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Managing the care of patients receiving antiresorptive therapy for prevention and treatment of osteoporosis: executive summary of recommendations from the American Dental Association Council on Scientific Affairs
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Managing the care of patients receiving antiresorptive therapy for prevention and treatment of osteoporosis: executive summary of recommendations from the American Dental Association Council on Scientific Affairs

John W Hellstein, Robert A Adler, Beatrice Edwards, Peter L Jacobsen, John R Kalmar, Sreenivas Koka, Cesar A Migliorati and Helen Ristic
The Journal of the American Dental Association (1939), Vol.142(11), pp.1243-1251
11/2011
DOI: 10.14219/jada.archive.2011.0108
PMID: 22041409

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Abstract

This narrative review of osteonecrosis of the jaw in patients with low bone mass receiving treatment with antiresorptive agents is based on an appraisal of the literature by an advisory committee of the American Dental Association Council on Scientific Affairs. It updates the committee's 2008 advisory statement. The authors searched MEDLINE for literature published between May 2008 (the end date of the last search) and February 2011. This report contains recommendations based on the findings of the literature search and on expert opinion that relate to general dentistry; periodontal disease management; implant placement and maintenance; oral and maxillofacial surgery; endodontics; restorative dentistry and prosthodontics; orthodontics; and C-terminal telopeptide testing and drug holidays. The highest reliable estimate of antiresorptive agent-induced osteonecrosis of the jaw (ARONJ) prevalence is approximately 0.10 percent. Osteoporosis is responsible for considerable morbidity and mortality. Therefore, the benefit provided by antiresorptive therapy outweighs the low risk of developing osteonecrosis of the jaw. An oral health program consisting of sound hygiene practices and regular dental care may be the optimal approach for lowering ARONJ risk. No validated diagnostic technique exists to determine which patients are at increased risk of developing ARONJ. Discontinuing bisphosphonate therapy may not lower the risk but may have a negative effect on low-bone-mass-treatment outcomes.
 Patient Care Planning Collagen Type I - blood Peptides - blood Bone Density Conservation Agents - adverse effects Osteoporosis - prevention & control Humans Risk Factors Antibodies, Monoclonal - adverse effects Bone Density Conservation Agents - therapeutic use Antibodies, Monoclonal - therapeutic use Osteoporosis - drug therapy Biomarkers - blood Oral Surgical Procedures Denosumab Dental Care for Chronically Ill Oral Hygiene Antibodies, Monoclonal, Humanized RANK Ligand - antagonists & inhibitors Diphosphonates - therapeutic use Diphosphonates - adverse effects Bisphosphonate-Associated Osteonecrosis of the Jaw - prevention & control

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