[Oradlist] mail survey

[Allan G Farman]

There are too many "experts" or "gurus" on the "weekend warier" and State Meeting speaking circuit providing  courses that are accredited for CE credits despite lacking any semblance of scientific evidence. Often continuing education does more harm than good.



Allan G. Farman, BDS, PhD, MBA, DSc, Diplomate ABOMR

Prof. Radiology & Imaging Science
Univ. Louisville School of Dentistry: SUHD
501 South Preston Street,
Louisville, Kentucky 40292, USA 

Tel: +1(502) 852.1241
Fax: +1(502)852.1626


>>> "Benn, Douglas K." <DouglasBenn at creighton.edu> 5/5/2009 8:22 AM >>>
I went to an Oral Medicine CE course last year and the speaker said the problem with bisphosphonates is they have a long half life of 10 years. It would be interesting to know how stopping treatment 9 months before surgical treatment fits into this scenario.

Douglas

Dr Douglas K Benn, BDS, M.Phil., Ph.D., Dipl. Dental Radiology (Royal College of Radiologists, England).
Professor
Dept of General Dentistry
Creighton University Dental School
2500 California Plaza
Omaha
Nebraska 68178

Tel: (402)280 5025
Fax: (402)280 5094



-----Original Message-----
From: oradlist-bounces at lists.ucla.edu on behalf of Dania Tamimi
Sent: Tue 5/5/2009 5:28 AM
To: oradlist at lists.ucla.edu 
Subject: Re: [Oradlist] mail survey
 

Hello everyone,

 

 I am attending the ACOMS meeting (American College of OM Surgery). Just yesterday, I sat through a talk on the guidelines of treatement for BIONJ. The speaker recommended non-invasive procedures if possible. If an invasive procedure is indicated, then a "drug holiday" of 9 months is recommended prior to the treatment. A diagnostic test is before the drug holiday and when the treatment is done to determine the levels of something called CTX (C-terminal telopeptide). Apparently if this goes up, then the healing is supposed to be more favorable. Here's a reference J Oral Maxillofac Surg. 2007 Dec;65(12):2397-410.

 

He also said that the worst offender amongst bisphosponates is Fosamax, because it delivers a higher dose in  shorter period of time (75 whatever the unit is a week, in contrast to intravenous, which gives double the quantity but is only given once a month) 

 

 The speaker seemed to be the go-to guy for BIONJ. His name is Robert Marx (Marx RE). If you search for his articles on medline, you will find a good amount of info on the subject.
 


Date: Mon, 4 May 2009 15:43:18 -0400
From: lurie at nso.uchc.edu 
To: oradlist at lists.ucla.edu 
Subject: Re: [Oradlist] mail survey

Dear ORAD Listers,

I have never, in my aging memory, sent a hostile email to the list.  However, yet again we have a case of ONJ being subtly mis-represented.  Following is the concluding paragraph from the report:


"Chronic refractory osteomyelitis of the jaws (CROJ) is a potential side effect of bisphosphonates, in particular with zoledronic acid. Both mandible and maxilla can be affected. The treatment of CROJ should be, if possible, discontinuation of the zoledronic acid therapy, in combination with a surgical debridement of the osteonecrotic lesion, a strict antibiotic protocol and a meticulous oral hygiene by the patient."

This patient had intravenous bisphosphonate therapy as part of treatment for breast cancer.  The vast majority of ONJ which is related to bisphosphonate therapy is thus.  The cases of ONJ which are related to oral bisphosphonate therapy for osteopenia and osteoporosis is miniscule compared to the millions and millions - perhaps tens of millions - of patient receiving such therapy.  Physicians, dentists and patients are being excessively, and in my opinion unnecessarily, sent into a quasi-panic mode by such representations.  Review of the literature concerning ONJ from oral bisphosphonate therapy is thin at best.  We need controlled, prospective studies before potentially condemming a superb treatment of bone demineralizing diseases which cause such tremendous morbidity and mortality worldwide. 

We should all be exceptionally clear when we report any ONJ cases such as this that we clearly state, throughout the report, that the patient received intravenous bisphosphonate treatment. 


On 5/4/09 3:25 PM, "Johan Aps" <johan.aps at ugent.be> wrote:

> Dear OradFriends,
> 
> I hereby repost my mail of 8 April 09 again with the PDF file on  
> bisphosphonates.
> I hope this may be of any help to anyone who is keen on this  
> interesting issue.
> 
> Kind regards from Belgium (it is 9.25 PM now)
> 
> Johan

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