Osteonecrosis of Jaw: Story of Bisphosphonates
Introduction:
Bisphosphonates (BPs), also known as diphosphonates are class of drugs used for prevention and treatment of bone related disorders. They came into existence in 19th century and were primarily used as detergents, water softener, anticorrosive, and antiscaling agents (Russell, Watts, Ebetino, & Rogers, 2008). In 1960s, after understanding their properties and mechanism of action their use was determined in humans. BPs acted as antiresorptive agents with high affinity towards skeletal tissue. Their unique characteristics of controlling calcium and phosphate dissolution thereby preventing of loss of mineralized tissue attracted many industries and created potential market for their development. BPs were developed and used in the treatment of bone diseases such as Paget’s disease, multiple myeloma, hypercalcemia of malignancy, and osteoporosis.
Structure and mechanism of action:
BPs has a P-C-P backbone. They are synthetic analogs of inorganic pyrophosphate in which the oxygen is substituted by carbon. The R1 and R2 side-chains attached to the carbon atom are responsible for the large range of activity observed among the BPs. R1 enhances the binding to hydroxyapatite while R2 determines anti-resorptive properties and carbon enhances chemical stability and resistance to enzymatic degradation (Russell et al., 2008). Source: http://en.wikipedia.org/wiki/File:BisphosStruct.svg
There are 2 main types of BPs: nitrogen containing and non nitrogen containing. Depending on their type the mode of action differs. The nitrogen containing BPs are more potent and exert their action via inhibition of the mevalonate pathway which is by binding and blocki...
... middle of paper ...
...Watts, N. B., Ebetino, F. H., & Rogers, M. J. (2008). Mechanisms of action of bisphosphonates: Similarities and differences and their potential influence on clinical efficacy. Osteoporosis International, 19(6), 733-759.
Schwartz, H. C. (2005). Bisphosphonate-associated osteonecrosis of the jaws. Journal of Oral and Maxillofacial Surgery, 63(10), 1555-1556.
Silverman, S. L., & Landesberg, R. (2009). Osteonecrosis of the jaw and the role of bisphosphonates: A critical review. The American Journal of Medicine, 122(2S), 33-45.
V.M. Cartsos, S. Zhu and A.I. Zavras,. (2008). Bisphosphonate use and the risk of adverse jaw outcomes: A medical claims study of 714,217 people. J Am Dent Assoc, 139, 23-30.
Woo, S. B., Hellstein, J. W., & Kalmar, J. R. (2006). Systematic review: Bisphosphonates and osteonecrosis of the jaws. Annals of Internal Medicine, 144(10), 753.
Antiarrhythmic agents are used to suppress abnormal rhythms of the heart. Many attempts have been made to classify antiarrhythmic agents. There is a problem from the fact that many of the antiarrhythmic agents have multiple actions, making any classification accurate. Betapace (sotalol) comes in tablets and solution for oral a...
Osteoporosis comes from the latin word meaning “porous bone”. If you were to look closely at a bone you could see there are these small spaces on the bone which is good, now if you look at someone who suffers from osteoporosis you will see these spaces are much larger. As these spaces become larger it takes away from the strength and integrity of the bone making it grow weak and thin. Osteoporosis is most common in women over the age of 50 and gives them a higher risk of fractures and or breaks especially common in the hips. While we know osteoporosis comes from a number of things it can be broken down to age, the hormonal changes most commonly seen in menopause and a lower intake of Vitamin D and Calcium. Age is the unpreventable factor that doctors or you cannot change. Hormonal changes can be fixed with supplements or hormone therapy along with ones intake of Vitamin D and Calcium. Hormone therapy, estrogen alone or the combination of estrogen and progestin have been proven to prevent and aide in the treatment of osteoporosis in
Overdosed America bestows a powerful allegation of the evidence that guides medical practice. It may seem absurd that Abramson is challenging greatly accepted academic research, but Abramson’s detailed analysis of the existing data is hard to overlook. The earnestness with which Abramson examines clinical issues merits a great dispute over those issues found in the leading medical journals. In order to understand the logic of many of Abramsons arguments, it is worthy to analyze his argument on osteoporosis.
Discussion and Conclusions: Interpreting these results have concluded that relative reactivity of these three anilines in order of most reactive to least reactive go; Aniline > Anisole > Acetanilide. Aniline, has an NH2 , the most active substituent , and adds to any ortho/para position available on the ring. This data is confirmed with the product obtained, (2,4,6 tribromoaniline, mp of 108-110 C). As for anisole, it has a strongly activating group attached, OMe an alkoxy group, and it added in two of the three available spots, both ortho. The results conclude: (2,4-Dibromoanisol mp 55-58 C ). Acetanilide has a strong activating group attached, acylamino group, but this group is large and the ortho positions are somewhat hindered so the majority of the product obtained added at the para position, results conclude: (p-bromoacetanilide mp 160-165 C). Since all the substituents attached to the aromatic rings were activators the only products able to be obtained were ortho/para products.
Roux C, Dougados M. Treatment of patients with Paget’s disease of Bone. Drugs. 1999 Nov; 58 (5): 823-830.
11. Following her recovery, Margaret was placed on three medications: (A) oral calcium supplementation, (B) oral estrogen, and (C) oral alendronate sodium (Fosamax). Specifically describe how each of these medications works to treat Margaret’s condition. Oral calcium is given to Margaret to help with the loss of bone tissue and to help with the aid of forming stronger bone tissue. Oral estrogen is for to help make up for the loss of estrogen deficiency in her body due to menopause and this drug also helps to prevent weakened bones and due to the lack of activity Margert is accustomed to this will be beneficial for her. Oral alendronate sodium is for an inhibitor to help with bone reabsorption of
Osteoporosis is a condition, which advances with age, resulting in fragile, weak bones due to a decrease in bone mass. Externally osteoporotic bone is shaped like normal bone, however it’s internal appearance differs. Internally the bone becomes porous due to a loss in essential minerals, including phosphate and calcium. The minerals are loss more quickly than they can be replaced and in turn cause the bones to become less dense and weak. The bones become prone to fracture, due to their weakness. Therefore the awareness of the disease tends to occur after a fracture has been sustained. The bones most commonly affected are the ribs, wrist, pelvis and the vertebrae.
Osteoporosis is a condition, in which bones are weak from deterioration, loss of bone mass, and quality-bone strength. Osteoporosis usually triggers postmenopausal women (women who have not had their period for a whole year), or older men and women. Some risks both older men and women endure when experiencing Osteoporosis are decrease of calcium and bone fractures. These symptoms or effects can all be caused by weight loss, smoking, age, ethnicity, genetics, medications, bone structure, and certain diseases that can later on contribute to Osteoporosis, such as rheumatoid arthritis. Osteoporosis may be prevented by going to drug therapy to stop alcoholism and smoking, a sufficient amount of calcium intake, and exercising; such as jogging, walking,
Osteoporosis is a serious disease that leads to a faster than normal loss of the bone density, which puts the bone at a higher risk for fractures. In order to understand the causes of Osteoporosis, it is important to understand how bones are formed. Bone is a living tissue that is made mainly of collagen, calcium phosphate, and calcium carbonate. The mixture of collagen and calcium gives the bone strength and flexibility. The body deposits new bones and removes old ones; moreover, there are two types of bone cells that control the reproduction of bones. Cells called osteoclasts breakdown bone tissues thus, damaging the bone. Once the damaged bone is removed, cells called osteoblasts, use minerals including calcium and phosphate from the blood stream to make new healthy bone tissues. In order for osteoblasts and osteoclasts to work properly, hormones such us thyroid, estrogen, testosterone, and growth hormones are
Thus, the recommended treatment for a patient with osteoporosis would receive supplementary calcium (1,000 to 1,500 mg of calcium daily) as confirmed in the National Institutes of Health Consensus Development Conference on osteoporosis in 1984. But studies have shown that as humans age their ability to absorb calcium starts to diminish making this treatment almost ineffective in some elderly patients. Patients of this time, with little treatment options were forced to endure many fracture related injuries; most commonly fractures of the hip which is a very complicated fracture requiring hospitalisation and a surgical practice would be required. Even if the surgery had been successful the patient would not be able to return to the previous levels of activity they were once at; forcing the patient from self-care to supervised living situations/nursing
Dozier, T., Duncan, I., Klein, A., Lambert, P., & Key, L. J. (2005, April 26). Otologic manifestations of malignant osteopetrosis. National Center for Biotechnology Information. Retrieved November 27, 2011, from http://ncbi.nlm.nih.gov
Bowers, L., Allan, T., Simpson, A., Nijman, H., & Warren, J. (2007). Adverse Incidents, Patient
One of the strongest support systems of the human body is the skeletal system. The skeletal system is comprised of hundreds of bones that help protect our delicate internal organs. For example, our twelve pairs of ribs are designed to protect the heart, in which circulates blood throughout the body and allows us to survive. Both bones and muscles work simultaneously to also allow us to preform physical activities such as walking, running, and climbing. In order to continue preforming these day-to-day activities, it is important to keep our bones strong and healthy throughout our lifetimes.
Hirschfeld L, Wasserman B (May 1978). "A long-term survey of tooth loss in 600 treated periodontal patients". J. Periodontol. 49 (5): 225–37.doi:10.1902/jop.1978.49.5.225. PMID 277674
Retrieved from http://www.britannica.com/EBchecked/topic/498140/renin-angiotensin-system Retrieved from http://esa.act.gov.au/wp-content/uploads/Morphine-Sulphate-Jan-2014.pdf Retrieved from http://esa.act.gov.au/wp-content/uploads/Time-Critical-Patients.pdf State Government of Victoria. (2013, July 10). Bone fractures. Retrieved from http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Bone_fractures