Risk of mortality following clinical fractures.

There are about 10 million Americans aged 50 years and older who suffer from osteoporosis and additional 34Pmillion low bone mass or osteopenia, which puts them at risk of osteoporosis. After fracture, osteoporosis is responsible for significant morbidity and mortality. P about 1. 8000000 people suffering from disease-related bone fractures every year. Antirezorbtivnoy agents such as bisphosphonates and denosumab, often used to treat osteoporosis, reduces the risk of fractures. P In some cases, the use of antiresorptive agents have been associated with necrosis of the jaw. However, the risk of antiresorptive agent caused necrosis of the jaw (ARONJ) low and high HIV prevalence is estimated at 0. 10% in a large sample of patients (n = 952) who took oral bisphosphonates. While osteonecrosis can occur spontaneously, often ARONJ reported after dental treatmentsmost often invasive procedures like tooth extractionsin patients with antiresorptive agents. Although it is not possible to determine who will develop ARONJ, and who is not, research shows the following risk factors exist

typical clinical manifestations ARONJ includes pain, soft tissue swelling and infection, loosening of teeth, drainage and exposed bone. P Patients also may complain of numbness, heaviness and dysesthesias of the jaw. P, however, may remain asymptomatic ARONJ for weeks or months and may become apparent after a bone in the jaw is exposed. Note: The recommendations discussed here apply only to patients who are prescribed antirezorbtivnyh drugs to prevent and treat osteoporosis. P

experts gathered ADAS Board of Scientific Affairs have developed recommendations for dental patients who receive medications to prevent and treat osteoporosis. Since there is currently no clinical trial data, evaluation of dental patients on antiresorptive therapy recommendations based on expert opinion alone. The report contains recommendations related to general dentistry, periodontal disease management, installation and maintenance of the implant, maxillofacial surgery, endodontics, dental therapy and prosthetics, and orthodontics. P Group also considers the C-terminal telopeptydu (CTX), testing and drug holidays. Group reports that physicians ask questions about osteoporosis, osteopenia and use of a different antirezorbtivnyh drugs during the interview, the history of health. P However, the current dental treatment generally should not be delayed only by the use of antiresorptive agents, the risks and consequences of untreated probably outweighs the risk of ARONJ. P

All patients should receive a dental examination. P patients who intended antiresorptive agents and do not receive regular dental care, most likely benefit from a comprehensive oral examination or treatment. P Although no doctor or dentist can avoid ARONJ development, regular dental visits and maintain excellent oral hygiene are essential components of risk management. Footnotes 1. National Endowment for osteoporosis. Osteoporosis review of data for prevention, diagnosis and treatment, and analysis of costs and efficiency. Osteoporos Int 1998; Appendix 4: S7-S80. P

2. Abrahams B, van Staa T, et al. Excess mortality after hip fracture: a systematic review of epidemiology. Osteoporos Int 2009; 20 (10) :1633-50. P

3. Breytueyt RS, Colonel NF, Wong JB. Evaluation of hip fracture morbidity, mortality and costs. J Am Soc Geriatr 2003; 51 (3) :364-70. 4. Browner WS, Pressman AR, Nevitt MC, Cummings SR. Mortality following fractures in older women: the study of fracture. Arch domestic Med 1996; 156 (14) :1521-5. P

5. Caliri, De lasix generic online Filippis L, Bagnato GL, Bagnato GF. Fractures: mortality and quality of life. Panminerva Med 2007; 49 (1) :21-7. P

6. When JA, Thompson DE, Ensrud KS et al. Risk of mortality following clinical fractures. Osteoporos Int 2000; 11 (7) :556-61. P

7. Ensrud KE, Thompson DE, Coley JA, et al. Mostly vertebral deformities predict mortality and hospitalization among older women with low bone mass: the failure of judicial intervention Research Group. J Am Soc Geriatr 2000; 48 (3) :241-9. P

8. Riggs BL, kind Epidemiology of osteoporosis. In: Riggs BL, Melton LJ III (eds.) Osteoporosis: etiology, diagnosis and management. Philadelphia: Lippinkott-Raven Publishers, 1995. 9. Chrischilles EA, Butler CD, Davis CS, Wallace RB. Model life impact of osteoporosis. Arch domestic Med 1991; 151 (10) :2026-32. P

10. Lo JC, O'Ryan FS, Gordon N. et al. The prevalence of osteonecrosis of the jaw in patients with oral bisphosphonates influence: Prediction of risk of jaw osteonecrosis with oral bisphosphonates influence (probe) investigators. J Oral Maxillofac Surg 2010; 68 (2) :243-53. P

11. Migliorati CA. Bisphosphanates and mouth aseptic necrosis of bone. J Clin Oncol 2003; 21 (22) :4253-4. P

12. Yar N, R Yahalom, Shoshanni Y, and others. Osteonecrosis of the jaw induced oral bisphosphonates: incidence, clinical characteristics, enabling factors and treatment outcome. Osteoporos Int 2007; 18 (10) :1363-70. P

13. Ruggiero SL, Mehrotra B, Rosenberg TJ, Engroff SL. Osteonecrosis of the jaws associated with bisphosphonates: a review of 63 cases. J Oral Maxillofac Surg 2004 62 (5) :527-34. P

14. Mavrokokki T, Cheng, Stein B, Goss A. Nature and frequency of bisphosphonates associated necrosis of the jaw in Australia. J Oral Maxillofac Surg 2007; 65 (3) :415-23. P

15. Khamaisi M, Regev E, N Yar, and others. Possible link between diabetes and related jaw osteonecrosis bisphosphonates. J Clin Endokrinol Metab 2007; 92 (3) :1172-5. P

16. Damato to Gralow J, Hoff, et al. P

(PDF). 17. Hellstein JW, Adler R. Edwards B, et al. , For the American Dental AssociationPCouncil Scientific Affairs Expert Panel antirezorbtivnoy agents. AP November 2011 (PDF)

Journal of the American Dental Association dental patients Pis column JADA, aimed at educating patients and to facilitate discussion between dentists and patients. ADA catalog of materials listed below can be ordered online by U.S. Drug Enforcement Administration MedWatch Food Program. If the practitioner suspects a patient is ARONJ, they must contact FDAsP.