Multiple myeloma
Anju Sahdev, Sarah J. Vinnicombe in 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).
Bones and fractures
Henry J. Woodford in Essential Geriatrics, 2022
Potential adverse effects of denosumab include hypocalcaemia (greater risk in people with renal impairment). Serum 25OHD should be tested prior to commencement and vitamin D supplementation given if low. Serum calcium should be checked two weeks prior to each dose. Use of this medication is also associated with the rare adverse effects of bisphosphonates – atypical fractures and osteonecrosis of the jaw. Denosumab prescription can be considered for people intolerant of oral therapy or when adherence with oral therapy is likely to be limited.21 It can be given for periods of up to five, possibly ten, years.
Renal cell cancer
Pat Price, Karol Sikora in Treatment of Cancer, 2014
In patients with solid tumours and bony metastatic disease, a number of clinical trials of bisphosphonates or denosumab have been conducted.77,78 Subset analysis of patients with metastatic RCC has revealed a reduction in skeletal-related events. These agents represent a treatment option for selected patients. Osteonecrosis of the jaw is a rare but important toxicity of these agents, which may be increased with concurrent use of VEGF-directed therapies.
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.
Hypercalcemia and acute kidney injury induced by eldecalcitol in patients with osteoporosis: a case series of 32 patients at a single facility
Published in Renal Failure, 2019
Seishi Aihara, Shunsuke Yamada, Hideaki Oka, Taro Kamimura, Toshiaki Nakano, Kazuhiko Tsuruya, Atsumi Harada
Osteoporosis is a common disease characterized by decreased bone strength, low bone mass, and skeletal fragility, which increase the risk of bone fracture [1]. In Japan, older subjects make up 26.7% of the total population, and osteoporosis in the older generation is a major public health problem [2]. To date, there have been several classes of drugs prescribed for patients with osteoporosis. Among them, bisphosphonates, which inhibit bone resorption and maintain a positive bone-remodeling balance [3], have been used as a first-line treatment for osteoporosis because they have been shown to greatly reduce the risk for bone fracture. However, bisphosphonates have the potential to cause serious side effects such as osteonecrosis of the jaw, atypical femoral fracture, and esophageal ulcer, and are not always the best treatment option. Hence, some of the patients with osteoporosis are still being treated with vitamin D receptor activators (VDRAs).
Related Knowledge Centers
- Avascular Necrosis
- Bisphosphonate
- Bone
- Mandible
- Maxilla
- Osteoporosis
- Cancer
- Jaw
- Medication-Related Osteonecrosis of The Jaw
- Gums