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      Conocimientos y decisiones clínicas de los odontólogos colombianos acerca del riesgo de las osteonecrosis de los maxilares en pacientes que reciben tratamiento para la osteoporosis Translated title: Knowledge and clinical decisions of Colombian dentists about the risk of osteonecrosis of the jaws in patients receiving treatment for osteoporosis

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          Abstract

          Resumen Objetivo: Una dieta rica en calcio se ha recomendado generalmente para mantener una adecuada salud ósea; no obstante, estudios recientes han despertado la controversia sobre sus beneficios. En este sentido, la mayoría de los estudios existentes en modelos animales están realizados con dietas deficientes en vitamina D. En este estudio se evaluará el efecto de una dieta rica en calcio sobre el metabolismo mineral y la histomorfometría ósea en rata. Además, en células UMR-106 se evaluó el efecto directo del suplemento de calcio sobre la expresión de genes osteogénicos. Material y métodos: Un grupo de ratas wistar macho de aproximadamente 3 meses de edad fue alimentado con dieta de contenido normal de calcio (0,6%) mientras que otro grupo se alimentó con dieta de alto contenido en calcio (1,2%). Transcurridos 20 días se recogieron muestras de orina 24h, sangre para análisis bioquímicos y el fémur para estudio de histomorfometría ósea. In vitro, se estudió la expresión génica de Runx2, Osterix y Osteocalcina en células UMR-106 cultivadas en condiciones de alto contenido en calcio. Resultados: La ingesta de una dieta rica en calcio redujo la concentración de PTH y calcitriol en plasma, aumentó la calciuria y disminuyó la fosfaturia. A nivel óseo, se observó una drástica disminución de la actividad osteoblástica consistente con la bajada de PTH; sin embargo, el volumen trabecular permaneció similar en ambos grupos. In vitro, el suplemento de calcio no disminuyó la expresión de marcadores osteoblásticos en UMR-106, indicando que los efectos in vivo son mayormente indirectos y debidos a la bajada de PTH. Conclusiones: Una dieta de alto contenido en calcio reduce la concentración de PTH y calcitriol en plasma, resultando en una disminución de la actividad osteoblástica.

          Translated abstract

          Summary Introduction: Osteonecrosis of the jaws is a rare, severe adverse reaction associated with the administration of drugs used to treat osteoporosis and cancer, such as bisphosphonates and denosumab. However, many professionals suspend these medications or defer the procedures until they have the referring physician's authorization. This study evaluates the knowledge and attitudes of a group of Colombian dentists regarding the risk of developing maxillary osteonecrosis with the use of bisphosphonates and denosumab. Methods: Methods: A survey was designed from a focus group that was endorsed by experts. A tool of 30 questions was obtained, which was sent to a group of dentists, maxillofacial surgeons, periodontists and oral rehabilitators affiliated with dental societies through the Survey Monkey software. Results: The responses of 187 dentists (42.6% with postgraduate studies) were analyzed. 50.3% of dentists mistakenly considered the use of bisphosphonates an absolute contraindication for major dental procedures and 51.3% believed the same regarding denosumab use. 74.6% of professionals would unnecessarily request approval from the referring physician to schedule procedures in patients receiving bisphosphonates and 43.8% for patients receiving denosumab. Our findings were similar regardless of years of experience or level of education. Conclusion: Our results suggest that the respondents had little knowledge as to the risk of developing maxillary osteonecrosis with the use of medications for the management of osteoporosis.

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          Denosumab for prevention of fractures in postmenopausal women with osteoporosis.

          Denosumab is a fully human monoclonal antibody to the receptor activator of nuclear factor-kappaB ligand (RANKL) that blocks its binding to RANK, inhibiting the development and activity of osteoclasts, decreasing bone resorption, and increasing bone density. Given its unique actions, denosumab may be useful in the treatment of osteoporosis. We enrolled 7868 women between the ages of 60 and 90 years who had a bone mineral density T score of less than -2.5 but not less than -4.0 at the lumbar spine or total hip. Subjects were randomly assigned to receive either 60 mg of denosumab or placebo subcutaneously every 6 months for 36 months. The primary end point was new vertebral fracture. Secondary end points included nonvertebral and hip fractures. As compared with placebo, denosumab reduced the risk of new radiographic vertebral fracture, with a cumulative incidence of 2.3% in the denosumab group, versus 7.2% in the placebo group (risk ratio, 0.32; 95% confidence interval [CI], 0.26 to 0.41; P<0.001)--a relative decrease of 68%. Denosumab reduced the risk of hip fracture, with a cumulative incidence of 0.7% in the denosumab group, versus 1.2% in the placebo group (hazard ratio, 0.60; 95% CI, 0.37 to 0.97; P=0.04)--a relative decrease of 40%. Denosumab also reduced the risk of nonvertebral fracture, with a cumulative incidence of 6.5% in the denosumab group, versus 8.0% in the placebo group (hazard ratio, 0.80; 95% CI, 0.67 to 0.95; P=0.01)--a relative decrease of 20%. There was no increase in the risk of cancer, infection, cardiovascular disease, delayed fracture healing, or hypocalcemia, and there were no cases of osteonecrosis of the jaw and no adverse reactions to the injection of denosumab. Denosumab given subcutaneously twice yearly for 36 months was associated with a reduction in the risk of vertebral, nonvertebral, and hip fractures in women with osteoporosis. (ClinicalTrials.gov number, NCT00089791.) 2009 Massachusetts Medical Society
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            American Association of Oral and Maxillofacial Surgeons position paper on medication-related osteonecrosis of the jaw--2014 update.

            Strategies for management of patients with, or at risk for, medication-related osteonecrosis of the jaw (MRONJ) were set forth in the American Association of Oral and Maxillofacial Surgeons (AAOMS) position papers in 2007 and 2009. The position papers were developed by a special committee appointed by the board and composed of clinicians with extensive experience in caring for these patients and basic science researchers. The knowledge base and experience in addressing MRONJ has expanded, necessitating modifications and refinements to the previous position paper. This special committee met in September 2013 to appraise the current literature and revise the guidelines as indicated to reflect current knowledge in this field. This update contains revisions to diagnosis, staging, and management strategies and highlights current research status. The AAOMS considers it vitally important that this information be disseminated to other relevant health care professionals and organizations.
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              Denosumab versus zoledronic acid in bone disease treatment of newly diagnosed multiple myeloma: an international, double-blind, double-dummy, randomised, controlled, phase 3 study

              Multiple myeloma is characterised by monoclonal paraprotein production and osteolytic lesions, commonly leading to skeletal-related events (spinal cord compression, pathological fracture, or surgery or radiotherapy to affected bone). Denosumab, a monoclonal antibody targeting RANKL, reduces skeletal-related events associated with bone lesions or metastases in patients with advanced solid tumours. This study aimed to assess the efficacy and safety of denosumab compared with zoledronic acid for the prevention of skeletal-related events in patients with newly diagnosed multiple myeloma.
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                Author and article information

                Journal
                romm
                Revista de Osteoporosis y Metabolismo Mineral
                Rev Osteoporos Metab Miner
                Sociedad Española de Investigaciones Óseas y Metabolismo Mineral (Madrid, Madrid, Spain )
                1889-836X
                2173-2345
                March 2022
                : 14
                : 1
                : 55-63
                Affiliations
                [03] Bogotá orgnameUniversidad Javeriana orgdiv1Departamento de Epidemiologia Clínica y Bioestadística Colombia
                [01] Bogotá orgnamePontificia Universidad Javeriana - Hospital Universitario San Ignacio orgdiv1Departamento de Medicina Interna Colombia
                [04] Bogotá orgnameUniversidad Javeriana orgdiv1Facultad de Odontología Colombia
                [02] Bogotá orgnameHospital Universitario San Ignacio orgdiv1Unidad de Reumatología Colombia
                Article
                S1889-836X2022000100007 S1889-836X(22)01400100007
                10.4321/s1889-836x2022000100007
                cad2037c-7793-4aec-8542-b59bda615051

                This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 International License.

                History
                : 13 January 2022
                : 01 July 2021
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 18, Pages: 9
                Product

                SciELO Spain

                Categories
                Originales

                osteoporosis,odontólogos,osteonecrosis of the jaws,bisphosphonates,denosumab,dentists,osteonecrosis de maxilar,bisfosfonatos

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