Original article
Bisphosphonates, healthcare professionals and oral health Dasera V. Raj1, Menaka Abuzar2 and Gelsomina L. Borromeo2 1
Ministry of Health, Kuala Lumpur, Malaysia; 2Melbourne Dental School, University of Melbourne, Victoria, Vic., Australia
doi:10.1111/ger.12141 Bisphosphonates, healthcare professionals and oral health Objective: General medical and dental practitioner and pharmacists all encounter patients on bisphosphonates and as such require adequate knowledge regarding osteonecrosis of the jaw, a potential complication associated with its use. The cross-sectional study investigated perceived implications of and attitudes towards bisphosphonate use in oral health among general medical and dental practitioners and pharmacists. Materials and methods: Medical and dental practitioners and pharmacists registered in Victoria, Australia, completed an online survey (SurveyMonkey©). Data analysis consisted of chi-square tests with significance as p < 0.05. Results: One hundred and thirty six doctors (general medical practitioners, GMPs), 283 dentists (GDPs) and 26 pharmacists (PHs) participated. 70, 38 and 80%, respectively, reviewed patients prescribed bisphosphonates (BPs). GMPs (88%), GDPs (76%) and PHs (85%) were aware of osteonecrosis of the jaws (ONJ). GMPs (76%) and PHs (100%) advised patients to inform dentists. GMPs (45%) referred patients for dental assessments prior to commencing BPs with 71.9% of GDPs received such referrals. In terms of available information on oral health and BPs, GMPs (56%), GDPs (50%) and PH (53.8%) were either unsure any existed or reported receiving sufficient information. Conclusions: Discrepancies exist amongst different healthcare professionals in terms of BP use and oral health, and common consensus guidelines are warranted. Keywords: bisphosphonates, oral health, clinical guidelines, drug therapy, osteonecrosis. Accepted 19 June 2014
Introduction Bisphosphonates (BPs) are used for the prevention and treatment of osteopenia and hypercalcaemia associated with osteoporosis1, metastatic malignancies2, Paget’s disease3 and other skeletal-related disorders such as osteogenesis imperfecta4. The incidence of life-threatening skeletal-related events commonly seen with these conditions was drastically reduced with BP use and as a direct result; these medications have become the preferred supportive and therapeutic modality of treatment5,6. Osteonecrosis of the jaws (ONJ) is a significant complication associated with the use of BPs and is described as a painful exposure of necrotic jaw bone predominately following dental procedures in patients receiving BPs as part of the management of either skeletal-related events associated with malignancy or in benign bone disease7,8. It occurs in the jaw with other parts of the skeletal
system rarely being affected9. ONJ incidence related to intravenous bisphosphonate use is reported at 0.8–12%10,11 but
Bisphosphonates, healthcare professionals and oral health Dasera V. Raj1, Menaka Abuzar2 and Gelsomina L. Borromeo2 1
Ministry of Health, Kuala Lumpur, Malaysia; 2Melbourne Dental School, University of Melbourne, Victoria, Vic., Australia
doi:10.1111/ger.12141 Bisphosphonates, healthcare professionals and oral health Objective: General medical and dental practitioner and pharmacists all encounter patients on bisphosphonates and as such require adequate knowledge regarding osteonecrosis of the jaw, a potential complication associated with its use. The cross-sectional study investigated perceived implications of and attitudes towards bisphosphonate use in oral health among general medical and dental practitioners and pharmacists. Materials and methods: Medical and dental practitioners and pharmacists registered in Victoria, Australia, completed an online survey (SurveyMonkey©). Data analysis consisted of chi-square tests with significance as p < 0.05. Results: One hundred and thirty six doctors (general medical practitioners, GMPs), 283 dentists (GDPs) and 26 pharmacists (PHs) participated. 70, 38 and 80%, respectively, reviewed patients prescribed bisphosphonates (BPs). GMPs (88%), GDPs (76%) and PHs (85%) were aware of osteonecrosis of the jaws (ONJ). GMPs (76%) and PHs (100%) advised patients to inform dentists. GMPs (45%) referred patients for dental assessments prior to commencing BPs with 71.9% of GDPs received such referrals. In terms of available information on oral health and BPs, GMPs (56%), GDPs (50%) and PH (53.8%) were either unsure any existed or reported receiving sufficient information. Conclusions: Discrepancies exist amongst different healthcare professionals in terms of BP use and oral health, and common consensus guidelines are warranted. Keywords: bisphosphonates, oral health, clinical guidelines, drug therapy, osteonecrosis. Accepted 19 June 2014
Introduction Bisphosphonates (BPs) are used for the prevention and treatment of osteopenia and hypercalcaemia associated with osteoporosis1, metastatic malignancies2, Paget’s disease3 and other skeletal-related disorders such as osteogenesis imperfecta4. The incidence of life-threatening skeletal-related events commonly seen with these conditions was drastically reduced with BP use and as a direct result; these medications have become the preferred supportive and therapeutic modality of treatment5,6. Osteonecrosis of the jaws (ONJ) is a significant complication associated with the use of BPs and is described as a painful exposure of necrotic jaw bone predominately following dental procedures in patients receiving BPs as part of the management of either skeletal-related events associated with malignancy or in benign bone disease7,8. It occurs in the jaw with other parts of the skeletal
system rarely being affected9. ONJ incidence related to intravenous bisphosphonate use is reported at 0.8–12%10,11 but
