• Monday July 13,2020

Bisphosphonate-associated bone necrosis

Bisphosphonate-associated bone necrosis is a bone necrosis that results from bisphosphonate treatments. In the majority of cases, bone necrosis sets in after treatment with the dentist or orthodontist after bisphosphonates have been used. Therefore, bisphosphonate-associated bone necrosis of the jaw occur particularly frequently. In addition, spontaneous bisphosphonate-associated bone necroses are possible.

What is a bisphosphonate-associated bone necrosis?

In the majority of cases, bone necrosis sets in after treatment with the dentist or orthodontist after bisphosphonates have been used.
© Adiano - stock.adobe.com

Bisphosphonate-associated bone necrosis is caused by the medicinal active ingredients of bisphosphonates. Bisphosphonates are substances that inhibit bone degradation. For this reason, they are used, for example, as drugs in osteoporosis or metastases of the bones.

They have a strong affinity on the surface of the bones and affect the osteoclasts. As a result, bone resorption is reduced. If the degradation of the bone substance is accelerated, for example by an osteoporosis disease or bone metastases, bisphosphonates inhibit this degradation and thus counteract the disease.

In the case of therapy with bisphosphonates, the density of the bone substance also increases for a short time. The half-life of bisphosphonates inside the bone is extremely long, sometimes more than ten years. This requires strict standards in the medical use of bisphosphonates. Bisphosphonates are currently approved mainly for the treatment of bone metastases and osteoporosis after menopause.

causes

The exact formation mechanisms of bisphosphonate-associated bone necroses are currently unknown. Even in people who receive bisphosphonates as part of a systemic treatment, there is still a need for research regarding the pathogenesis. Some physicians suspect a connection to the inhibition of osteoclasts and osteoblasts. This may result in depression of the osteoblasts, reducing the ability of the bone to regenerate.

Bisphosphonate-associated bone necroses are now a significant medical problem. Especially in people with cancer, bisphosphonate-associated bone necrosis develops in nearly 20 percent of cases after bisphosphonates are given intravenously. In benign conditions such as osteoporosis, the risk of bisphosphonate-associated bone necrosis is only 0.1 percent.

Symptoms, complaints & signs

As part of bisphosphonate-associated bone necrosis, necrotic areas develop on the bones of diseased patients. The disease is sometimes severe, with the individual course of Bisphosphonatassoziierten bone necrosis in individual cases differs greatly and also depends on the underlying diseases.

A particular risk for bisphosphonate-associated bone necrosis is exposed to people who have cancer and are taking immunosuppressive drugs. Basically, bisphosphonate-associated bone necrosis occurs mainly in connection with amino bisphosphonates, which the doctor injects intravenously.

Diagnosis & History

The diagnosis of bisphosphonate-associated bone necrosis is made by a specialized specialist. Anamnesis focuses on the discussion of underlying diseases of the patient as well as treatment with bisphosphonates in the past. When diagnosing, note that the bisphosphonate is associated

In some cases, bone necrosis does not develop until some time after the administration of bisphosphonates. This fact is due to the long half-life of the bisphosphonates in the substance of the bone. For this reason, a thorough history at the beginning of the diagnosis of bisphosphonate-associated bone necrosis is essential. The clinical examination of the diseased person is based on various procedures.

For example, the doctor measures the bone density and uses imaging methods of the bones. Possible, for example, X-ray or MRI examinations. In addition, the attending physician may perform punctures on the bone and order a laboratory analysis of the tissue samples obtained. In general, blood analyzes also play an important role in the diagnosis of bisphosphonate-associated bone necrosis.

complications

Bisphosphonate-associated bone necrosis is a very serious disease. The further course and the complications depend strongly on the underlying disease. In most cases, diagnosis can be relatively quick, so treatment can be started early. A blood analysis is also carried out.

The treatment is primarily aimed at stopping the medication. This will help to stop and limit the symptoms and prevent the disease from spreading. Should the patient expect further surgery, antibiotics will be used instead. The operation is done with great care, so that there is no trauma to the affected area.

If the disease occurs in a cancer patient, the treatment must be discussed with a doctor, as the use of the bisphospahte inhibits the degradation of the bones, but contributes to the disease. A direct and causal treatment of this disease is unfortunately not possible. Life expectancy is greatly reduced. As a rule, this is based on the expectation by the tumor. During treatment, there are no further complications for the patient directly resulting from the treatment.

When should you go to the doctor?

For this complaint, a doctor must be consulted immediately. As a rule, this does not lead to a self-healing, so that an improvement of the symptoms is only possible by stopping or changing the respective drugs. However, this should only be done after a medical instruction. As a rule, the doctor should be consulted if it comes to a bone necrosis.

Especially in case of severe pain or significant restrictions in everyday life and in the movement of the person concerned must consult a doctor. This also applies to patients who have cancer and for this reason take medications that can lead to bone necrosis. In most cases, the diagnosis and treatment of this condition will be performed by a specialist. This requires X-rays or MRI scans.

The further treatment depends strongly on the underlying disease and is also carried out by a specialist. Whether this leads to a completely positive course can not be universally predicted.

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Treatment & Therapy

The possibilities of the treatment of bisphosphonate-associated bone necroses are relatively limited. The most important approach for the treatment of bisphosphonate-associated bone necrosis is to stop the administration of bisphosphonates. If surgical intervention is required in patients with bisphosphonate treatment, individuals will receive antibiotics.

In addition, the doctors try to cause as little trauma as possible in the operated areas. Basically, the implementation of therapeutic measures and follow-up of bisphosphonate-associated bone necrosis in appropriate specialized medical centers is recommended. If the bisphosphonate-associated bone necrosis occurs in cancer patients, the further treatment of the bone metastases against the disease is to be weighed.

Although the use of bisphosphonates inhibits the degradation of the bone substance, it also leads to the formation of bisphosphonate-associated bone necrosis. Since the exact causes of the formation of bisphosphonate-associated bone necroses are not yet known exactly, adequate treatment options are also lacking. However, medical research is working on the development of drugs and methods for bisphosphonate-associated bone necroses.

Outlook & Forecast

The healing prospects of bisphosphonate-associated bone necrosis are very low. Despite medical advances, researchers and scientists have so far failed to find adequate treatment to cure the disease. Bisphosphonate-associated bone necrosis has a progressive course of disease that can not be stopped.

Without medical care there is a continuous bone loss in the patient. There are other complaints that make the daily life of the patient very difficult. With a medical care is trying to slow the progress of the disease. In addition, accompanying symptoms are treated. Thus, the well-being of the person affected increases significantly.

A very unfavorable course can be observed in patients with cancer. Due to the treatment as well as the cancer therapy the organism of the patient is very weakened. This minimizes the chances of relieving the symptoms of bisphosphonate-associated bone necrosis by another.

With a mild underlying disease, good patient health and early diagnosis, and the earliest possible start of bone necrosis, there is a great chance of improving health. With various remedies, the organism can be optimally cared for, as much as possible to curb the progress of the disease. Although healing is not possible, some patients manage to stop the deterioration.

prevention

Medical research has identified several risk factors to prevent bisphosphonate-associated bone necrosis. Necrosis of the jawbone occurs in cancer patients, especially at high dosages of the active ingredients. In the process, lesions only develop with medicines containing nitrogen. The risk of bisphosphonate-associated bone necrosis diminishes when subjects ingest the bisphosphonates in the form of tablets rather than injections.

By contrast, intravenous administration increases the likelihood of bisphosphonate-associated bone necrosis. The implementation of highly invasive dental therapies, such as implant placement, tooth extraction, or dental root enhancement, increase the risk of contracting. If dental treatment is required, its completion before therapy with intravenous bisphosphonates makes sense.

aftercare

Aftercare is usually not possible with this disease. Those affected depend on a therapy, whereby a complete cure of the disease is not possible. Since the symptoms can be reduced with the help of antibiotics, the patient should pay attention to the regular use of the drugs and also consider possible interactions with other drugs.

If the disease is caused by a tumor, regular examinations should be performed to identify and treat more tumors quickly and early. The life expectancy of the person affected is often very limited in this disease. Since the disease can often lead to mental discomfort, psychological counseling during treatment is very useful.

In this case, the contact with other victims of the disease may prove useful and lead to an exchange of information. Frequently, the patient's relatives also require psychological treatment. If the disease is treated by surgery, care should be taken to ensure adequate recovery of the patient after surgery. The wounds must heal completely, and the operation itself must not cause any other damage to the body to prevent further trauma.

You can do that yourself

Bisphosphonate-associated bone necrosis is a disease requiring treatment. Self-help measures can not sufficiently alleviate the complaints. Therefore, the person concerned should discuss the complaints and changes in cooperation with a doctor of his or her trust.

Since it comes to the relief of symptoms for the time being to a dose of medication, side effects and changes should be considered. Under no circumstances should the medication be changed or discontinued on its own responsibility. The consumption of alcohol is to be omitted, since the organism is overburdened in the interaction with the active ingredients of the medicines and adjust to complications. These significantly worsen the quality of life and trigger delays in the healing process.

If surgical intervention is necessary, the risk factors should be reduced in advance. Stress should be avoided and well-being promoted. Through a balanced and healthy diet, the body's immune system can be stabilized. This is of immense importance in the healing process and especially after surgery. The consumption of pollutants such as nicotine, drugs or caffeine should be avoided. They delay the recovery of the sufferer and also trigger complications.

Show the bone necrosis in the area of ​​the jaw, despite all adversities sufficient dental care is carried out. Together with a dentist the optimal care of the mouth is to be discussed, so that no consequential illnesses are triggered.


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