Bisphosphonate-Related Osteonecrosis of the Jaw: An Enigma among Medical Practitioners

Abstract

Context: Owing to the increasing number of cancer cases, and introduction of newer drugs like bisphosphonates (BP) for the management of metastatic bone disease, complications such as bisphosphonate-related osteonecrosis of the jaw (BRONJ) have come into light. However, several of the treating physicians are not fully aware of this adverse effect. Aim: This study aimed to assess the knowledge and awareness of physicians regarding BRONJ and practices related to bisphosphonate use. Settings and Design: A cross-sectional study conducted among health-care professionals in various medical institutions in Mangalore. Subjects and Methods: A questionnaire was developed to assess the knowledge and awareness of physicians about osteonecrosis of the jaw and practices related to bisphosphonate use, consisting of 21 questions, 12 – knowledge based and 9 – practice based. The questionnaire was validated and distributed among 113 doctors; their responses assigned scores, tabulated and assessed. Statistical Analysis: One-way analysis of variance and Tukey test. Results: More than 50% of the medical professionals had a score <40%, which shows a lack of knowledge about BP and BRONJ. About 45% of the medical professionals in the study group failed to identify the clinical features of BRONJ, and 67.26% were unaware of the risk associated with tooth extractions and oral surgical procedures in the development of the condition. Conclusion: Bisphosphonate-related osteonecrosis is almost exclusively seen in the jaws and hence, the diagnosis usually made by a dental practitioner. Lack of awareness of jaw osteonecrosis among the medical practitioners can result in delay in providing the right treatment.

Keywords

Awareness - bisphosphonate-related osteonecrosis of the jaw - bisphosphonates - osteonecrosis - physicians

Publikationsverlauf

Artikel online veröffentlicht:
03. Juni 2021

• References

• 1 Coleman RE, McCloskey EV. Bisphosphonates in oncology. Bone 2011; 49: 71-6
• 2 Migliorati CA, Siegel MA, Elting LS. Bisphosphonate-associated osteonecrosis: A long-term complication of bisphosphonate treatment. Lancet Oncol 2006; 7: 508-14
• 3 Lenz JH, Steiner-Krammer B, Schmidt W, Fietkau R, Mueller PC, Gundlach KK. Does avascular necrosis of the jaws in cancer patients only occur following treatment with bisphosphonates?. J Craniomaxillofac Surg 2005; 33: 395-403
• 4 Marx RE. Pamidronate (Aredia) and zoledronate (Zometa) induced avascular necrosis of the jaws: A growing epidemic. J Oral Maxillofac Surg 2003; 61: 1115-7
• 5 Ruggiero SL, Mehrotra B, Rosenberg TJ, Engroff SL. Osteonecrosis of the jaws associated with the use of bisphosphonates: A review of 63 cases. J Oral Maxillofac Surg 2004; 62: 527-34
• 6 Watters AL, Hansen HJ, Williams T, Chou JF, Riedel E, Halpern J. et al. Intravenous bisphosphonate-related osteonecrosis of the jaw: Long-term follow-up of 109 patients. Oral Surg Oral Med Oral Pathol Oral Radiol 2013; 115: 192-200
• 7 Ruggiero SL, Dodson TB, Fantasia J, Goodday R, Aghaloo T, Mehrotra B. et al. American association of oral and maxillofacial surgeons position paper on medication-related osteonecrosis of the jaw – 2014 update. J Oral Maxillofac Surg 2014; 72: 1938-56
• 8 Rabiei S, Mohebbi SZ, Patja K, Virtanen JI. Physicians’ knowledge of and adherence to improving oral health. BMC Public Health 2012; 12: 855
• 9 Melo MD, Obeid G. Osteonecrosis of the jaws in patients with a history of receiving bisphosphonate therapy: Strategies for prevention and early recognition. J Am Dent Assoc 2005; 136: 1675-81
• 10 Bhatt G, Bhatt A, Dragu AE, Xiao-Feng LI, Civelek AC. Bisphosphonate-related osteonecrosis of the jaw mimicking bone metastasis. Radiographics 2009; 29: 1971-84
• 11 Abughazaleh K, Kawar N. Osteonecrosis of the jaws: What the physician needs to know: Practical considerations. Dis Mon 2011; 57: 231-241
• 12 Thumbigere-Math V, Michalowicz BS, Hughes PJ, Basi DL, Tsai ML, Swenson KK. et al. Serum markers of bone turnover and angiogenesis in patients with bisphosphonate-related osteonecrosis of the jaw after discontinuation of long-term intravenous bisphosphonate therapy. J Oral Maxillofac Surg 2016; 74: 738-46
• 13 El Osta L, El Osta B, Lakiss S, Hennequin M, El Osta N. Bisphosphonate-related osteonecrosis of the jaw: Awareness and level of knowledge of Lebanese physicians. Support Care Cancer 2015; 23: 2825-31
• 14 de Lima PB, Brasil VL, de Castro JF, de Moraes Ramos-Perez FM, Alves FA, dos Anjos Pontual ML. et al. Knowledge and attitudes of Brazilian dental students and dentists regarding bisphosphonate-related osteonecrosis of the jaw. Support Care Cancer 2015; 23: 3421-6
• 15 Al-Mohaya MA, Al-Khashan HI, Mishriky AM, Al-Otaibi LM. Physicians’ awareness of bisphosphonates-related osteonecrosis of the jaw. Saudi Med J 2011; 32: 830-5
• 16 Sturrock A, Preshaw PM, Hayes C, Wilkes S. Attitudes and perceptions of GPs and community pharmacists towards their role in the prevention of bisphosphonate-related osteonecrosis of the jaw: A qualitative study in the North East of England. BMJ Open 2017; 7: e016047
• 17 Masson D, O’Callaghan E, Seager M. The knowledge and attitudes of North Wales healthcare professionals to bisphosphonate associated osteonecrosis of the jaws. J Disabil Oral Health 2009; 10: 175-83
• 18 Epstein JB, Kish RV, Hallajian L, Sciubba J. Head and neck, oral, and oropharyngeal cancer: A review of medicolegal cases. Oral Surg Oral Med Oral Pathol Oral Radiol 2015; 119: 177-86
• 19 Fantasia JE. The role of antiangiogenic therapy in the development of osteonecrosis of the jaw. Oral Maxillofac Surg Clin North Am 2015; 27: 547-53
• 20 Khan AA, Morrison A, Kendler DL, Rizzoli R, Hanley DA, Felsenberg D. et al. Case-based review of osteonecrosis of the jaw (ONJ) and application of the international recommendations for management from the International Task Force on ONJ. J Clin Densitom 2017; 20: 8-24