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SDCEP Guidance > Medication-Related Osteonecrosis of the Jaw > Flashcards

Medication-Related Osteonecrosis of the Jaw Flashcards

1
Q

what drugs could potentially make a patient more at risk of suffering MRONJ

A

anti-resorptive or anti-angiogenic

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2
Q

how should a patient who is low risk of MRONJ be reclassified as if they continue to take bisphosphonate drugs after 5 year medication review

A

higher risk

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3
Q

how should patients who have taken bisphosphonates in the past be allocated to risk group

A

allocate them to a risk group as if they are still taking the drugs

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4
Q

if a patient has taken denosumab in the past nine months how should their risk be classified

A

as if they are still taking the drugs

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5
Q

what is the initial management of patient at risk of MRONJ

A

get patient as dentally fit as possible before commencement of the drugs through prevention

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6
Q

should straightforward extractions and other bone impacting treatment be done if a patient is low risk in primary care

A

yes

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7
Q

should antibiotic or antiseptic prophylaxis be prescribed to patients following extractions or other bone impacting treatments to reduce risk of MRONJ

A

no

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8
Q

how should low risk patients of MRONJ be treated in primary care

A

carry out all routine dental treatment as normal and review healing

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9
Q

what should happen if at 8 weeks the socket has not healed and you suspect patient has MRONJ

A

refer to oral surgery/ special care dentistry
report to MHRA via yellow card scheme

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10
Q

what is MRONJ

A

rare side effect of anti-resorptive and anti-angiogenic drugs that results in exposed bone that has persisted for more than 8 weeks with NO history of radiation therapy to the jaw

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11
Q

what are signs of MRONJ

A

delayed healing following extraction
pain
soft tissue infection and swelling
numbness
paraesthesia
exposed bone

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12
Q

how do anti-resorptive drugs work

A

they inhibit osteoclast differentiation and function which leads to decreased bone resorption and remodelling

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13
Q

what two anti-resorptive drugs have been associated with osteonecrosis of the jaw

A

bisphosphonates
denosumab

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14
Q

what is the action of bisphosphonates

A

they reduce bone resorption by inhibiting enzymes essential for formation of osteoclasts

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15
Q

what is the half life of alendronate (bisphosphonate)

A

10 years

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16
Q

what are bisphosphonates used to treat

A

osteoporosis
Paget’s disease
osteogenesis imperfecta
fibrous dysplasia

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17
Q

when might bisphosphonates be used as a prophylaxis

A

when a patient is taking glucocorticoids to counteract the osteoporotic effects

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18
Q

what is denosumab

A

monoclonal antibody which inhibits osteoclast function and bone resorption by binding to receptor activator nuclear factor kB ligand (RANKL)

19
Q

how is denosumab administered

A

subcutaneously every 6 months

20
Q

how do anti-angiogenic drugs work

A

they target processes by which new blood vessels are formed - used to restrict tumour vascularisation

21
Q

what would be suggested by a patient taking an anti-angiogenic drug in combination with bisphosphonates

A

higher MRONJ risk

22
Q

what is MHRA

A

medicines and healthcare products regulatory agency

23
Q

what is the most significant risk factor for MRONJ

A

the underlying medical condition for which the patient is being treated

24
Q

what is the higher risk group for MRONJ - cancer patients or patients with osteoporosis

A

cancer patients

25
Q

irrespective of underlying medical condition, which group of patients are also deemed high risk

A

patients who have had a previous episode of MRONJ

26
Q

what dental aspects are considered risk factors for MRONJ

A

dento-alveolar surgery
any surgery that impacts on bone
dental trauma (including dentures)

27
Q

how does duration of bisphosphonate therapy affect risk of MRONJ

A

increases as the cumulative dose of drug increases

28
Q

what should patients with dental implants placement prior to commencement of anti-resorptive or anti-angiogenic drugs be informed

A

the small risk of spontaneous MRONJ

29
Q

what are the four factors to consider when assessing a patient’s risk for MRONJ

A

medical condition
type
duration of drug therapy
any other complicating factors

30
Q

how often should bisphosphonate therapy be reviewed

A

every 5 years

31
Q

what is classified as low risk for MRONJ

A

patients who have been treated for osteoporosis or other non-malignant diseases of bones with bisphosphonates for less than 5 years and not taking concurrent systemic glucocorticoids

32
Q

what is classified as high risk for MRONJ

A

cancer patients and those treated for osteoporosis or other non-malignant diseases of bone who have other modifying risk factors

33
Q

what risk factor group would this patient be in - Patient is being treated for osteoporosis with oral bisphosphonates for less than 5 years and is not currently being treated with systemic glucocorticoids

A

low risk

34
Q

what risk factor group would this patient be in - Patient being treated for osteoporosis with quarterly/ yearly infusions of IV bisphosphonates for less than 5 years and not currently being treated with systemic glucocorticoids

A

low risk

35
Q

what risk factor group would this patient be in - patient being treated for osteoporosis with denosumab who are not being treated with systemic glucocorticoids

A

low risk

36
Q

what risk factor group would this patient be in - Patient being treated for osteoporosis with oral or IV bisphosphonates for more than 5 years

A

high risk

37
Q

what risk factor group would this patient be in - patient being treated for osteoporosis with bisphosphonates or denosumab for any length of time and are taking systemic glucocorticoids at the same time

A

high risk

38
Q

what risk factor group would this patient be in - patient is being treated with anti-resorptive or anti-angiogenic drugs (or both) as part of cancer management

A

high risk

39
Q

what risk factor group would this patient be in - patient has previously been diagnosed with MRONJ

A

high risk

40
Q

where can straightforward extractions and other bone impacting treatments be carried out in low risk individuals

A

primary care

41
Q

what is alendronic acid used to treat (bisphosphonate)

A

osteoporosis

42
Q

what is denosumab (RANKL inhibitor) used to treat

A

osteoporosis and cancer

43
Q

name two anti-angiogenic drugs

A

bevaxizumab
sunitinib

44
Q
A

SDCEP Guidance (17 decks)

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