In pharmacology,bisphosphonates (also called:diphosphonates) are a class of drugs that inhibit osteoclast action and the resorption of bone.
Its uses include the prevention and treatment of osteoporosis, osteitis deformans ("Paget's disease of bone"), bone metastasis (with or without hypercalcaemia), multiple myeloma and other conditions that feature bone fragility.
This document provides an overview of bisphosphonates including their history, chemical structure, types, mechanism of action, uses, administration, and potential side effects like BRONJ. Some key points:
- Bisphosphonates are a class of drugs that prevent bone loss and are used to treat bone metastases, osteoporosis, and Paget's disease.
- They have a high affinity for hydroxyapatite crystals in bone and inhibit osteoclast activity and bone resorption.
- Nitrogen-containing bisphosphonates are more potent than early non-nitrogenous versions. Mechanisms of action differ between the two classes.
- While bisphosphonates showed
Bisphosphonates are pyrophosphate analogues that are resistant to enzymatic destruction and bind strongly to bone. They are used to treat osteoporosis, Paget's disease, and bone metastases. Newer generations of bisphosphonates are more potent and selectively inhibit bone resorption over formation. They work by inhibiting enzymes in the HMG-CoA reductase pathway, preventing osteoclast function. Clinical trials demonstrate bisphosphonates' ability to increase bone mineral density and reduce fracture risk. While generally well-tolerated, they can cause jaw necrosis or atypical femoral fractures with prolonged use.
This document provides an overview of bisphosphonates. It discusses their history, structure, indications, mechanisms of action, roles in periodontal therapy, side effects including BRONJ (bisphosphonate-related osteonecrosis of the jaw), and dental management considerations for patients receiving oral bisphosphonate therapy. The document covers bisphosphonates' effects at the tissue, cellular, and molecular levels and reviews both animal and human studies on their use in periodontal applications. It also addresses their potential analgesic properties and optimal duration of use.
Bisphosphonates are drugs that bind strongly to bone minerals and inhibit bone resorption by osteoclasts. They are categorized as either nitrogen-containing (e.g. zoledronic acid) or non-nitrogen containing (e.g. tiludronate), with nitrogen-containing being up to 1000 times more potent. Bisphosphonates are used to treat osteoporosis, Paget's disease, bone metastases from cancers like breast and prostate cancer, and other bone diseases. While they are generally safe, side effects can include gastrointestinal issues and osteonecrosis of the jaw in rare cases.
This document discusses osteonecrosis of the jaws (ONJ) and provides information on its causes, classification, and prevention. It summarizes that ONJ is bone death in the jaw that fails to heal for 8 weeks in patients receiving bisphosphonates or denosumab. Risk factors include intravenous bisphosphonates, duration of oral bisphosphonate use over 3 years, dental extractions, and low bone turnover as measured by serum CTX levels below 150 pg/mL. Prevention strategies aim to increase bone turnover above safe thresholds through drug holidays before invasive dental procedures.
Zoldronic acid is a treatment for certain cancers. Zoldronic acid comes in many different kinds of generic brands. You can buy Zoldronic acid from http://www.genericanticancer.com
This document discusses several bone diseases. It provides information on bone types and classifications of bone diseases. Key bone diseases mentioned include fibrous dysplasia of bone, which involves bone being replaced by fibrous tissue; Paget's disease of bone, which is the second most common bone condition after osteopetrosis; and cherubism, a familial condition involving fibrous dysplasia of the jaws. Details are provided on symptoms, characteristics, pathogenesis and treatment of these diseases.
(1) Hemostasis involves three synergistic factors - platelet plug formation, vasoconstriction, and fibrin clot formation. Secondary hemostasis specifically refers to the activation of the coagulation cascade and formation of a permanent fibrin plug.
(2) Surgical bleeding can be arterial, venous, or oozing and is influenced by patient factors like medications and coagulopathies as well as procedural factors. Excess bleeding can adversely impact the surgical field and patient.
(3) Methods to achieve hemostasis include mechanical methods like direct pressure, sutures and staples, and chemical methods like pharmacological agents and topical hemostatic agents. Topical agents can be passive, promoting cl
This document provides an overview of bisphosphonates including their history, chemical structure, types, mechanism of action, uses, administration, and potential side effects like BRONJ. Some key points:
- Bisphosphonates are a class of drugs that prevent bone loss and are used to treat bone metastases, osteoporosis, and Paget's disease.
- They have a high affinity for hydroxyapatite crystals in bone and inhibit osteoclast activity and bone resorption.
- Nitrogen-containing bisphosphonates are more potent than early non-nitrogenous versions. Mechanisms of action differ between the two classes.
- While bisphosphonates showed
Bisphosphonates are pyrophosphate analogues that are resistant to enzymatic destruction and bind strongly to bone. They are used to treat osteoporosis, Paget's disease, and bone metastases. Newer generations of bisphosphonates are more potent and selectively inhibit bone resorption over formation. They work by inhibiting enzymes in the HMG-CoA reductase pathway, preventing osteoclast function. Clinical trials demonstrate bisphosphonates' ability to increase bone mineral density and reduce fracture risk. While generally well-tolerated, they can cause jaw necrosis or atypical femoral fractures with prolonged use.
This document provides an overview of bisphosphonates. It discusses their history, structure, indications, mechanisms of action, roles in periodontal therapy, side effects including BRONJ (bisphosphonate-related osteonecrosis of the jaw), and dental management considerations for patients receiving oral bisphosphonate therapy. The document covers bisphosphonates' effects at the tissue, cellular, and molecular levels and reviews both animal and human studies on their use in periodontal applications. It also addresses their potential analgesic properties and optimal duration of use.
Bisphosphonates are drugs that bind strongly to bone minerals and inhibit bone resorption by osteoclasts. They are categorized as either nitrogen-containing (e.g. zoledronic acid) or non-nitrogen containing (e.g. tiludronate), with nitrogen-containing being up to 1000 times more potent. Bisphosphonates are used to treat osteoporosis, Paget's disease, bone metastases from cancers like breast and prostate cancer, and other bone diseases. While they are generally safe, side effects can include gastrointestinal issues and osteonecrosis of the jaw in rare cases.
This document discusses osteonecrosis of the jaws (ONJ) and provides information on its causes, classification, and prevention. It summarizes that ONJ is bone death in the jaw that fails to heal for 8 weeks in patients receiving bisphosphonates or denosumab. Risk factors include intravenous bisphosphonates, duration of oral bisphosphonate use over 3 years, dental extractions, and low bone turnover as measured by serum CTX levels below 150 pg/mL. Prevention strategies aim to increase bone turnover above safe thresholds through drug holidays before invasive dental procedures.
Zoldronic acid is a treatment for certain cancers. Zoldronic acid comes in many different kinds of generic brands. You can buy Zoldronic acid from http://www.genericanticancer.com
This document discusses several bone diseases. It provides information on bone types and classifications of bone diseases. Key bone diseases mentioned include fibrous dysplasia of bone, which involves bone being replaced by fibrous tissue; Paget's disease of bone, which is the second most common bone condition after osteopetrosis; and cherubism, a familial condition involving fibrous dysplasia of the jaws. Details are provided on symptoms, characteristics, pathogenesis and treatment of these diseases.
(1) Hemostasis involves three synergistic factors - platelet plug formation, vasoconstriction, and fibrin clot formation. Secondary hemostasis specifically refers to the activation of the coagulation cascade and formation of a permanent fibrin plug.
(2) Surgical bleeding can be arterial, venous, or oozing and is influenced by patient factors like medications and coagulopathies as well as procedural factors. Excess bleeding can adversely impact the surgical field and patient.
(3) Methods to achieve hemostasis include mechanical methods like direct pressure, sutures and staples, and chemical methods like pharmacological agents and topical hemostatic agents. Topical agents can be passive, promoting cl
This document provides an overview of allografts, specifically freeze-dried bone allografts (FDBA) and demineralized freeze-dried bone allografts (DFDBA). It discusses the history, procurement, preparation, and applications of FDBA and DFDBA in periodontal regenerative procedures like intra-bony defects, extraction sockets, sinus lifts, implants, and guided tissue regeneration. Studies have found that FDBA and DFDBA can promote new bone formation and regeneration when used alone or in combination with other materials and procedures.
Osteoporosis is a disease characterized by low bone mass and deterioration of bone structure, leading to an increased risk of fractures. It occurs when bone resorption exceeds bone formation due to increased bone turnover. Bisphosphonates are commonly used to treat osteoporosis and have been shown to reduce fracture risk by 50%, but issues with low diagnostic rates and non-adherence exist. A potential rare side effect of long-term bisphosphonate use is osteonecrosis of the jaws, especially among cancer patients receiving intravenous bisphosphonates. Serum CTX levels and taking a drug holiday may help assess risk and prevent osteonecrosis when dental work is needed. Strontium has also been studied as
Mandibular fractures are common injuries that result from facial trauma. The document discusses the history, anatomy, classification, examination, and treatment of mandibular fractures. Key points include that mandibular fractures were first described in ancient Egyptian medical texts, occur most often in males ages 20-30 from vehicular accidents or assaults, and can be classified based on location, number of fragments, involvement of teeth, and direction of the fracture. Radiographic examination including panoramic x-rays are important for diagnosis.
This document provides an overview of bisphosphonate-induced osteonecrosis of the jaws (BIONJ). It begins with definitions and a brief history, noting BIONJ was first discussed in 2001 and has similarities to "phossy jaw" seen in early match factory workers exposed to white phosphorus. The document covers the mechanism of action, classification, and structure of bisphosphonates. It discusses the clinical use of bisphosphonates to treat osteoporosis, Paget's disease, and complications of malignant bone disease. Potential risk factors and pathophysiology of BIONJ are presented. The document provides detail on diagnosing and staging BIONJ as well as treatment guidelines.
This document discusses several types of primary bone tumors. It begins with an introduction to the classification of bone tumors based on histologic criteria. It then discusses several benign bone tumors in more detail, including chondroma, osteoma, osteoid osteoma, benign osteoblastoma, and osteochondroma. For malignant tumors, it focuses on explaining osteosarcoma, including its etiology, classification, and characteristics. It provides histologic images and descriptions of the key features of many of these tumors. In summary, the document provides an overview of the classification and characteristics of both benign and malignant primary bone tumors.
This document provides an overview of fibro-osseous lesions and focuses on fibrous dysplasia. It discusses the classification, etiology, clinical features, radiographic features, histologic features, treatment and prognosis of fibrous dysplasia. Fibrous dysplasia is a benign bone lesion caused by a mutation in the GNAS1 gene. It can present as monostotic, polyostotic or craniofacial lesions. Radiographically, it appears as radiolucent or radiopaque areas with a "ground glass" appearance. Histologically, it is characterized by fibrous tissue and irregular woven bone trabeculae. Treatment involves surgery or bisphosphonates and the prognosis is generally good
BRONJ bisphosphonates osteonecrosis of jawWeam Faroun
This document discusses bisphosphonate-related osteonecrosis of the jaws (BRONJ) and provides guidance on dental management of patients taking bisphosphonates. It notes that bisphosphonates are commonly used to treat osteoporosis and bone metastases but can increase the risk of BRONJ, especially after dental surgery. The document recommends conservative dental treatment and antibiotic prophylaxis for high-risk patients. It identifies risk factors for BRONJ and advises monitoring of bone turnover markers like CTX to further assess surgical risk. The goal is to minimize but not eliminate the low risk of BRONJ from oral bisphosphonate use through preventative dental care and cautious management of invasive procedures.
The document discusses different types of bone grafts. Autografts, which are bone grafts taken from one site of a patient's own body and transplanted to another site, are still considered the best option. Autografts can incorporate, revascularize, and withstand mechanical stresses well over time. Allografts, which are bone grafts transplanted between two genetically unrelated individuals of the same species, are becoming more widely accepted but do not completely vascularize. A variety of graft forms and sources are discussed including cortical, cancellous, corticocancellous grafts as well as some newer options like vascularized grafts.
Oral consideration and laboratory investigations of bleeding and clotting dis...kashmira483
This document provides information on bleeding and clotting disorders. It discusses the pathophysiology of hemostasis including the vascular, platelet, coagulation, and fibrinolytic phases. It describes different types of bleeding disorders like vessel wall disorders, platelet disorders, and coagulation disorders. Laboratory tests for identifying bleeding disorders are outlined. Oral manifestations and dental considerations for management are summarized. Local hemostatic agents and systemic agents for different bleeding disorders are also mentioned.
This document provides an overview of bone formation, resorption, and remodeling. It discusses the classification of bones based on shape and development. It describes the composition of bone including cells like osteoblasts, osteoclasts, and osteocytes. Bone formation is mediated by growth factors while resorption involves acid secretion and enzyme activity by osteoclasts. Remodeling is a continuous process where old bone is replaced, maintaining bone strength through the coupled activities of formation and resorption. Markers of bone turnover provide information about these dynamic processes.
This document discusses different types of bone grafts used in periodontics. It describes autografts, which are transplanted from one site to another within the same individual, as the gold standard due to their osteoinductive properties. Autografts can be obtained from both extraoral sites like the hip or iliac crest, as well as intraoral sites like the tuberosity, tori, or osseous coagulum collected from the surgical site. The document outlines the advantages and disadvantages of various graft materials and their properties like osteoinduction, osteoconduction, and osteogenesis that facilitate bone regeneration.
This document discusses various medications approved for treating osteoporosis. It describes bisphosphonates, which decrease bone loss by inhibiting osteoclasts, as well as selective estrogen receptor modulators like raloxifene. Strontium ranelate, teriparatide, and calcitonin are also outlined as they increase bone formation or decrease resorption. New drugs under investigation include denosumab, romosozumab, and ostabolin-cyclic PTH1-35 which aim to reduce fractures by novel mechanisms of bone formation or resorption inhibition.
This document provides an overview of bone graft materials and procedures, as well as first stage surgery. It discusses the history of bone grafting, defines common types of grafts like autografts, allografts, xenografts, and alloplasts. Characteristics of ideal graft materials are outlined. The document also examines graft choice considerations, various graft forms, and the biological properties and mechanisms of different materials. First stage surgery is briefly mentioned at the end.
Bone grafts in periodontal therapy
Presenter:
Dr. Rebicca Ranjit
Lecturer
Dept. of Periodontology & Oral Implantology
Historical Review:
In orthopaedics, bone grafts have been used for years.
Beuke and Silver, 1936 used boiled cow bone powder to successfully repair intrabony defects in humans.
Melcher, 1962 used anorganic bone (bovine bone) which were followed for 3 years.
Implant related complications and failureJignesh Patel
This document discusses complications related to dental implants. It begins by discussing surgical complications such as hemorrhage, hematoma, neurosensory disturbances, and implant malposition. It then discusses biological complications affecting the peri-implant soft tissues, such as inflammation, recession, and progressive bone loss which can lead to peri-implantitis. Mechanical complications are also summarized, including screw loosening/fracture and implant fracture.
This document discusses bone healing and repair. It begins with an introduction and overview of bone structure and function. There are several cell types involved in bone healing including osteoblasts, osteoclasts and fibroblasts. Bone healing can occur directly through primary healing or indirectly through secondary healing which involves callus formation. Several factors can affect bone healing such as nutrition, age, infection and vascularity. Complications of bone healing include nonunion, malunion and delayed union. Bone grafts undergo revascularization from the recipient site and healing of extraction sockets occurs in stages from coagulum to bone development.
Bisphosphonates are a class of drugs that prevent bone loss and are used to treat bone metastases, osteoporosis, and Paget's disease. They have a high affinity for hydroxyapatite crystals in bone and work by inhibiting bone resorption. There are two types - non-nitrogenous bisphosphonates which induce osteoclast apoptosis, and nitrogenous bisphosphonates which inhibit protein prenylation in osteoclasts. Common indications include postmenopausal osteoporosis, glucocorticoid-induced osteoporosis, and bone metastases. While generally well-tolerated, side effects can include upset stomach, esophagus problems, and osteonecrosis of the
Pyogenic granuloma is a non-neoplastic, inflammatory hyperplasia that presents as a tumor-like, nodular growth in the oral cavity, most commonly on the gingiva. It appears as a red-to-purple, smooth or lobulated mass that can range in size from a few millimeters to several centimeters. While the lesions often bleed easily and are extremely vascular early on, they become more collagenous and pink as they mature. Potential causes include chronic oral irritation from factors like overhanging restorations or hormonal changes. Radiographs appear normal unless calcifications are present, in which case it may be a peripheral ossifying fibroma. Histologically, it shows a lobulated
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Bisphosphonates are a class of drugs that prevent bone loss and are used to treat bone metastases, osteoporosis, and Paget's disease. They have a high affinity for hydroxyapatite crystals in bone and work by inhibiting bone resorption. There are two types - non-nitrogenous bisphosphonates which induce osteoclast apoptosis, and nitrogenous bisphosphonates which inhibit protein prenylation in osteoclasts. Common indications include postmenopausal osteoporosis, glucocorticoid-induced osteoporosis, and bone metastases. While generally well-tolerated, side effects can include upset stomach, esophagitis, and osteonecrosis of the
This document provides an overview of allografts, specifically freeze-dried bone allografts (FDBA) and demineralized freeze-dried bone allografts (DFDBA). It discusses the history, procurement, preparation, and applications of FDBA and DFDBA in periodontal regenerative procedures like intra-bony defects, extraction sockets, sinus lifts, implants, and guided tissue regeneration. Studies have found that FDBA and DFDBA can promote new bone formation and regeneration when used alone or in combination with other materials and procedures.
Osteoporosis is a disease characterized by low bone mass and deterioration of bone structure, leading to an increased risk of fractures. It occurs when bone resorption exceeds bone formation due to increased bone turnover. Bisphosphonates are commonly used to treat osteoporosis and have been shown to reduce fracture risk by 50%, but issues with low diagnostic rates and non-adherence exist. A potential rare side effect of long-term bisphosphonate use is osteonecrosis of the jaws, especially among cancer patients receiving intravenous bisphosphonates. Serum CTX levels and taking a drug holiday may help assess risk and prevent osteonecrosis when dental work is needed. Strontium has also been studied as
Mandibular fractures are common injuries that result from facial trauma. The document discusses the history, anatomy, classification, examination, and treatment of mandibular fractures. Key points include that mandibular fractures were first described in ancient Egyptian medical texts, occur most often in males ages 20-30 from vehicular accidents or assaults, and can be classified based on location, number of fragments, involvement of teeth, and direction of the fracture. Radiographic examination including panoramic x-rays are important for diagnosis.
This document provides an overview of bisphosphonate-induced osteonecrosis of the jaws (BIONJ). It begins with definitions and a brief history, noting BIONJ was first discussed in 2001 and has similarities to "phossy jaw" seen in early match factory workers exposed to white phosphorus. The document covers the mechanism of action, classification, and structure of bisphosphonates. It discusses the clinical use of bisphosphonates to treat osteoporosis, Paget's disease, and complications of malignant bone disease. Potential risk factors and pathophysiology of BIONJ are presented. The document provides detail on diagnosing and staging BIONJ as well as treatment guidelines.
This document discusses several types of primary bone tumors. It begins with an introduction to the classification of bone tumors based on histologic criteria. It then discusses several benign bone tumors in more detail, including chondroma, osteoma, osteoid osteoma, benign osteoblastoma, and osteochondroma. For malignant tumors, it focuses on explaining osteosarcoma, including its etiology, classification, and characteristics. It provides histologic images and descriptions of the key features of many of these tumors. In summary, the document provides an overview of the classification and characteristics of both benign and malignant primary bone tumors.
This document provides an overview of fibro-osseous lesions and focuses on fibrous dysplasia. It discusses the classification, etiology, clinical features, radiographic features, histologic features, treatment and prognosis of fibrous dysplasia. Fibrous dysplasia is a benign bone lesion caused by a mutation in the GNAS1 gene. It can present as monostotic, polyostotic or craniofacial lesions. Radiographically, it appears as radiolucent or radiopaque areas with a "ground glass" appearance. Histologically, it is characterized by fibrous tissue and irregular woven bone trabeculae. Treatment involves surgery or bisphosphonates and the prognosis is generally good
BRONJ bisphosphonates osteonecrosis of jawWeam Faroun
This document discusses bisphosphonate-related osteonecrosis of the jaws (BRONJ) and provides guidance on dental management of patients taking bisphosphonates. It notes that bisphosphonates are commonly used to treat osteoporosis and bone metastases but can increase the risk of BRONJ, especially after dental surgery. The document recommends conservative dental treatment and antibiotic prophylaxis for high-risk patients. It identifies risk factors for BRONJ and advises monitoring of bone turnover markers like CTX to further assess surgical risk. The goal is to minimize but not eliminate the low risk of BRONJ from oral bisphosphonate use through preventative dental care and cautious management of invasive procedures.
The document discusses different types of bone grafts. Autografts, which are bone grafts taken from one site of a patient's own body and transplanted to another site, are still considered the best option. Autografts can incorporate, revascularize, and withstand mechanical stresses well over time. Allografts, which are bone grafts transplanted between two genetically unrelated individuals of the same species, are becoming more widely accepted but do not completely vascularize. A variety of graft forms and sources are discussed including cortical, cancellous, corticocancellous grafts as well as some newer options like vascularized grafts.
Oral consideration and laboratory investigations of bleeding and clotting dis...kashmira483
This document provides information on bleeding and clotting disorders. It discusses the pathophysiology of hemostasis including the vascular, platelet, coagulation, and fibrinolytic phases. It describes different types of bleeding disorders like vessel wall disorders, platelet disorders, and coagulation disorders. Laboratory tests for identifying bleeding disorders are outlined. Oral manifestations and dental considerations for management are summarized. Local hemostatic agents and systemic agents for different bleeding disorders are also mentioned.
This document provides an overview of bone formation, resorption, and remodeling. It discusses the classification of bones based on shape and development. It describes the composition of bone including cells like osteoblasts, osteoclasts, and osteocytes. Bone formation is mediated by growth factors while resorption involves acid secretion and enzyme activity by osteoclasts. Remodeling is a continuous process where old bone is replaced, maintaining bone strength through the coupled activities of formation and resorption. Markers of bone turnover provide information about these dynamic processes.
This document discusses different types of bone grafts used in periodontics. It describes autografts, which are transplanted from one site to another within the same individual, as the gold standard due to their osteoinductive properties. Autografts can be obtained from both extraoral sites like the hip or iliac crest, as well as intraoral sites like the tuberosity, tori, or osseous coagulum collected from the surgical site. The document outlines the advantages and disadvantages of various graft materials and their properties like osteoinduction, osteoconduction, and osteogenesis that facilitate bone regeneration.
This document discusses various medications approved for treating osteoporosis. It describes bisphosphonates, which decrease bone loss by inhibiting osteoclasts, as well as selective estrogen receptor modulators like raloxifene. Strontium ranelate, teriparatide, and calcitonin are also outlined as they increase bone formation or decrease resorption. New drugs under investigation include denosumab, romosozumab, and ostabolin-cyclic PTH1-35 which aim to reduce fractures by novel mechanisms of bone formation or resorption inhibition.
This document provides an overview of bone graft materials and procedures, as well as first stage surgery. It discusses the history of bone grafting, defines common types of grafts like autografts, allografts, xenografts, and alloplasts. Characteristics of ideal graft materials are outlined. The document also examines graft choice considerations, various graft forms, and the biological properties and mechanisms of different materials. First stage surgery is briefly mentioned at the end.
Bone grafts in periodontal therapy
Presenter:
Dr. Rebicca Ranjit
Lecturer
Dept. of Periodontology & Oral Implantology
Historical Review:
In orthopaedics, bone grafts have been used for years.
Beuke and Silver, 1936 used boiled cow bone powder to successfully repair intrabony defects in humans.
Melcher, 1962 used anorganic bone (bovine bone) which were followed for 3 years.
Implant related complications and failureJignesh Patel
This document discusses complications related to dental implants. It begins by discussing surgical complications such as hemorrhage, hematoma, neurosensory disturbances, and implant malposition. It then discusses biological complications affecting the peri-implant soft tissues, such as inflammation, recession, and progressive bone loss which can lead to peri-implantitis. Mechanical complications are also summarized, including screw loosening/fracture and implant fracture.
This document discusses bone healing and repair. It begins with an introduction and overview of bone structure and function. There are several cell types involved in bone healing including osteoblasts, osteoclasts and fibroblasts. Bone healing can occur directly through primary healing or indirectly through secondary healing which involves callus formation. Several factors can affect bone healing such as nutrition, age, infection and vascularity. Complications of bone healing include nonunion, malunion and delayed union. Bone grafts undergo revascularization from the recipient site and healing of extraction sockets occurs in stages from coagulum to bone development.
Bisphosphonates are a class of drugs that prevent bone loss and are used to treat bone metastases, osteoporosis, and Paget's disease. They have a high affinity for hydroxyapatite crystals in bone and work by inhibiting bone resorption. There are two types - non-nitrogenous bisphosphonates which induce osteoclast apoptosis, and nitrogenous bisphosphonates which inhibit protein prenylation in osteoclasts. Common indications include postmenopausal osteoporosis, glucocorticoid-induced osteoporosis, and bone metastases. While generally well-tolerated, side effects can include upset stomach, esophagus problems, and osteonecrosis of the
Pyogenic granuloma is a non-neoplastic, inflammatory hyperplasia that presents as a tumor-like, nodular growth in the oral cavity, most commonly on the gingiva. It appears as a red-to-purple, smooth or lobulated mass that can range in size from a few millimeters to several centimeters. While the lesions often bleed easily and are extremely vascular early on, they become more collagenous and pink as they mature. Potential causes include chronic oral irritation from factors like overhanging restorations or hormonal changes. Radiographs appear normal unless calcifications are present, in which case it may be a peripheral ossifying fibroma. Histologically, it shows a lobulated
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Bisphosphonates are a class of drugs that prevent bone loss and are used to treat bone metastases, osteoporosis, and Paget's disease. They have a high affinity for hydroxyapatite crystals in bone and work by inhibiting bone resorption. There are two types - non-nitrogenous bisphosphonates which induce osteoclast apoptosis, and nitrogenous bisphosphonates which inhibit protein prenylation in osteoclasts. Common indications include postmenopausal osteoporosis, glucocorticoid-induced osteoporosis, and bone metastases. While generally well-tolerated, side effects can include upset stomach, esophagitis, and osteonecrosis of the
Bisphosphonates are a class of drugs that prevent bone loss and are used to treat bone metastases, osteoporosis, and Paget's disease. They have a high affinity for hydroxyapatite crystals in bone and work by inhibiting bone resorption. There are two types - non-nitrogenous bisphosphonates which induce osteoclast apoptosis, and nitrogenous bisphosphonates which inhibit protein prenylation in osteoclasts. Common indications include postmenopausal osteoporosis, glucocorticoid-induced osteoporosis, and bone metastases. While generally well-tolerated, side effects can include upset stomach, esophagus problems, and osteonecrosis of the
The lectures in points : -
1- Osteoporosis.
2- Paget's disease.
3- Drugs used in osteoporosis and paget's disease treatment.
4- Practical notes.
5- Rapid review.
6- Test yourself.
Osteoporosis is a disease characterized by low bone mass and deterioration of bone structure. It increases bone fragility and risk of fractures. Primary types include postmenopausal osteoporosis in women over 50 and senile osteoporosis in those over 70. Treatment focuses on preventing bone loss and increasing bone mass. First line drugs are bisphosphonates like alendronate and risedronate. Second line includes selective estrogen receptor modulators like raloxifene. Non-pharmacological prevention focuses on calcium, vitamin D, and weight-bearing exercise.
This document discusses the pharmacotherapy of osteoporosis. It begins by defining osteoporosis and describing the problem it presents. It then covers the types of osteoporosis and risk factors. Diagnostic methods like DEXA scans and laboratory tests are outlined. Current treatment options are explained, including bisphosphonates, selective estrogen receptor modulators, calcitonin, vitamin D, and teriparatide. Specific drugs like alendronate, pamidronate, ibandronate, and raloxifene are described in detail. Non-pharmacological treatment and recent advances like neridronate and denosumab are also summarized.
Use of bisphosphonates in orthopaedic surgeryLove2jaipal
Bisphosphonates are a class of drugs used to treat bone disorders involving increased bone resorption. They work by inhibiting osteoclast activity and bone resorption. There are several generations of bisphosphonates with varying potencies, and they have many orthopedic indications including osteoporosis, bone metastases, and Paget's disease. Bisphosphonates have been shown to effectively reduce fracture risk in osteoporosis trials and decrease mortality in elderly patients at high risk for fracture. While generally well-tolerated, they can cause side effects including upset stomach and joint pain.
This document discusses bisphosphonates and their effects on bone remodeling and dental practice. Bisphosphonates work by reducing osteoclast activity and bone resorption, which increases bone mineral density and is useful for treating osteoporosis. However, long-term use can lead to osteonecrosis of the jaws due to impaired bone turnover and reduced blood vessel formation. The risk is highest with intravenous bisphosphonates. Dental procedures also increase the risk, so proper preventative dental care is important for patients on bisphosphonate therapy.
This document provides information on bisphosphonate-related osteonecrosis of the jaws (BRONJ). It begins with background on bisphosphonates, including their uses, mechanisms of action, and side effects. It then discusses the history, estimated incidence, risk factors, clinical presentation, staging, and treatment of BRONJ. The document aims to educate on this condition caused by prolonged bisphosphonate use that results in exposed bone in the jaw.
Calcium and phosphate metabolism in the body.pptxPrenisha Preethi
This document discusses calcium and phosphate metabolism. It begins with introducing the topics to be covered and providing an overview of metabolism. It then discusses the distribution and ratio of calcium and phosphate in the body, how their levels are maintained, daily requirements, dietary sources, functions, absorption, and regulating hormones. The document outlines several disorders related to calcium and phosphate, including hypercalcemia, hypocalcemia, and osteoporosis. It concludes by discussing prosthodontic implications and management of patients with metabolic bone diseases.
Seminar on pharmacotherapy of osteoporosis copydip4pharma
This document summarizes information about osteoporosis, including its definition, pathophysiology, causes, prevention, and treatment. It is characterized by low bone density and deterioration of bone tissue, increasing the risk of fractures. Key factors that influence bone loss are hormonal status, exercise, aging, nutrition, and some genetic influences. Both non-pharmacological and pharmacological therapies can be used to prevent and treat osteoporosis by increasing bone mineral density and reducing fractures. Common treatments include calcium, vitamin D, bisphosphonates, and estrogen therapies.
This document discusses osteoporosis and related bone diseases. It defines osteoporosis as a metabolic bone disease characterized by low bone density and increased bone fragility. Common fracture sites are the forearm, vertebrae, humerus and hip. Hip fractures are the most serious with a 12% immediate mortality rate. The document outlines risk factors, pathophysiology, clinical features, investigations and management strategies for osteoporosis as well as related diseases including vitamin D deficiency, osteomalacia, rickets, and hereditary disorders.
This document provides an overview of osteoporosis including its pathophysiology, risk factors, clinical manifestations, diagnosis, and management. It discusses how osteoporosis results from an imbalance between bone resorption and formation leading to increased bone fragility and fracture risk. Key points covered include screening and diagnosis using DXA scans; assessing fracture risk factors; reducing further risk through lifestyle changes like calcium and vitamin D supplementation; and pharmacological treatments including bisphosphonates, PTH analogs, denosumab, and other drugs that build bone or reduce resorption to decrease fracture incidence. Adverse effects and monitoring of different therapies are also reviewed.
Osteoporosis is a disease characterized by decreased bone strength and increased risk of fractures. It most commonly causes breaks in the back, forearm, and hip bones. While there are typically no symptoms until a fracture occurs, bones can weaken enough that minor stress or even spontaneous breaks can happen. Treatment involves regulating cells that form and resorb bone, as well as medications like bisphosphonates, calcitonin, calcium supplements, and parathyroid hormone injections to increase bone density and reduce fracture risk.
Osteoporosis is a disease characterized by decreased bone strength and increased risk of fractures. It most commonly causes breaks in the back, forearm, and hip bones. While there are typically no symptoms until a fracture occurs, bones can weaken enough that minor stress or even spontaneous breaks can happen. Treatment involves regulating cells that form and resorb bone, as well as medications like bisphosphonates, calcitonin, calcium supplements, and parathyroid hormone injections to increase bone density and reduce fracture risk.
Bisfosfonatos _ Sociedad Canadiense del Cáncer.pdfrensoguardo
Bisphosphonates are a group of medications that can be used to help protect bones against some types of cancer and treat some bone conditions. They work by slowing the action of bone cells that break down bone tissue. Bisphosphonates can be used to reduce bone pain from bone metastases or multiple myeloma, lower high calcium levels in the blood, and help strengthen bones to reduce fracture risk from cancer, bone metastases or osteoporosis. Potential side effects depend on the type of bisphosphonate and can include fatigue, increased bone pain, digestive issues, flu-like symptoms, low calcium levels, kidney problems, and in rare cases, osteonecrosis of the jaw.
Osteoporosis is a disease characterized by low bone density and deterioration of bone tissue, leading to an increased risk of fractures. It is most common in postmenopausal women. Treatment focuses on preventing falls, maintaining calcium and vitamin D levels through diet, regular weight-bearing exercise, and medications like bisphosphonates to strengthen bone and reduce fracture risk. Bone mineral density tests are used for diagnosis, and response to treatment is monitored through repeat testing.
This study aims to investigate whether long-term bisphosphonate use for benign bone diseases is associated with impaired dental healing. A case-control study will be conducted comparing 54 cases of delayed dental healing in bisphosphonate users to 215 age-and visit period-matched controls without healing issues. Potential cases will be identified through dental records and confirmed by an adjudication panel. Data on demographics, bisphosphonate use, medical history and dental details will be collected through interviews and records. This study seeks to provide evidence on the relationship between bisphosphonates and dental complications to inform osteoporosis management for a growing aging population.
This study aims to investigate whether long-term bisphosphonate therapy for benign bone diseases is associated with impaired dental healing. A case-control study will be conducted comparing 54 cases of potential delayed dental healing in bisphosphonate users to 215 age-matched controls without this complication. The primary outcome is the incidence of delayed dental healing following dental procedures or spontaneously in those taking bisphosphonates for over one year for osteoporosis or other benign bone conditions compared to controls. This study seeks to provide valuable data on the potential relationship between long-term bisphosphonate use and dental healing issues.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Adhd Medication Shortage Uk - trinexpharmacy.comreignlana06
The UK is currently facing a Adhd Medication Shortage Uk, which has left many patients and their families grappling with uncertainty and frustration. ADHD, or Attention Deficit Hyperactivity Disorder, is a chronic condition that requires consistent medication to manage effectively. This shortage has highlighted the critical role these medications play in the daily lives of those affected by ADHD. Contact : +1 (747) 209 – 3649 E-mail : sales@trinexpharmacy.com
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
3. Bisphosphonates
In pharmacology,bisphosphonates (also
called:diphosphonates) are a class of drugs that
inhibit osteoclast action and the resorption of bone.
Its uses include the prevention and treatment of
osteoporosis, osteitis deformans ("Paget's disease of
bone"), bone metastasis (with or without
hypercalcaemia), multiple myeloma and other
conditions that feature bone fragility.
4. CYCLECAL CHANGES IN BONE REMODELLING
TRAUMA
Osteoclast
activity
Bone
resorption
Osteoblast
activity
Bone
formation
6. History
Bisphosphonates were developed in the 19th
century, but were first investigated in the 1960s
for use in disorders of bone metabolism. Their
non-medical use included water softening in
irrigation systems used in orange groves. The
initial rationale for their use in humans was their
potential in preventing the dissolution of
hydroxylapatite, the principal bone mineral, and
hence arresting bone loss. Only in the 1990s was
their actual mechanism of action demonstrated.
7. OH R-1 OH
O = P C P = O
OH R-2 OH
CHEMICAL STRUCTURE OF BISPHOSPOHONATE
All bisphosphonate drugs share a common P-C-P "backbone"
The two PO3 (phosphate) groups covalently linked to carbon determine both the
name "bisphosphonate" and the function of the drugs.
The long side chain (R2 in the diagram) determines the chemical properties, the
mode of action and the strength of bisphosphonate drugs. The short side chain (R1),
often called the 'hook,' mainly influences chemical properties and pharmacokinetics.
8. Alendronate and risedronate are also
nitrogen-containing bisphosphonates
HO
OH
P
O OH
OH
OH
P
O
N
CH3
CH3
Ibandronate
OH group at R1 increases
affinity for bone mineral
N-containing group within
R2 increases antiresorptive
potency
9. Pharmacokinetics
Of the bisphosphonate that is resorbed
(from oral preparation) or infused (for
intravenous drugs), about 50% is
excreted unchanged by the kidney. The
remainder has a very high affinity for
bone tissue, and is rapidly absorbed
onto the bone surface.
10. Mechanism of action
Bisphosphonates, when attached to bone tissue,
are "ingested" by osteoclasts, the bone cell that
breaks down bone tissue.
There are two classes of bisphosphonate: the N-
containing and non-N-containing bisphosphonates.
The two types of bisphosphonates work
differently in killing osteoclast cells.
11. Non-nitrogenous
Non-N-containing bisphosphonates:
•Etidronate
•Clodronate
•Tiludronate
The non-nitrogenous bisphosphonates are metabolised
in the cell to compounds that replace the terminal
pyrophosphate moiety of ATP, forming a
nonfunctional molecule that competes with adenosine
triphosphate (ATP) in the cellular energy metabolism.
The osteoclast initiates apoptosis and dies, leading to
an overall decrease in the breakdown of bone.
13. HMG-CoA reductase pathway
Disruption of the HMG CoA-reductase
pathway at the level of FPPS prevents the
formation of two metabolites (farnesol and
geranylgeraniol) that are essential for
connecting some small proteins to the cell
membrane. This phenomenon is known as
prenylation, and is important for proper sub-
cellular protein trafficking
14. While inhibition of protein prenylation may affect
many proteins found in an osteoclast, disruption to
the lipid modification of Ras, Rho, Rac proteins
has been speculated to underlie the effects of
bisphosphonates. These proteins can affect both
osteoclastogenesis, cell survival, and cytoskeletal
dynamics. In particular, the cytoskeleton is vital for
maintaining the "ruffled border" that is required for
contact between that inhibit the a resorbing
osteoclast and a bone surface.
15.
16.
17. Statins are another class of drugs HMG-CoA
reductase pathway. Unlike bisphosphonates,
statins do not bind to bone surfaces with
high affinity, and are thus not specific for
bone. Nevertheless, some studies have
reported a decreased rate of fracture (an
indicator of osteoporosis) and/or an
increased bone mineral density in statin
users. The overall efficacy of statins in the
treatment osteoporosis remains
controversial.
18. Uses
Bisphosphonates are used clinically for the treatment of osteoporosis, osteitis
deformans (Paget's disease of the bone), bone metastasis (with or without
hypercalcaemia), multiple myeloma and other conditions that feature bone fragility.
In osteoporosis and Paget's, alendronate and risedronate are the most popular first-
line drugs. If these are ineffective or the patient develops digestive tract problems,
intravenous pamidronate may be used. Alternatively, strontium ranelate or
teriparatide are used for refractory disease, and the SERM raloxifene is
occasionally administered in postmenopausal women instead of bisphosphonates.
High-potency intravenous bisphosphonates have shown to modify progression of
skeletal metastasis in several forms of cancer, especially breast cancer.
Other bisphosphonates, medronate (R1, R2 = H) and oxidronate (R1 = H, R2 = OH)
are mixed with radioactive technetium and are injected for imaging bone and
detecting bone disease.
More recently, bisphosphonates have been used to reduce fracture rates in children
with osteogenesis imperfecta.
19. INDICATIONS
Postmenopausal women with vertebral compression
fractures
Postmenopausal women with total hip bone density
T-score below -2.5
Elderly men with non-traumatic fractures
Some patients with secondary osteoporosis due to
corticosteroids
Paget's disease
Cancer metastatic to bone
Other bone diseases with high bone resorption
20. Fracture healing
The clinical trials of bisphosphonates have not
reported any increased incidence of fracture non-
union in patients treated with active drug. When
bisphosphonates are given to patients after joint
replacement surgery, there is less loosening of the
prosthesis ,although after 5 years there was no
residual positive effect of a dose of pamidronate
given at the time of surgery. When given to patients
2 weeks after a fracture of the lower leg,
bisphosphonates prevented the bone loss that was
seen in the proximal femur of placebo control
patients.
21. After a fragility fracture (for example, a hip
fracture) in an untreated patient with
osteoporosis, it makes sense to begin a
bisphosphonate. The demonstrated risk of a
future fracture is greater than the potential risk of
non-union or poor callus remodelling. Of course,
these patients need an evaluation for other
causes, and concomitant treatment with calcium
and vitamin D and physical therapy. It is possible
that treatment with anabolic agents will provide
even better benefit for the skeleton, but currently
bisphosphonates remain the first choice due to
their lower cost and greater familiarity
22. Side-effects
•Oral bisphosphonates can give stomach upset and inflammation
and erosions of the esophagus, which is the main problem of oral N-
containing preparations. This can be prevented by remaining seated
upright for 30 to 60 minutes after taking the medication.
•Intravenous bisphosphonates can give fever and flu-like symptoms
after the first infusion, which is thought to occur because of their
potential to activate human γδ T cells. Notably, these symptoms do
not recur with subsequent infusions.
•There is a slightly increased risk for electrolyte disturbances, but
not enough to warrant regular monitoring.
In chronic renal failure, the drugs are excreted much more slowly,
and dose adjustment is required.
23. •Bisphosphonates have been associated with
osteonecrosis of the jaw; with the mandible twice as
frequently affected as the maxilla and most cases
occurring following high-dose intravenous
administration used for some cancer patients. Some
60% of cases are preceded by a dental surgical
procedure and it has been suggested that
bisphosphonate treatment should be postponed until
after any dental work to eliminate potential sites of
infection.
24. Recent studies have reported bisphosphonate use
(specifically zoledronate and alendronate) as a risk
factor for atrial fibrillation in women. The inflammatory
response to bisphosphonates or fluctuations in calcium
blood levels have been suggested as possible
mechanisms. One study estimated that 3% of atrial
fibrillation cases might have been due to alendronate
use.Until now however, the benefits of bisphosphonates
generally outweigh this possible risk, although care
needs to be taken in certain populations at high risk of
serious adverse effects from atrial fibrillation (such as
patients with heart failure, coronary artery dise)
25. SIDE EFFECTS
Oral or IV forms Hypocalcaemia
Increased PTH
Skin rash
Atrial fibrillation
Bone pain
Oral forms Upper GI irritation
Esophageal ulceration
Intravenous forms Fever
Transient leukopenia
Eye inflammation
Nephrotic syndrome
Jaw osteonecrosis
Etidronate (Didronel) Osteomalacia
Hyperphosphatemia
26. American Academy of Oral and Maxillofacial Surgeons
(AAOMS) proposed a definition for bisphosphonate-
related ONJ that requires the satisfaction of the
following criteria:
(1) Current or prior use of bisphosphonate
(2) An area of exposed bone within the maxillofacial
region without healing for more than 8 weeks
(3) Absence of history of radiation to the jaws
BISPHOSPHONATE-RELATED OSTEONECROSIS
OF THE JAW
27. • It has been postulated that reduced bone
remodeling associated with bisphosphonate
use may lead to an increased risk of
developing bone necrosis in select patients.
• The antiangiogenic effects of
bisphosphonates may result in a reduction in
the blood supply to the region and contribute
to poor wound healing.
• Infection has also been implicated in the
pathogenesis of ONJ
28. Osteonecrosis of the right mandible after
tooth extraction in a patient taking
zoledronic acid for metastatic breast cancer.
Osteonecrosis of the palatal torus in a
patient with osteoporosis taking
alendronate.
31. • BPs accumulate in high turnover areas like mandible
than elsewhere.
• As a result of trauma or infection bone cannot
respond adequately.
Masticatory Forces
– Chronic Low Grade Trauma
– Unable to repair micro-fractures
Necrotic Bone
Bony sequestrum
32.
33.
34. • If there is exposed bone but no signs of
infection (AAOMS Stage 1) the treatment is
CHX rinses and analgesics.
• Where there is exposed bone and localized
infection (AAOMS Stage 2) . Antibiotics are
prescribed.
35. • The goal of surgical treatment is the removal of
necrotic bone and to create soft tissue coverage
over healthy bone.
• Most commonly symptomatic bony sequestrum
are removed with minimal soft tissue
disturbance.
• If there are large segments of necrotic bone more
radical surgical approaches are advocated.
36.
37. • It is suggested that cessation of the BPs allows
regeneration of osteoclasts and some
improvement in bone turnover.
• For a patient who has been taking an oral BP
longer than 3years, it should be discontinued, 3
months before and 3 months after the surgical
procedure, if approved by the patient’s physician.
• Serum C-telopeptide (CTx) levels should be
greater than 150 pg/mL before any surgical
procedure, and rechecked at the time of surgery.
38. CONTRA-INDICATIONS
Women who are pregnant or planning pregnancy
Chronic kidney disease stages 4 or 5
Low serum calcium
Osteomalacia
Vitamin D deficiency (until it is corrected)
Oral bisphosphonates should not be used in:
Patients with serious esophageal disease
Patients at bed rest who can't stay upright for an hour
39. Treatment : Medications
• Bisphosphonates are first-line drug therapy by
inhibiting bone resorption, bisphosphonates preserve
bone mass and can decrease vertebral and hip
fractures by 50%
• To treat osteoporosis, alendronate can be given at
doses of 10 mg once/day or 70 mg once/wk or
risendronate at 5 mg once/day or 35 mg once/wk
• Ibandronic acid can be given at 2.5mg/day or 150
mg every month.
• Parenteral preparations are also available
40. Treatment : Mode of Use
• Oral bisphosphonates must be taken on an empty
stomach with a full glass of water, and the patient
must remain upright for ≥ 30 min. Weekly therapy
is generally preferred for its greater convenience
and probably fewer adverse effects
• If a patient cannot tolerate oral bisphosphonates,
pamidronate or zoledronic acid can be given by IV
infusion. However, these have not yet been shown
to prevent fractures
41. Children
Children with severe osteogenesis imperfecta, who have multiple
fractures, show reduction in pain and fracture rates with
bisphosphonates. The radiographs of the long bones show a
unique striped pattern when pamidronate is given intermittently,
and this is caused by layers of thick bone alternating with
osteopenic bone. There may be some weakness in these areas.
Currently it is unclear when to stop giving these medications.
The drugs are still excreted in the urine 8 years after stopping.
Because of uncertainties about long-term effects, these drugs
should be used only in serious cases.
Children with polyostotic fibrous dysplasia or juvinile Paget's
disease may also benefit from bisphosphonates. Again, there are
uncertainties about how long to use the medications
42. Premenopausal women
Bisphosphonates are NOT APPROVED for
prevention of osteoporosis in premenopausal
women. They should not be used in women who
got a DEXA out of curiosity and discovered
osteopenia. They are beneficial in other situations,
such as prolonged high dose steroid use, organ
transplantation, fibrous dysplasia, and metastatic
carcinoma. Studies in animals show fetal and
maternal abnormalities in bones and calcium
metabolism, so it is unethical to study this
medication in pregnant women or women who
might become pregnant while the bisphosphonate
is still in the bones.
43. Recently postmenopausal women
Alendronate 5mg/day increases bone density compared to placebo, but not as
well as estrogen with norethindrone or estrogen with medroxyprogesterone.
44. Estrogen Vs Biphosphonates
Many experts say that bisphosphonates could be used
instead of estrogen in women with osteopenia, to prevent
osteoporotic fractures.
This is based on wishful thinking instead of evidence. It
takes decades to reach "the age of fracture" and we don't
know if any drugs except estrogen will work that long.
Therefore, presently,bisphosphonates should be used only
if the risk of fracture within the next ten years is high
enough to justify the potential risks.
As more evidence accumulates about long-term benefits,
present recommendations may change.
45. Bisphosphonates : Drug Interactions
• Aminoglycosides: May lower serum calcium
levels with prolonged administration.
Concomitant use may have an additive
hypocalcemic effect.
• Antacids: May decrease the absorption of
bisphosphonate derivatives; should be
administered at a different time of the day.
Antacids containing aluminum, calcium, or
magnesium are of specific concern.
• Calcium salts: May decrease the absorption
of bisphosphonate derivatives. Separate oral
dosing in order to minimize risk of
interaction.
46. • Iron & Magnesium salts:
May decrease the absorption of bisphosphonate
derivatives. Only oral route is of concern.
• Nonsteroidal anti-inflammatory drugs (NSAIDs):
May enhance the gastrointestinal adverse/toxic
effects (increased incidence of GI ulcers) of
bisphosphonate derivatives.
• Phosphate supplements:
Bisphosphonate derivatives may enhance the
hypocalcemic effect of phosphate supplements.
Bisphosphonates : Drug Interactions
47. Advantages:
• They are the most thoroughly investigated agents
we have for the treatment of osteoporosis and the
prevention of fractures in postmenopausal
osteoporosis.
• They prevent osteoclastic bone resorption, and
reduce fracture risk within 12-18 months of
treatment initiation.
• Given the cost, ease of once-weekly dosing, and
minimal side-effects, a biphosphonate is the agent
of choice for bone health unless the women has
symptoms necessitating estrogen use
48. Bisphosphonates : Commonly
Used Pharmacotherapy
Bisphosphonates : Commonly
Used Pharmacotherapy
• Prescribed for 73% of the 6.3 million physician
visits for osteoporosis in the United States in
20031
• Increase BMD at the hip and spine2
• Reduce the risk of fractures2,3
• Have a proven tolerability profile3
• Prescribed for 73% of the 6.3 million physician
visits for osteoporosis in the United States in
20031
• Increase BMD at the hip and spine2
• Reduce the risk of fractures2,3
• Have a proven tolerability profile3
1. Stafford RS, et al. Arch Intern Med. 2004;164:1525-1530.
2. NIH Consensus Development Panel on Osteoporosis Prevention, Diagnosis, and
Therapy. JAMA. 2001;285:785-795.
3.Ettinger MP. Arch Intern Med. 2003;163:2237-2246.
1. Stafford RS, et al. Arch Intern Med. 2004;164:1525-1530.
2. NIH Consensus Development Panel on Osteoporosis Prevention, Diagnosis, and
Therapy. JAMA. 2001;285:785-795.
3.Ettinger MP. Arch Intern Med. 2003;163:2237-2246.
49. Summery and conclusion
The bisphosphonates are powerful, they cause
dramatic changes in the bone physiology, and they
deserve respect. In women or men with a high risk of
fractures, these medicines reduce the incidence of
fractures and improve the quality of life. The vast
advertising in medical and public media has increased
the awareness of osteoporosis and possiblity of
treatment, which is good, but also has encouraged
use of this drug in people who don't really need it. A
report by Schousboe found that alendronate is NOT
cost-effective in treating women with osteopenia who
do not already have an osteoporotic fracture. We still
don't know the effects of long-term suppression of
bone formation.
50. HOW LONG THE DRUG CAN BE USED ?
Increased bone density does not necessarily equate with good bone
quality. Bone turnover is a natural part of maintaining bone health.
By decreasing osteoclast activity, micro damage that occur regularly
in bone which is normally repaired will hamper after long term use,
resulting in increased susceptibility to non spinal fracture with delay
healing.
The therapeutic efficacy of bisphosphonates in improving bone
density and diminishing the risk of fracture is the first five years of
therapy,although they are stored in bone for up to 10 years after their
consumption is over.
Due to shorter metabolic effect,long term use of the drug is
doubtful.The drug should be stopped after 5 years.High risk fracture
patient requiring longer treatment should be treated with intermittent
PTH instead of bisphosphonates.