osteonecrosis..let's cuss and discuss

[High Desert Doc]

hey folks....osteonecrosis due to bisphos and even due to h&n radiation...how does your program treat or approach it...or does everyone follow the petersen text guideline of hbo procedures...i'm just interested how other programs tackle this health problem...thanks to all who reply...

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[buck-E]

First of all those are two entirely different processess... osteonecrosis due to bisphosphanates and osteoRADIOnecrosis due to XRT... not the same disease process and therefore are treated differently... secondly I believe that the HBO protocol you are referring to was developed by Marx (although it may be in the Peterson text, make sure you give credit where it is due)..

 

[ca_dreamin']

hey folks....osteonecrosis due to bisphos and even due to h&n radiation...how does your program treat or approach it...or does everyone follow the petersen text guideline of hbo procedures...i'm just interested how other programs tackle this health problem...thanks to all who reply...

We still perform needed procedures on patients at OSU, but only after appropriate consent (special additional consent form for bisphosphonate pts.). By "needed", I am referring to procedures such as extractions that come through the Emergency department.

I am not 100% sure on elective procedures such as implants through our clinic, but I do know that there are several local area docs who will do implants when the pt has taken oral bisphosphonates...I think the # drops dramatically if the meds are taken IV.

 

[High Desert Doc]

First of all those are two entirely different processess... osteonecrosis due to bisphosphanates and osteoRADIOnecrosis due to XRT... not the same disease process and therefore are treated differently... secondly I believe that the HBO protocol you are referring to was developed by Marx (although it may be in the Peterson text, make sure you give credit where it is due)..

apologies to Dr. Marx...you are right he is credited for the hbo protocol...will keep that in mind next time...

 

[EuroOMFS]

hey folks....osteonecrosis due to bisphos and even due to h&n radiation...how does your program treat or approach it...or does everyone follow the petersen text guideline of hbo procedures...i'm just interested how other programs tackle this health problem...thanks to all who reply...

Like mentioned by Buck-E before, ONJ is a very different process from ORN. In our program we usually keep our fingers away when it comes to ONJ. We treat acute problems medically, with abx, and we don´t like to extract, unless it´s absolutely neccesary. HBO doesn´t work.

I guess for most part we follow Marx´s recommendations in his article in JOMS in Nov. 2005 (J Oral Maxillofac Surg. 2005 Nov;63(11):1567-75.) even though they´re not really evidence based, as pointed out by Schwarts in the July issue of JOMS.

When it comes to ORN we use HBO and resection with reconstruction if neccesary.

 

[Blue Tooth]

There's an outstanding systemic review article in Annals of Internal Medicine by the oral pathologists Kalmar, Woo,and Hellstein. I think it's from May but I might be mistaken. I'd get that and read it above all others.

Like mentioned by Buck-E before, ONJ is a very different process from ORN. In our program we usually keep our fingers away when it comes to ONJ. We treat acute problems medically, with abx, and we don´t like to extract, unless it´s absolutely neccesary. HBO doesn´t work.

I guess for most part we follow Marx´s recommendations in his article in JOMS in Nov. 2005 (J Oral Maxillofac Surg. 2005 Nov;63(11):1567-75.) even though they´re not really evidence based, as pointed out by Schwarts in the July issue of JOMS.

When it comes to ORN we use HBO and resection with reconstruction if neccesary.

 

[drPheta]

How often are physicians aware the ONJ complications from bisphoph? From what I'm told, tons of people on any bisphosph tx have no idea of the side effects, and when they bring it up to their MD they have no idea either.

I know that if someone is going to die from cancer, they don't care about ONJ as a side effect to chemo. But what about those taking it for osteoporosis or what not.

 

[EuroOMFS]

How often are physicians aware the ONJ complications from bisphoph? From what I'm told, tons of people on any bisphosph tx have no idea of the side effects, and when they bring it up to their MD they have no idea either.

I know that if someone is going to die from cancer, they don't care about ONJ as a side effect to chemo. But what about those taking it for osteoporosis or what not.

ONJ is a lot bigger problem with iv adm then when pts get treated for osteoporosis with oral alendrone. There are probably houndreds of thousands of women out there who use oral bisph. and very very few develop ONJ.

My experience is that most MDs don´t know of it. However, docs treating multiple myeloma and bone metastatsis are becoming increasingly aware of it. There are studies that show that as many as 10 % of MM patients in iv bisph. treatment develop ONJ, so they´d better know of it.