GRAND: the German retrospective cohort analysis on compliance and persistence and the associated risk of fractures in osteoporotic women treated with oral bisphosphonates

Summary  

This database analysis of over 4,000 German women prescribed oral bisphosphonates between December 2004 and November 2007 showed that compliance and persistence with oral bisphosphonates in German women with osteoporosis were inadequate.     

Treatment with intravenous pamidronate is a good alternative in case of gastrointestinal side effects or contraindications for oral bisphosphonates

Background  

In case of contraindications or intolerance during treatment with oral bisphosphonates (OB), administration of pamidronate intravenously is a widely used alternative.     

Oral bisphosphonates are associated with reduced mortality in frail older people: a prospective five-year study

Summary  

In a study of 2005 institutionalized older people, use of oral bisphosphonates was associated with a 27% reduction in risk of death compared to non-users after adjusting for potential confounders.     

Oral bisphosphonates are associated with reduced mortality after hip fracture

Summary  

Intravenous bisphosphonates reduce mortality following hip fracture. We determined whether new use of oral bisphosphonates was also associated with reductions in mortality in 209 hip fracture patients. Oral bisphosphonate exposure led to relative reduction of 8% per month of use (p = 0.001) or about a 60% reduction in mortality per year of use.     

Oral bisphosphonate-related osteonecrosis of the jaw: the first report in Asia

Summary  

Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a serious side effect of bisphosphonate therapy. The incidence of BRONJ is known to be low among patients treated with oral bisphosphonates. We investigated the prevalence, demographics, clinical manifestations, and treatment outcome of 24 patients with oral BRONJ in Asian populations.     

Tooth extraction in osteoporotic patients taking oral bisphosphonates

Summary

This prospective study compares two different surgical protocols with different degrees of invasiveness for tooth extraction in patients treated with oral bisphosphonates (BPs). No intraoperative complications were observed in either of the two groups, and there was no evidence of postoperative bisphosphonate-associated osteonecrosis of the jaw in any of the extractions in the study group at follow-up (1,480 extractions). According to our data, dental extraction seems to be safe in osteoporotic patients treated with oral bisphosphonates.

Introduction

Oral bisphosphonates are drugs commonly prescribed for the treatment of osteoporosis and other resorptive bone diseases. Since 2003, there have been numerous publications relating bisphosphonate-related osteonecrosis of the jaw (BRONJ) in patients using oral bisphosphonates, such as alendronate and risedronate. Most of the BRONJ cases reported in literature show a strong correlation with dental pathologies, dental extractions, and/or oral surgical procedures.

Methods

This study was conducted on 700 consecutive patients treated with oral bisphosphonates who underwent dental extractions. A total of 1,480 extractions were involved: 864 in the mandible and 616 in the maxilla. The patients were assigned randomly to one of two groups: 334 were treated with delicate surgery and closure by primary intention (Protocol A), and the other 366 were treated with nontraumatic avulsion and closure by secondary intention (Protocol B). All patients were administered with antibiotics coverage.

Results

Seven hundred patients with required removal of compromised teeth were included in the study. No intraoperative complications were observed in either of the two groups, and there was no evidence of postoperative bisphosphonate-associated osteonecrosis of the jaw in any of the extractions in the study group at follow-up (1,480 extractions).

Conclusions

The findings of this prospective study indicate that both suggested protocols for tooth extraction in patients treated with oral BPs can provide a predictable treatment outcome (100 % success). Therefore, because atraumatic surgery is more comfortable for patients, we suggest the adoption of Protocol B, which limits trauma to both the soft and hard tissues.     

A retrospective analysis of extended-interval dosing and the impact on bisphosphonate compliance in the US Military Health System

Summary  

This study evaluated whether patients treated with bisphosphonates in the US Military Health System were more compliant with treatment given monthly versus weekly. While medication compliance did improve with treatment given monthly, overall compliance with bisphosphonates was still suboptimal suggesting the need for further strategies to improve compliance with treatment for osteoporosis.     

The impact of vitamin D status on changes in bone mineral density during treatment with bisphosphonates and after discontinuation following long-term use in post-menopausal osteoporosis

Background  

It is still unclear whether addition of calcium/vitamin D supplements leads to an incremental benefit in patients taking bisphosphonates and whether achievement of serum level of 25 (OH) vitamin D of at least 70 nmol/L has an impact on the skeletal response to bisphosphonates. Moreover the maintenance of BMD after bisphosphonates withdrawal with the continuation of calcium/vitamin D supplements only, remains uncertain. The aims were to assess the impact of vitamin D status on changes in bone mineral density (BMD) in firstly patients with post-menopausal osteoporosis on bisphosphonates and secondly following discontinuation of bisphosphonates after long-term use.     

Use of oral bisphosphonates and risk of venous thromboembolism: a population-based case-control study

Summary  

Oral bisphosphonates are widely used for fracture prevention, but there is a concern regarding potential adverse cardiovascular effects of bisphosphonates. In this large, population-based case-control study, we found no evidence of an association between bisphosphonate use and risk of venous thromboembolism (VTE).     

Transoral endoscopic neck surgery: feasibility and safety in a porcine model based on the example of thymectomy

Background  

In anatomical studies and cadaver dissections, we developed an endoscopic transoral access to the anterior neck region to reduce surgical access trauma. Through a sublingual trocar and two additional trocars in the vestibule of the oral cavity, the pretracheal and thyroid region was reached with standard laparoscopic instruments.     

Use of bisphosphonates and raloxifene and risk of deep venous thromboembolism and pulmonary embolism

Summary  

Prior studies have associated raloxifene and strontium ranelate with deep venous thromboembolism and pulmonary embolism. In a cohort study, we observed an increased risk also with the bisphosphonates. However, the increase was present already before the start of bisphosphonates pointing at an effect of the underlying condition.     

Course of NTX changes under continuous bisphosphonate treatment in cases of NTX over-reduction due to long-term treatment with bisphosphonates

Background  

It has recently been suggested that long-term continuous treatment with bisphosphonates can eventually result in skeletal harm. We reported that the level of urinary cross-linked N-telopeptide of type I collagen (NTX) was over-reduced in 11 of 87 (12.7%) patients receiving long-term therapy with bisphosphonates. In this case, it is inconclusive whether treatment with bisphosphonates should be continued or not after over-reduction of bone resorption markers. In this study, we demonstrated changes in NTX levels in 13 patients who consented to continue treatment with bisphosphonates even after the over-reduction of NTX levels.     

Decrease in outpatient department visits and operative interventions due to bisphosphonates in children with osteogenesis imperfecta

Introduction  

Bisphosphonates are currently the medical treatment most often used in children with osteogenesis imperfecta (OI). The purpose of this retrospective pre–post study was to evaluate the efficacy of treatment with bisphosphonates. We measured the effect by evaluating the number of outpatient department consultations and operative interventions before and after treatment with bisphosphonates in children with OI.     

Is Surgery Necessary for Femoral Insufficiency Fractures after Long-term Bisphosphonate Therapy?

Background  

Prolonged use of bisphosphonates in patients with osteoporosis reportedly induces femoral insufficiency fractures. However, the natural course of these fractures and how to treat them remain unknown.     

Poor bisphosphonate adherence for treatment of osteoporosis increases fracture risk: systematic review and meta-analysis

Summary  

Systematic review of adherence to bisphosphonates for the treatment of osteoporosis finds suboptimal levels of persistence and compliance. Poor bisphosphonate compliance increases fracture risk.     

Bisphosphonates and osteoporotic fractures: a cross-design synthesis of results among compliant/persistent postmenopausal women in clinical practice versus randomized controlled trials

Summary  

In a cross-design synthesis, total fractures were similarly reduced by bisphosphonates among postmenopausal women in randomized trials (23.8%) and highly compliant/persistent patients in observational studies of large databases from routine practice (20.3%). Bisphosphonates also reduced nonvertebral, vertebral and hip fractures in randomized trials and observational studies. In the real-word setting, compliant/persistent patients can gain a benefit from bisphosphonates comparable to that of randomized trial participants.     

The association between compliance and persistence with bisphosphonate therapy and fracture risk: A review

Background  

Sub optimal levels of compliance and persistence with bisphosphonates are potentially compromising the reduction of post menopausal osteoporotic (PMO) fracture risk.     

Femoral Insufficiency Fractures Associated with Prolonged Bisphosphonate Therapy

Background  

Emerging evidence has linked the long-term use of bisphosphonates with femoral insufficiency fractures. It has been suggested that the prolonged effect on bone remodeling leads to the accumulation of microfractures and weakening of bone.