Knowledge Level of Physicians Prescribing Bisphosphonates: Prevention and Treatment of Medication-Related Osteonecrosis of the Jaw
,
Abstract
Introduction: Medication-related osteonecrosis of the jaw (MRONJ) is an important uncommon complication. Due to its complexity, its prevention requires a multidisciplinary approach, involving physicians and dental clinicians. Materials and Methods: This study aimed to assess the knowledge level of physicians prescribing bisphosphonates in Tehran, Iran, about dental considerations in such patients and the prevention and treatment of MRONJ in 2019. This descriptive, cross-sectional study evaluated 100 physicians (rheumatologists, endocrinologists, oncologists, and orthopedists) practicing in Tehran. A questionnaire comprising a demographic section and knowledge questions regarding dental considerations in patients taking bisphosphonates was administered among the physicians. The frequency of qualitative variables such as gender, type of specialty, and physicians’ responses to each question was calculated, and the knowledge scores were analyzed separately based on the physicians’ specialty types using one-way ANOVA followed by Tukey’s test for pairwise comparisons. The effect of different variables on knowledge scores was analyzed by simple regression. Results: The mean knowledge score of physicians was 5.19±1.78 (range 2-8). The mean knowledge score of oncologists was significantly higher than that of endocrinologists (5.88 versus 4.52, P=0.03). No other significant differences were noted. Work experience (P=0.04), age (P=0.02), orthopedics specialty (P=0.05), and oncology specialty (P=0.006) had significant effects on the knowledge score. Conclusion: Considering acquiring about 50% of the total score, physicians seem to have limited knowledge about dental considerations in patients taking bisphosphonates. Keywords: Knowledge; Tehran; Bisphosphonates; Bisphosphonate-associated osteonecrosis of the jaw.
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16- Paeng JY. Diagnosis and management of BRONJ (bisphosphonate related osteonecrosis of jaw). J Korean Dent Assoc. 2011; 49:378–388.
17- Choi SW, Kim SR, Lee KB. Osteonecrosis of the jaw in a patient with osteoporosis treated with oral bisphosphonates. J Korean Orthop Assoc. 2010; 45:151–154.
18- Khan AA, Sandor GK, Dore E. Canadian consensus practice guidelines for bisphosphonate associated osteonecrosis of the jaw. J Rheumatol. 2008; 35(7):1391-1397.
19- Epstein JB, Kish RV, Hallajian L, Sciubba J. Head and neck oral and orophryngeal cancer: a review of medicolegal cases. Oral Surg Oral Med Oral Pathol Oral Radiol. 2015; 119:177-186.
20- Hristamyan-Cilev MA, Pechalova PP, Raycheva RD, Hristamyan VP, Kevorkyan AK, Stoilova YD. Bisphosphonate-associated osteonecrosis of the jaws: a survey of the level of knowledge of dentists about the risks of bisphosphonate therapy. Folia Med (Plovdiv). 2019;
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21- Senturk MF, Cimen E, Tuzuner Oncul AM, Cambazoglu M. Oncologist's awareness about bisphosphonate related osteonecrosis of the jaws. J Pak Med Assoc. 2016; 66(7):880-883.
22- Al-Mohaya MA, Al-Khashan HI, Mishriky AM, Al-Otaibi LM. Physicians' awareness of bisphosphonates-related osteonecrosis of the jaw. Saudi Med J. 2011; (8):830-835.
23- Ruggiero SL, Dodson TB, Assael LA, Landsberg R, Mars RE, Mehrotra B. American Association of oral and maxillofacial surgeons' positions paper on bisphosphonate-related osteonecrosis of the jaws–2009 update. J Oral Maxillofac Surg. 2009; 67:2-12.
24- Moinzadeh AT, Shemesh H, Neirynck NA, Aubert C, Wesselink PR. Bisphosphonates and their clinical implications in endodontic therapy. Int Endod J. 2013; 46(5):391-398.
25- Vahtsevanos K, Kyrgidis A, Verrou E, Katodritou E, Triaridis S, Andreadis CG, Boukovinas I, Koloutsos GE, Teleioudis Z, Kitikidou K, Paraskevopoulos P, Zervas K, Antoniadaes K. Longitudinal cohort study of risk factors in cancer patients of bisphosphonate-related osteonecrosis of the jaw. J Clin Oncol. 2009; 27:5356-5362.
26- Saad F, Brown JE, Van Poznak C, Ibrahim T, Stemmer SM, Stopeck AT, Diel IJ, Takahashi S, Shore N, Henry DH, Barrios CH, Facon T, Senecal F, Fizazi K, Zhou L, Daniels A, Carriere P, Dansey R. Incidence, risk factors, and outcomes of osteonecrosis of the jaw: integrated analysis from three blinded active-controlled phase III trials in cancer patients with bonemetastases. Ann Oncol. 2012; 23:1341-1347.
27- Fehm T, Beck V, Banys M, Lipp HP, Hairass M, Reinert S, Solomayer EF, Wallwiener D, Krimmel M. Bisphosphonate-induced osteonecrosis of the jaw (ONJ): Incidence and risk factors in patients with breast cancer and gynecological malignancies. Gynecol Oncol. 2009; 112:605-609.
28- Dickinson M, Prince HM, Kirsa S, Zannettino A, Gibbs SD, Mileshkin L, OGrady J, Seymour JF, Szer J, Horvath N, Joshua DE. Osteonecrosis of the jaw complicating bisphosphonate treatment for bone disease in multiple myeloma: an overview with recommendations for prevention and treatment. Intern Med J. 2009; 39:304-316.
29- Kwon YD, KimYR, Choi BJ, Lee DW, Kim DY. Oral bis-phosphonate related osteonecrosis of the jaws: favorable outcome after bisphosphonate holiday. Quintessence Int. 2009; 40:277-278.
30- .McLeod NM, Brennan PA, Ruggiero SL. Bisphosphonate osteonecrosis of the jaw: a historical and contemporary review. Surgeon. 2012; 10:36-42.
31.Vescovi P, Merigo E, Meleti M, Manfredi M, Guidotti R, Nammour S. Bisphosphonates-related osteonecrosis of the jaws: a concise review of the literature and a report of a single-centre experience with 151 patients. J Oral Pathol Med. 2012; 41:214-221.
32- Patel V, McLeod NM, Rogers SN, Brennan PA. Bisphosphonate osteonecrosis of the jaw--a literature review of UK policies versus international policies on bisphosphonates, risk factors and prevention. Br J Oral Maxillofac Surg. 2011; 49:251-257.
33- Migliorati CA, Mattos K, Palazzolo MJ. How patients' lack of knowledge about oral bisphosphonates can interfere with medical and dental care. J Am Dent Assoc. 2010; 141(5):562-566.
2- Verenna M, Zucchi F, Ghiringhelli D, Binelli L, Bevilacqua M, Bettica P. Intravenous clodronate in the treatment of reflex sympathetic dystrophy syndrome. A randomized, double blind, placebo controlled study. J Rheumatol. 2000; 27(6):1477-1483.
3- Rosenberg TJ, Ruggiero S. Osteonecrosis of the jaws associated with the use of bisphosphnates. J Oral Maxillofac Surg. 2003; 61(8):60-61.
4- Ruggiero SL, Mehrotra B, Rosenberg TJ, Engroff SL. Osteonecrosis of the jaws associated with the use of bisphosphonates: a review of 63 cases. J Oral Maxillofac Surg. 2004; 62(5):527-534.
5- Greenberg MS. Intravenous bis-phosphonates and osteonecrosis. Oral Surg Oral Med Oral Radiol Endod. 2004; 93(3):259-260.
6- Marx RE, Sawatari Y, Fortin M, Broumand V. Bisphosphonate-induced exposed bone (osteonecrosis osteopetrosis) of the jaws: risk factors, recognition, prevention and treatment, J Oral Maxillofac Surg. 2005; 63(11):1567-1575.
7- Kim JW, Jeong SR, Kim SJ, Kim Y. Perceptions of medical doctors on bisphosphonate-related osteonecrosis of the jaw. BMC Oral Health. 2016; 16(1):92.
8- Hupp JR, Ellis IIIE, Tucker MR. Contemporary Oral and Maxillofacial
Surgery. Mosby Co. Elsevier. 7th Edition 2019.
9- Işık, G, Özden Yüce, M, Özveri Koyuncu, B. & Mandıracıoğlu, A. Medication-related osteonecrosis of the jaw: awareness and level of knowledge of a group of Turkish physicians. Selcuk Dental Journal. 2022; 9 (2), 494-500.
10- Reid IR, Cornish J. Epidemiology and pathogenesis of osteonecrosis of the jaw. Nat Rev Rheumatol. 2012; 8:90–96.
11- Ruggiero SL, Dodson TB, Fantasia J, Goodday R, Aghaloo T, Mehrotra B, O’Ryan F. American Association of Oral and Maxillofacial Surgeons position paper on medication-related osteonecrosis of the jaw–2014 update. J Oral Maxillofac Surg. 2014; 72:1938–1956.
12- Khan AA, Morrison A, Hanley DA, Felsenberg D, McCauley LK, O’Ryan F, Reid IR, Ruggiero SL, Taguchi A, Tetradis S, Watt NB, Brandi ML, Peters E, Guise T, Eastell R, Cheung AM, Morin SN, Masri B, Cooper C, Morgan SL, Obermayer-Pietsch B, et al. Diagnosis and management of osteonecrosis of the jaw: a systematic review and international consensus. J Bone Miner Res. 2015; 30:3–23.
13- Lam DK, Sandor GK, Holmes HI, Evans AW, Clokie CM. A review of bisphosphonate-associated osteonecrosis of the jaws and its management. J Can Dent Assoc. 2007; 73:417–422.
14- Khosla S, Burr D, Cauley J, Dempster DW, Ebeling PR, Felsenberg D, Gagel RF, Gilsanz V, Guise T, Koka S, et al. Bisphosphonate-associated osteonecrosis of the jaw: report of a task force of the American Society for Bone and Mineral Research. J Bone Miner Res. 2007; 22:1479–1491.
15- Pazianas M, Miller P, Blumentals WA, Bernal M, Kothawala P. A review of the literature on osteonecrosis of the jaw in patients with osteoporosis treated with oral bisphosphonate: prevalence, risk factors, and clinical characteristics. Clin Ther. 2009; 29:1548–1558.
16- Paeng JY. Diagnosis and management of BRONJ (bisphosphonate related osteonecrosis of jaw). J Korean Dent Assoc. 2011; 49:378–388.
17- Choi SW, Kim SR, Lee KB. Osteonecrosis of the jaw in a patient with osteoporosis treated with oral bisphosphonates. J Korean Orthop Assoc. 2010; 45:151–154.
18- Khan AA, Sandor GK, Dore E. Canadian consensus practice guidelines for bisphosphonate associated osteonecrosis of the jaw. J Rheumatol. 2008; 35(7):1391-1397.
19- Epstein JB, Kish RV, Hallajian L, Sciubba J. Head and neck oral and orophryngeal cancer: a review of medicolegal cases. Oral Surg Oral Med Oral Pathol Oral Radiol. 2015; 119:177-186.
20- Hristamyan-Cilev MA, Pechalova PP, Raycheva RD, Hristamyan VP, Kevorkyan AK, Stoilova YD. Bisphosphonate-associated osteonecrosis of the jaws: a survey of the level of knowledge of dentists about the risks of bisphosphonate therapy. Folia Med (Plovdiv). 2019;
1; 61(2):303-311.
21- Senturk MF, Cimen E, Tuzuner Oncul AM, Cambazoglu M. Oncologist's awareness about bisphosphonate related osteonecrosis of the jaws. J Pak Med Assoc. 2016; 66(7):880-883.
22- Al-Mohaya MA, Al-Khashan HI, Mishriky AM, Al-Otaibi LM. Physicians' awareness of bisphosphonates-related osteonecrosis of the jaw. Saudi Med J. 2011; (8):830-835.
23- Ruggiero SL, Dodson TB, Assael LA, Landsberg R, Mars RE, Mehrotra B. American Association of oral and maxillofacial surgeons' positions paper on bisphosphonate-related osteonecrosis of the jaws–2009 update. J Oral Maxillofac Surg. 2009; 67:2-12.
24- Moinzadeh AT, Shemesh H, Neirynck NA, Aubert C, Wesselink PR. Bisphosphonates and their clinical implications in endodontic therapy. Int Endod J. 2013; 46(5):391-398.
25- Vahtsevanos K, Kyrgidis A, Verrou E, Katodritou E, Triaridis S, Andreadis CG, Boukovinas I, Koloutsos GE, Teleioudis Z, Kitikidou K, Paraskevopoulos P, Zervas K, Antoniadaes K. Longitudinal cohort study of risk factors in cancer patients of bisphosphonate-related osteonecrosis of the jaw. J Clin Oncol. 2009; 27:5356-5362.
26- Saad F, Brown JE, Van Poznak C, Ibrahim T, Stemmer SM, Stopeck AT, Diel IJ, Takahashi S, Shore N, Henry DH, Barrios CH, Facon T, Senecal F, Fizazi K, Zhou L, Daniels A, Carriere P, Dansey R. Incidence, risk factors, and outcomes of osteonecrosis of the jaw: integrated analysis from three blinded active-controlled phase III trials in cancer patients with bonemetastases. Ann Oncol. 2012; 23:1341-1347.
27- Fehm T, Beck V, Banys M, Lipp HP, Hairass M, Reinert S, Solomayer EF, Wallwiener D, Krimmel M. Bisphosphonate-induced osteonecrosis of the jaw (ONJ): Incidence and risk factors in patients with breast cancer and gynecological malignancies. Gynecol Oncol. 2009; 112:605-609.
28- Dickinson M, Prince HM, Kirsa S, Zannettino A, Gibbs SD, Mileshkin L, OGrady J, Seymour JF, Szer J, Horvath N, Joshua DE. Osteonecrosis of the jaw complicating bisphosphonate treatment for bone disease in multiple myeloma: an overview with recommendations for prevention and treatment. Intern Med J. 2009; 39:304-316.
29- Kwon YD, KimYR, Choi BJ, Lee DW, Kim DY. Oral bis-phosphonate related osteonecrosis of the jaws: favorable outcome after bisphosphonate holiday. Quintessence Int. 2009; 40:277-278.
30- .McLeod NM, Brennan PA, Ruggiero SL. Bisphosphonate osteonecrosis of the jaw: a historical and contemporary review. Surgeon. 2012; 10:36-42.
31.Vescovi P, Merigo E, Meleti M, Manfredi M, Guidotti R, Nammour S. Bisphosphonates-related osteonecrosis of the jaws: a concise review of the literature and a report of a single-centre experience with 151 patients. J Oral Pathol Med. 2012; 41:214-221.
32- Patel V, McLeod NM, Rogers SN, Brennan PA. Bisphosphonate osteonecrosis of the jaw--a literature review of UK policies versus international policies on bisphosphonates, risk factors and prevention. Br J Oral Maxillofac Surg. 2011; 49:251-257.
33- Migliorati CA, Mattos K, Palazzolo MJ. How patients' lack of knowledge about oral bisphosphonates can interfere with medical and dental care. J Am Dent Assoc. 2010; 141(5):562-566.
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| Issue | Vol 11, No 2 (Spring 2024) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/jcr.v11i2.17024 | |
| Keywords | ||
| Knowledge Tehran Bisphosphonates Bisphosphonate-associated osteonecrosis of the jaw | ||
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How to Cite
1.
Padeganeh T, Dehghani N, Azarsina M, Mahmoudi X. Knowledge Level of Physicians Prescribing Bisphosphonates: Prevention and Treatment of Medication-Related Osteonecrosis of the Jaw. J Craniomaxillofac Res. 2024;11(2):79-86.
