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Multiple myeloma
Published in Anju Sahdev, Sarah J. Vinnicombe, Husband & Reznek's Imaging in Oncology, 2020
Central venous catheters represent a potential source of bacteraemia (182). Melphalan is associated with increased risk of pancytopaenia, mucositis, and pulmonary complications (183–186). Conventional radiography and CT scanning are appropriate imaging investigations. High doses of corticosteroids may cause spinal fractures and avascular necrosis of the femoral heads (amongst other bones). MRI is useful for assessing both of these conditions. Abdominal discomfort resulting from constipation is a well-recognized side effect of thalidomide and can be readily assessed radiologically using a supine plain radiograph of the abdomen. A further reported side effect is interstitial pneumonitis, which can be identified on high-resolution CT (187). The drug bortezomib is associated with cytopaenia, and a decrease in platelet count to <50 000 mm3 occurs in almost 30% of patients, increasing the risk of haemorrhage (188). Other reported adverse effects are sensory neuropathy and pseudomembranous colitis (189). Side effects of intravenous bisphosphonates and newer bone modifying agents include acute-phase reactions, inflammatory reactions at the injection site, hypocalcaemia, hypophosphataemia, renal impairment, osteonecrosis of the jaw, and atypical fractures of the femur (190–194). Regular dental checkups in association with an orthopantomogram and a CT scan enable early diagnosis of osteonecrosis of the jaw (195). Peripheral neuropathy is a significant complication of multiple myeloma that can be caused by the disease itself or by certain therapies including thalidomide and bortezomib (54).
Cancer Pain
Published in Gary W. Jay, Practical Guide to Chronic Pain Syndromes, 2016
Concerns regarding osteonecrosis of the jaw in patients who have been given bisphosphonates have led to particular care in the use of these agents (52). Dental evaluation prior to initiating therapy is crucial as poor dentition is thought to be a risk factor.
Randomized head-to-head comparison of minodronic acid and raloxifene for fracture incidence in postmenopausal Japanese women: the Japanese Osteoporosis Intervention Trial (JOINT)-04
Published in Current Medical Research and Opinion, 2020
Yukari Uemura, Teruki Sone, Shiro Tanaka, Teruhiko Miyazaki, Mayumi Tsukiyama, Akira Taguchi, Satoshi Soen, Satoshi Mori, Hiroshi Hagino, Toshitsugu Sugimoto, Masao Fukunaga, Hiroaki Ohta, Toshitaka Nakamura, Hajime Orimo, Masataka Shiraki
Serious adverse reactions were rare in both the groups and were noted in only four and six patients in the minodronate and raloxifene groups, respectively. There are reports that the risk of osteonecrosis of the jaw (ONJ) may increase with the severity of osteoporosis, and bisphosphonate use may play a synergistic role in the development of ONJ43. However, no established osteonecrosis of the jaw (ONJ) were observed in JOINT-04 study. Details of the results of ONJ were reported by Taguchi et al44. Also, one patient occurred pulmonary embolism in the raloxifene arm. There are reports that raloxifene increases risk of pulmonary embolism45, although the incidence of pulmonary embolism varies widely among diverse racial/ethnic cohorts, and is lowest in Asians46. This may be the reason for relatively small number that occurred. The case of pulmonary embolism reported in this study was a serious adverse event that required hospitalization, although the subject was eventually resolved.
The use of selective estrogen receptor modulators on bone health in men
Published in The Aging Male, 2019
Sok Kuan Wong, Nur-Vaizura Mohamad, Putri Ayu Jayusman, Ahmad Nazrun Shuid, Soelaiman Ima-Nirwana, Kok-Yong Chin
Selective estrogen receptor modulators have several advantages over other osteoporosis medications. Osteonecrosis of the jaw (ONJ) is a concern among patients using antiresorptive therapy. A retrospective cohort study was carried out to compare the risk of ONJ between oral alendronate (bisphosphonates) and raloxifene/calcitonin (nonbisphosphonates) in the Taiwanese population [77]. This study has found that osteoporotic patients receiving raloxifene/calcitonin treatment have no excess risk of developing ONJ. In another cohort study, the risk of ONJ in men and women Taiwanese osteoporotic patients taking oral alendronate was compared with a group of patients taking raloxifene only. From the findings, only one out of total eligible patients using raloxifene was diagnosed as having ONJ. However, only women subjects were analyzed in this study, as raloxifene was not licensed to treat male osteoporosis.
Drug-induced bone loss: a major safety concern in Europe
Published in Expert Opinion on Drug Safety, 2018
Khac-Dung Nguyen, Bahador Bagheri, Haleh Bagheri
Bisphosphonates, given orally or intravenously, are most commonly used in the osteoporosis treatment because they can be used for wide range of osteoporosis types (postmenopausal, male, and steroid-induced osteoporosis) and relatively inexpensive. The other antiresorptive drug (such as raloxifene, strontium ranelate, teriparatide, or full-length parathyroid hormone) and denosumab (RANK ligand inhibitor) are less commonly used. However, these agents may also induce severe bone damage, particularly osteonecrosis of the jaw. Increasing our attention and knowledge of these deleterious skeletal effects will improve our ability to appropriately reduce and manage the risk related patients. Therefore, future research should aim to not only provide certain evidences but also determine the best prevention and treatment strategies for many drugs induced bone loss or fractures.