Osteoporosis 2016 | Surgically treated osteonecrosis and osteomyelitis of the jaw and oral cavity in patients highly adherent to alendronate treatment: Bo Abrahamsen #osteo2016
Bo Abrahamsen's presentation from Osteoporosis 2016: Surgically treated osteonecrosis and osteomyelitis of the jaw and oral cavity in patients highly adherent to alendronate treatment.
Find out more at: https://nos.org.uk/conference
Dr Zoe Paskins's presentation from Osteoporosis 2016: Risk of fragility fracture over 10 years across eight inflammatory conditions: A UK population study.
Find out more at: https://nos.org.uk/conference
Mayrine Fraser, Service Development Project Manager, National
Osteoporosis Society, presentation slides from Osteoporosis Manchester 2016. Mayrine presentation was on Fracture Liaison Services. #osteomanchester16
Osteoporosis currently affects over three million people in
the UK with approximately 300,000 people suffering from
a fragility fracture each year.
As our national life expectancy increases so will the prevalence
of this chronic disease. With this, osteoporosis places a massive burden on the NHS in the UK.
Osteoporosis Manchester 2016 aims to provide understanding of the current challenges and issues in tackling this condition. It will
update participants on current and emerging treatment and
management strategies of the disease with specific case study sessions to provide practical ideas to take away from the meeting
Prof. Nicholas Harvey's presentation from Osteoporosis 2016: Calcium, with or without vitamin D supplementation, is not associated with ischaemic heart disease or cardiac death: the UK Biobank cohort.
Find out more at: https://nos.org.uk/conference
Dr Zoe Paskins's presentation from Osteoporosis 2016: Risk of fragility fracture over 10 years across eight inflammatory conditions: A UK population study.
Find out more at: https://nos.org.uk/conference
Mayrine Fraser, Service Development Project Manager, National
Osteoporosis Society, presentation slides from Osteoporosis Manchester 2016. Mayrine presentation was on Fracture Liaison Services. #osteomanchester16
Osteoporosis currently affects over three million people in
the UK with approximately 300,000 people suffering from
a fragility fracture each year.
As our national life expectancy increases so will the prevalence
of this chronic disease. With this, osteoporosis places a massive burden on the NHS in the UK.
Osteoporosis Manchester 2016 aims to provide understanding of the current challenges and issues in tackling this condition. It will
update participants on current and emerging treatment and
management strategies of the disease with specific case study sessions to provide practical ideas to take away from the meeting
Prof. Nicholas Harvey's presentation from Osteoporosis 2016: Calcium, with or without vitamin D supplementation, is not associated with ischaemic heart disease or cardiac death: the UK Biobank cohort.
Find out more at: https://nos.org.uk/conference
Sanni Ali's presentation from Osteoporosis 2016: Antidiabetic medication use and the risk of fracture amongst type 2 diabetic patients: a nested case-control study
Find out more at: https://nos.org.uk/conference
Dr Andrea Burden's presentation from Osteoporosis 2016: Intermittent use of high-dose glucocorticoids and risk of fracture in Denmark: A population-based case-control study.
Find out more at: https://nos.org.uk/conference
Mayrine Fraser, National Development Manager/Specialist Nurse from the National Osteoporosis Society, Scotland presents at the #Rheum2016 Conference to raise awareness of Fracture Liaison Services.
Sarah Chiu's presentation from Osteoporosis 2016: Impact of falls on fractures and mortality – an opportunity for intervention and enhancement of fracture prediction?
Find out more at: https://nos.org.uk/conference
Analytical Study of Clinicopathological Data of Saudi Patients with Osteoarth...Prof. Hesham N. Mustafa
SUMMARY: Knee osteoarthritis (OA) is a common disabling disease. Epidemiological studies have revealed various risk
factors for OA, including sex, aging, obesity, occupational illnesses, and chronic diseases. Here we evaluate the clinical, pathological,
and radiological findings of knee OA in a subset of Saudi patients who were subjected to total knee replacement (TKA). The study
population included 30 Saudi patients with knee OA who were operated by TKA (from June 2014 to December 2015) in the Department
of Orthopedics, Faculty of Medicine, King Abdulaziz University, Saudi Arabia. Patient’s clinical and radiological data were collected
from the hospital files. Pathological examination of the excised superior articular surface of tibia and femoral condyles were done.
Pearson Chi-squared analysis was used to test for differences between the variables in associated risk factors. There were more women
than men. Sixty per cent of patients were older than 60 years [mean age, 59.2 (females) and 61.7 (men) years-old]. All patients exceeded
obesity class 1, with females being more obese than males. Pathological examination of the superior articular surface of tibia and femoral
condyles showed high score lesions, which was more apparent in females than in males. Radiological findings showed that most lesions
were high grade. The findings of this study will help to understand the pathogenesis of OA and improve treatment decision making
relevant to TKA in knee OA in Saudi Arabia and elsewhere.
KEY WORDS: Osteoarthritis; Knee; Arthroplasty.
Frank de Vries's presentation from Osteoporosis 2016: The epidemiology of mortality after fragility fracture in England and Wales.
Find out more at: https://nos.org.uk/conference
Arti Gauvri Bhimjiyani's presentation from Osteoporosis 2016: The effect of social deprivation on hip fracture incidence has not changed over 10 years in England.
Find out more at: https://nos.org.uk/conference
Sanni Ali's presentation from Osteoporosis 2016: Antidiabetic medication use and the risk of fracture amongst type 2 diabetic patients: a nested case-control study
Find out more at: https://nos.org.uk/conference
Dr Andrea Burden's presentation from Osteoporosis 2016: Intermittent use of high-dose glucocorticoids and risk of fracture in Denmark: A population-based case-control study.
Find out more at: https://nos.org.uk/conference
Mayrine Fraser, National Development Manager/Specialist Nurse from the National Osteoporosis Society, Scotland presents at the #Rheum2016 Conference to raise awareness of Fracture Liaison Services.
Sarah Chiu's presentation from Osteoporosis 2016: Impact of falls on fractures and mortality – an opportunity for intervention and enhancement of fracture prediction?
Find out more at: https://nos.org.uk/conference
Analytical Study of Clinicopathological Data of Saudi Patients with Osteoarth...Prof. Hesham N. Mustafa
SUMMARY: Knee osteoarthritis (OA) is a common disabling disease. Epidemiological studies have revealed various risk
factors for OA, including sex, aging, obesity, occupational illnesses, and chronic diseases. Here we evaluate the clinical, pathological,
and radiological findings of knee OA in a subset of Saudi patients who were subjected to total knee replacement (TKA). The study
population included 30 Saudi patients with knee OA who were operated by TKA (from June 2014 to December 2015) in the Department
of Orthopedics, Faculty of Medicine, King Abdulaziz University, Saudi Arabia. Patient’s clinical and radiological data were collected
from the hospital files. Pathological examination of the excised superior articular surface of tibia and femoral condyles were done.
Pearson Chi-squared analysis was used to test for differences between the variables in associated risk factors. There were more women
than men. Sixty per cent of patients were older than 60 years [mean age, 59.2 (females) and 61.7 (men) years-old]. All patients exceeded
obesity class 1, with females being more obese than males. Pathological examination of the superior articular surface of tibia and femoral
condyles showed high score lesions, which was more apparent in females than in males. Radiological findings showed that most lesions
were high grade. The findings of this study will help to understand the pathogenesis of OA and improve treatment decision making
relevant to TKA in knee OA in Saudi Arabia and elsewhere.
KEY WORDS: Osteoarthritis; Knee; Arthroplasty.
Frank de Vries's presentation from Osteoporosis 2016: The epidemiology of mortality after fragility fracture in England and Wales.
Find out more at: https://nos.org.uk/conference
Arti Gauvri Bhimjiyani's presentation from Osteoporosis 2016: The effect of social deprivation on hip fracture incidence has not changed over 10 years in England.
Find out more at: https://nos.org.uk/conference
Arti Gauvri Bhimjiyani's presentation from Osteoporosis 2016: The effect of social deprivation on hip fracture incidence has not changed over 10 years in England.
Find out more at: https://nos.org.uk/conference
Kate Ward's presentation from Osteoporosis 2016: Relationships between muscle function and bone microarchitecture in the Hertfordshire cohort study.
Find out more at: https://nos.org.uk/conference
Dr Steve Cummings presentation from Osteoporosis 2016: Patients receiving bisphosphonates should not take holidays from treatment.
Find out more at: https://nos.org.uk/conference
Prof. Richard Eastell's presentation from Osteoporosis 2016: Patients receiving bisphosphonates should take holidays from treatment. The case for holidays.
Find out more at: https://nos.org.uk/conference
Prof. Jon Tobias's presentation from Osteoporosis 2016: Day-to-day levels of high impact physical activity are positively related to lower limb bone strength in older women: findings from a population based study using accelerometers to classify impact magnitude.
Find out more at: https://nos.org.uk/conference
Elizabeth Curtis's presentation from Osteoporosis 2016: Variation in UK fracture incidence by age, sex, geography, ethnicity, socioeconomic status, and time: results from the UK CPRD:
Find out more at: https://nos.org.uk/conference
Frank de Vries's presentation from Osteoporosis 2016: The epidemiology of mortality after fragility fracture in England and Wales.
Find out more at: https://nos.org.uk/conference
Prof. Eugene McCloskey's presentation from Osteoporosis 2016: Assessment and intervention thresholds for FRAX probabilities in the UK- Impact on the need for BMD in older women with prior fracture
Find out more at: https://nos.org.uk/conference
Prof. Jon Tobias's presentation from Osteoporosis 2016: What are the properties of the perfect therapy?
Find out more at: https://nos.org.uk/conference
Prof. Richard Keen's presentation from Osteoporosis 2016: Teaching old dogs new tricks? Combination therapy in osteoporosis.
Find out more at: https://nos.org.uk/conference
Dr Jennifer Walsh's presentation from Osteoporosis 2016: Management of osteoporosis in the young adult.
Find out more at: https://nos.org.uk/conference
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GOAL
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being to preserve human and animal health and the effectiveness of antimicrobial medications.
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Osteoporosis 2016 | Surgically treated osteonecrosis and osteomyelitis of the jaw and oral cavity in patients highly adherent to alendronate treatment: Bo Abrahamsen #osteo2016
1. SURGICALLY TREATED OSTEONECROSIS AND
OSTEOMYELITIS OF THE JAW AND ORAL
CAVITY IN PATIENTS HIGHLY ADHERENT TO
ALENDRONATE TREATMENT
Bo Abrahamsen, Pia A Eiken, Daniel Prieto-Alhambra, Richard Eastell
University of Southern Denmark, Odense, Denmark.Holbæk Hospital, Holbæk, Denmark.
Hillerød Hospital, Hillerød, Denmark University of Copenhagen, Copenhagen, Denmark.
Musculoskeletal Pharmaco- and Device Epidemiology, NDORMS, University of Oxford, Oxford,UK.
IMIM-Parc de Salut Mar and RETICEF, Universitat Autònoma de Barcelona and Instituto Carlos III Barcelona, Spain.
University of Sheffield, Sheffield, UK
2. Disclosures
Institutional research contracts and grants
UCB
Novartis
Other
International Osteoporosis Foundation, Committee of Scientific Advisors
American Society for Bone and Mineral Research, Board of Directors
Journal of Bone and Mineral Research, Associate Editor
This study received no external funding.
3. Osteonecrosis of the jaw (ONJ) is regarded as
a rare event in users of oral bisphosphonates
whereas it is a common adverse event in an
oncology setting where dose intensity is higher
and the route is intravenous.
Clinical diagnosis based on exposed bone for
more than 8 weeks observed by a health
professional.
No clear indication from past studies that the risk
of ONJ increases with increasing treatment time
for oral bisphosphonates.
Background
Solomon, DH et al Osteoporosis International 2013,24 (1):237–44.
4. The study used Danish national health registers covering all
residents in the country.
The National Prescription Database was used to identify incident
users of alendronate between 1.1.1996 and 31.1.2007.
(N=61,990) aged 50-94.
In- and outpatient hospital billing codes were followed until
31.12.2013 for surgery to the oral cavity or jaws using the Danish
National Hospital Discharge Register. The indication for surgery was
identified from ICD-10 codes coded on the same hospital contact.
Methods and study population
5. The study used Danish national health registers covering all
residents in the country.
The National Prescription Database was used to identify incident
users of alendronate between 1.1.1996 and 31.1.2007:
(N=61,990) aged 50-94.
In- and outpatient hospital billing codes were followed until
31.12.2013 for surgery to the oral cavity or jaws using the Danish
National Hospital Discharge Register. The indication for surgery was
identified from ICD-10 codes coded on the same hospital contact.
The first step of the analysis focused by highly adherent alendronate
use by truncating the study period for life tables and Cox analyses at
death, end of study or failing refill adherence (<80% MPR).
Second, a nested case-control design was employed irrespective of
level of adherence to compare the influence of dose years, recency
of use and refill compliance on risk.
Methods and study population
6. ICD-10 code indicating
inflammatory conditions of the jaw
or oral cavity, excluding
osteoradionecrosis: K102, K102B,
K102C, K102D, K102G, K102I,
K102J
ICD-10 code indicating
osteonecrosis or osteomyelitis at
any anatomical location:
M861, M862, M864, M866, M868,
M869C, M870, M871, M873, M878,
M879
WHEN
CODED
WITH
Case definition
Hospital procedure
code billing for
surgery to jaw or oral
cavity
7. Duration of highly adherent
alendronate exposure, years
Persons
with
events
Patient
years at
risk
Rate per 10,000
patient years
Before start (last 12mo) 7 61,990 1.13 (0.45-2.33)
0-5 77 194,445 3.96 (3.13-4.95)
5 to 10 27 56,269 4.80 (3.16-6.98)
10+ 3 5,292 5.67 (1.17-16.57)
Duration of use and surgery rate
Rate (with 95% CI) of surgically treated osteomyelitis or osteonecrosis of the jaw or
oral cavity as a function of duration of highly adherent alendronate use
(MPR>80%).
≈ “Noise rate”
A total of 107 alendronate exposed patients received surgery.
8. Strongest predictors of surgically treated
osteonecrosis/osteomyelitis of the jaw/oral cavity in
highly adherent users:
Rheumatic disorders (OR 1.75, 95% CI 1.14-2.69).
Chronic lung diseases (OR 1.78, 1.14-2.77).
Diabetes (OR 2.32, 1.21-4.43).
Prednisolone use (OR 1.72, 1.11-2.66).
Ulcer disease (OR 1.85, 1.02-3.36).
Risk factors
9. Adjusted OR
(107 cases and
534 control subjects)
User status , alendronate
Past user (≥ 1 year before)
Recent user (< 1y before) 4.00 (1.90-8.40) p<0.001
Current user (< 3 mo) 1.29 (0.70-2.37) p=0.41
MPR , alendronate
<50%
50-80% 2.76 (1.32-5.80) p=0.007
>80% 2.11 (1.16-3.82) p=0.014
Dose years of alendronate
<5
5-10 2.20 (1.11-4.34) p=0.023
≥ 10 2.25 (0.47-10.70) p= 0.31
Comorbid conditions and comedications
Diabetes 3.79 (1.81-7.95) p<0.001
Rheumatoid disorders 2.10 (1.21-3.65)p=0.009
Chronic pulmonary disease 1.96 (1.10-3.48) p=0.02
PPI in last year 3.17 (1.90-5.29) p<0.001
Chronic kidney disease 1.51 (0.24-9.54) p=0.66
Dementia 1.82 (0.57-5.78) p=0.32
Ulcer disease 1.07 (0.53-2.16) p=0.86
Major osteoporotic fracture 1.23 (0.75-2.00) p=0.41
Fractures, other 0.83 (0.44-1.59) p=0.58
Prednisolone in last year 1.18 (0.65-2.45) p=0.58
10. The absolute rate of surgically treated osteomyelitis
and osteonecrosis of the jaw or oral cavity is low, ~5
per 10,000 patient years, even in longer term (5-10
years) adherent (MPR>80%) users of alendronate.
Risk factors include conditions that directly or
indirectly influence the oral mucosa (diabetes,
conditions associated with oral or inhaled
glucocorticoid use). Also importance of PPI use /
ulcer disease.
Confounder adjusted analyses indicate that risk are
significantly higher after 5+ years of use and that
risks are higher in users with high adherence.
Key findings
11. Milder stages of ONJ are treated conservatively
and the events tracked in this study likely
represent more advanced osteonecrosis and
osteomyelitis that could compare with major
osteoporotic fractures in morbidity.
Limitations