalışmaya osteoporoz nedeniyle bifosfonat kullanımı olan postmenopozal dönemdeki 110 kadın hasta dahil edildi. Hastaların panoramik radyografları üzerinde: oral sağlık durumunun değerlendirilmesinde çürük, vertikal ve horizontal kemik kaybı, diş kaybı, periapikal lezyon varlığını içeren oral indeks kullanıldı. Ayrıca erken evre ilaçla ilişkili osteonekroz bulguları olan lamina durada kalınlaşma, fokal veya diffüz kemik sklerozu, peridontal aralıkta genişleme, persiste alveolar soket, eksternal oblik çizginin kalınlaşması gibi bulgular kaydedildi.
Bulgular: Hastaların %68.2'sinde erken evre MRONJ bulgusunun olduğu belirlendi. Eksternal oblik çizginin kalınlaşması (%33.6), lamina durada kalınlaşma (%28.2) ve fokal/diffüz kemik sklerozu (%23.6) en fazla gözlenen bulgulardı. Hastaların %30.9'unda çürüğün olmadığı, %88.2'sinde horizontal kemik kaybı, %49.1'inde 10 dişten fazla eksik dişi olduğu ve %36.3'ünde periapikal lezyon bulunduğu belirlendi.
Sonuç: Katılımcıların çoğunda dental problemlerin fazla olduğu ve erken evre MRONJ bulgusunun varlığı tespit edildi. Tıp ve diş hekimlerinin birlikte çalışması ile dental tedavi ihtiyacı olan hastalar belirlenebilir. Ayrıca osteonekroz bulguları erken evrede fark edilebilir. Bu durum hastaların takibi ve tedavisi açısından önemlidir.

Keywords

Bifosfonat, Osteonekroz, Osteoporoz, Ağız sağlığı

References

• 1. Türkiye Endokrinoloji ve Metabolizma Derneği Osteoporoz ve Metabolik Kemik Hastalıkları Tanı ve Tedavi Kılavuzu. 2021
• 2. Lorentzon, M., Johansson, H., Harvey, N. C., Liu, E., Vandenput, L., McCloskey, E. V., et al. (2022). Osteoporosisandfractures in women: theburden of disease. Climacteric, 25(1), 4-10.
• 3. Anil, S., Preethanath, R. S., AlMoharib, H. S., Kamath, K. P., &Anand, P. S. (2013). Impact of osteoporosisanditstreatment on oral health. TheAmericanjournal of themedicalsciences, 346(5), 396-401.
• 4. Kanis, J. A., Cooper, C., Rizzoli, R., &Reginster, J. Y. (2019). Europeanguidanceforthediagnosisandmanagement of osteoporosis in postmenopausalwomen. Osteoporosis International, 30(1), 3-44.
• 5. Gümüşel, F. T., & Şener, E. (2021). İlaca bağlı çene kemiklerinde gözlenen osteonekrozun erken tanı ve tedavisinde görüntüleme sistemlerinin rolü. İzmir Diş Hekimleri Odası Bilimsel Dergisi, 1(1), 7.
• 6. Ruggiero, S. L., Dodson, T. B., Assael, L. A., Landesberg, R., Marx, R. E., &Mehrotra, B. (2009). Americanassociation of oral andmaxillofacialsurgeonspositionpaper on bisphosphonate- relatedosteonecrosis of thejaws—2009 update. Journal of Oral andMaxillofacialSurgery, 67(5), 2-12.
• 7. Hayashida, S., Soutome, S., Yanamoto, S., Fujita, S., Hasegawa, T., Komori, T., et al. (2017). Evaluation of thetreatmentstrategiesformedication‐relatedosteonecrosis of thejaws (MRONJ) andthefactorsaffectingtreatmentoutcome: a multicenterretrospectivestudywithpropensityscorematchinganalysis. Journal of Bone and Mineral Research, 32(10), 2022-2029.
• 8. Sivri, D., Çebi Atak, S., Çetiner, S., Öztürk, K., & Okur, B. (2020). İlaç kullanımına bağlı gelişen çene osteonekrozu: tanımı, önlenmesi, tedavisi ve güncel yaklaşımlar. Turkiye Klinikleri Dishekimligi Bilimleri Dergisi, 26(3), 462-471.
• 9. Ertaş, E. T., & Atıcı, M. Y. (2015). Bifosfonatlar ve çene kemiğinde görülen osteonekroz. Selcuk Dental Journal, 2(2), 91-101.
• 10. Goller-Bulut, D., Özcan, G., &Avci, F. (2018). Changes in dimension of neurovascularcanals in themandibleandmaxilla: A radiographicfinding in patientsdiagnosedwith MRONJ. Medicina Oral, Patología Oral y CirugíaBucal, 23(3), e282.
• 11. Şahin, O., Odabaşı, O., Demiralp, K. Ö., Kurşun-Çakmak, E. Ş., & Aliyev, T. (2019). Comparison of findings of radiographicandfractaldimensionanalyses on panoramicradiographs of patientswithearly-stageandadvanced-stagemedication-relatedosteonecrosis of thejaw. Oral surgery, oral medicine, oral pathologyand oral radiology, 128(1), 78-86.
• 12. Bozdemir, E., & Yılmaztürk, S. S. (2020). İlaç kullanımına bağlı çene kemiklerinin osteonekrozunun ortaya çıkmasında rol oynayan risk faktörleri ve klinik, radyografik özellikleri. Dental andMedicalJournal-Review, 2(3), 95-110.
• 13. Ruggiero, S. L., Dodson, T. B., Aghaloo, T., Carlson, E. R., Ward, B. B., &Kademani, D. (2022). Americanassociation of oral andmaxillofacialsurgeons’ positionpaper on medication- relatedosteonecrosis of thejaw–2022 Update. Journal of oral andmaxillofacialsurgery.
• 14. Barngkgei, I., Halboub, E., &Almashraqi, A. (2019). Effect of bisphosphonatetreatment on thejawbone: an exploratorystudyusingperiapicalandpanoramicradiographicevaluation. Oral Radiology, 35(2), 159-170.
• 15. Moreno-Rabié, C., Gaêta-Araujo, H., Oliveira-Santos, C., Politis, C., & Jacobs, R. (2020). Earlyimagingsigns of theuse of antiresorptivemedicationand MRONJ: a systematicreview. Clinical oral investigations, 24(9), 2973-2989.
• 16. O'Ryan, F. S., Khoury, S., Liao, W., Han, M. M., Hui, R. L., Baer, D., et al. (2009). Intravenousbisphosphonate-relatedosteonecrosis of thejaw: bone scintigraphy as an earlyindicator. Journal of Oral andMaxillofacialSurgery, 67(7), 1363-1372.
• 17. Zaman, M. U., Nakamoto, T., &Tanimoto, K. (2013). A retrospectivestudy of digitalsubtractiontechniquetodetectscleroticchanges in alveolar bone on intraoral radiographs of bisphosphonate- treatedpatients. DentomaxillofacialRadiology, 42(10), 20130242.
• 18. Klingelhöffer, C., Klingelhöffer, M., Müller, S., Ettl, T., &Wahlmann, U. (2016). Can dental panoramicradiographicfindingsserve as indicatorsforthedevelopment of medication-relatedosteonecrosis of thejaw?.DentomaxillofacialRadiology, 45(5), 20160065.
• 19. Bagan, L., Leopoldo-Rodado, M., Poveda-Roda, R., Murillo-Cortes, J., Diaz-Fernández, J. M., &Bagan, J. (2017). Grade of sclerosis in thecontralateralmandibulararea in osteonecrosis of thejaws. International Journal of Oral andMaxillofacialSurgery, 46(2), 167-172.
• 20. Soundia, A., Hadaya, D., Mallya, S. M., Aghaloo, T. L., &Tetradis, S. (2018). Radiographicpredictors of bone exposure in patientswithstage 0 medication-relatedosteonecrosis of thejaws. Oral surgery, oral medicine, oral pathologyand oral radiology, 126(6), 537-544.
• 21. Koth, V. S., Figueiredo, M. A., Salum, F. G., &Cherubini, K. (2017). Interrelationship of clinical, radiographicandhaematologicalfeatures in patientsunderbisphosphonatetherapy. DentomaxillofacialRadiology, 46(4), 20160260.
• 22. Kubo, R., Ariji, Y., Taniguchi, T., Nozawa, M., Katsumata, A., &Ariji, E. (2018). Panoramicradiographicfeaturesthatpredictthedevelopment of bisphosphonate-relatedosteonecrosis of thejaw. Oral Radiology, 34(2), 151-160.
• 23. Wongratwanich, P., Shimabukuro, K., Konishi, M., Nagasaki, T., Ohtsuka, M., Suei, Y., et al. (2021). Do variousimagingmodalitiesprovidepotentialearlydetectionanddiagnosis of medication- relatedosteonecrosis of thejaw? A review. DentomaxillofacialRadiology, 49, 20200417.
• 24. Ruggiero, S. L., Dodson, T. B., Fantasia, J., Goodday, R., Aghaloo, T., Mehrotra, B., et al. (2014). Americanassociation of oral andmaxillofacialsurgeonspositionpaper on medication- relatedosteonecrosis of thejaw—2014 update. Journal of oral andmaxillofacialsurgery, 72(10), 1938-1956.
• 25. Assiri, K. I., Sandeepa, N. C., Asiri, R. S., Mulawi, S. A., Najmi, S. M., &Srivastava, K. C. (2020). Assessment of oral–systemicdiseaseassociationamongst dental patients: A retrospectivepanoramicradiographicstudy. TheJournal of Contemporary Dental Practice, 21(7), 748-755.
• 26. Grgić, O., Kovačev-Zavišić, B., Veljović, T., Novaković-Paro, J., Maravić, T., &Bajkin, B. (2017). Theinfluence of bone mineral densityandbisphosphonatetherapy on thedeterminants of oral healthandchanges on dental panoramicradiographs in postmenopausalwomen. Clinical oral investigations, 21(1), 151-157.
• 27. Kunchur, R., &Goss, A. N. (2008). The oral healthstatus of patients on oral bisphosphonatesforosteoporosis. Australian dental journal, 53(4), 354-357.
• 28. Somay, E., & Yılmaz, B. (2020). Postmenopozal dönemin kadınlarda dental sağlık ve oral hijyen alışkanlıklarına etkisi. Ege Tıp Dergisi, 59(4), 287-293.
• 29. Buencamino, M. C., Palomo, L., &Thacker, H. L. (2009). How menopauseaffects oral health, andwhatwe can do about it. CleveClin J Med, 76(8), 467-75.
• 30. Preety, G. (2013). Osteoporosis: A silent oral healthdeterrent. Journal of Dentistryand Oral Hygiene, 5(6), 51-54.
• 31. Marya, C. M., &Dhingra, C. (2015). Effect of osteoporosis on oral health. ArchMed, 8(21), 1-8.
• 32. Rocha, M. L., Malacara, J. M., Sánchez‐Marin, F. J., de la Torre, C. J. V., &Fajardo, M. E. (2004). Effect of alendronate on periodontal disease in postmenopausalwomen: a randomizedplacebo‐ controlledtrial. Journal of Periodontology, 75(12), 1579-1585.
• 33. Akram, Z., Abduljabbar, T., Kellesarian, S. V., Abu Hassan, M. I., Javed, F., &Vohra, F. (2017). Efficacy of bisphosphonate as an adjuncttononsurgical periodontal therapy in themanagement of periodontal disease: a systematicreview. British Journal of ClinicalPharmacology, 83(3), 444-454.
• 34. Helmi, M., AlOsaimy, S., Goodson, J. M., Hasturk, H., &Natto, Z. S. (2019). Annual alveolar bone loss in olderadultstaking oral bisphosphonate: a retrospectivecohortstudy. BMC Oral Health, 19(1), 1-8.
• 35. Nicopoulou‐Karayianni, K., Tzoutzoukos, P., Mitsea, A., Karayiannis, A., Tsiklakis, K., Jacobs, et al. (2009). Toothlossandosteoporosis: the OSTEODENT Study. Journal of clinicalperiodontology, 36(3), 190-197.
• 36. Darcey, J., Horner, K., Walsh, T., Southern, H., Marjanovic, E. J., &Devlin, H. (2013). Toothlossandosteoporosis: toassesstheassociationbetweenosteoporosisstatusandtoothnumber. British dental journal, 214(4), E10-E10.
• 37. SavićPavičin, I., Dumančić, J., Jukić, T., &Badel, T. (2017). Therelationshipbetween periodontal disease, toothlossanddecreased skeletal bone mineral density in ageingwomen. Gerodontology, 34(4), 441-445.
• 38. López‐López, J., Castellanos‐Cosano, L., Estrugo‐Devesa, A., Gómez‐Vaquero, C., Velasco‐Ortega, E., &Segura‐Egea, J. J. (2015). Radiolucentperiapicallesionsand bone mineral density in post‐ menopausalwomen. Gerodontology, 32(3), 195-201.
• 39. Katz, J., &Rotstein, I. (2021). Prevalence of periapicallesions in patientswithosteoporosis. Journal of Endodontics, 47(2), 234-238.
• 40. Edwards, B. J., &Migliorati, C. A. (2008). Osteoporosisanditsimplicationsfor dental patients. TheJournal of theAmerican Dental Association, 139(5), 545-552.
• 41. Kirazlı, Y. (2019). Osteoporozda farmakolojik tedavi. Ege Tıp Dergisi, 58, 58-63.
• 42. Krimmel, M., Ripperger, J., Hairass, M., Hoefert, S., Kluba, S., &Reinert, S. (2014). Does dental and oral healthinfluencethedevelopmentandcourse of bisphosphonate-relatedosteonecrosis of thejaws (BRONJ)?.Oral andmaxillofacialsurgery, 18(2), 213-218.