Working Paper of Public Health Volume 2012 - Azienda Ospedaliera ...

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Azienda Ospedaliera Nazionale“SS. Antonio e Biagio e Cesare Arrigo”Working Paper of Public Healthnr. 12/2012Methods: Literature review about osteonecrosis of jaw (ONJ) with selection of Italian authorsand publications, on year 2003-2011, by research on international electronic journaldatabases, Italian language journals, congress acta, web sources;Results: at October 2011, among 1272 papers published worldwide on ONJ issue, 128 (10%)were from Italian Authors;Conclusions: relevant articles by Italian groups were published about pathogenesishypotheses, animal models, biology studies, risk factors, preventive measures,dental extraction protocols in BP-exposed patients, laser therapy, ozone therapy,surgical treatment. Experience of Italian patients suffering from ONJ, togetherwith work of Italian dentists, physicians and researchers, appears of paramountimportance in order to study ONJ and minimize a possible severe side-effect ofefficacious medical treatments.1. IntroductionOsteonecrosis of jaws (ONJ) has been largely described since first 2000 years [1-4] inpatients receiving bisphosphonates (BPs), drugs widely administered for the treatment ofbone disease in multiple myeloma and metastatic solid tumors but also in osteoporosis andother non-malignant bone pathologies. The mechanisms underlying the development ofBisphosphonate-Related ONJ (BRONJ) are not completely understood [5-6]. Furtherly , ONJhas been recently observed also in patients treated with other drugs, such as bevacizumab,sunitinib, and denosumab [7-9]. In Italy, the number of BRONJ cases observed is particularlyhigh in comparison with other countries [10]. We present a review of several aspects of ONJin Italy and the role of Italian health professionals and researchers on increasing knowledgeand adequate reporting of ONJ phenomenon.2. Material and methodsA manual searching was performed using a full text electronic journal database (Pub Med);the main applied key was “Osteonecrosis AND (jaw OR jaws)” , and publications includingItalian authors were selected.2
Azienda Ospedaliera Nazionale“SS. Antonio e Biagio e Cesare Arrigo”Working Paper of Public Healthnr. 12/2012Further research was conducted on Pub Med using terms : "Diphosphonates" [Mesh] ORBisphosphonate* OR Diphosphonates*”, "Breast Neoplasms" [Mesh], "Prostatic Neoplasms"[Mesh], " Multiple myeloma " [Mesh] AND “osteonecrosis”.Italian language journals (of oncology, haematology, maxillofacial surgery and dentistinterest) not included on Pub Med were reviewed, since 2003 to October 2011.National and international congress and conference acta (abstract books, educational books,highlights, etc.), both in English and Italian language, were examined to search possiblecontributions of interest.Reports from AIFA (the Italian Drug Surveillance Agency) including ONJ cases andrecommendations were considered. Guidelines from several Italian scientific societies anddeliberations from Italian Ministry of Health about prevention and early diagnosis of ONJwere examined.Further papers, recommendations, position papers, books, documents were found by amanual searching on the web.3. ResultsPub Med publicationsBetween 2003 and October 2011, a large amount of articles have been published worldwideon ONJ issue (1272); 10 % of them (128) were from Italian Authors. We classified the latteritems as follows: 38% are case reports and clinical experiences; 13 % report a therapeutic orbehaviour protocol; 32% were about therapy; 13% were guidelines about preventivemeasures; 15% were literature reviews.The analysis showed that 55% of publications by Italian authors were issued in the last threeyears (2009-2011), representing the increased interest and recent work of Italian physiciansand researchers towards ONJ.BRONJ pathogenesis hypotheses, animal models, pathological and genetics studies wereobjects of papers by several groups, located in Verona [11-12], Trieste [13] , Torino [14-15] ,Florence [16], Bari [17] , Messina [18-21], and other academic centers [22-24].Several BRONJ case reports and case series in cancer and myeloma patients have beenpublished since first years of BRONJ appearance [25-40]. Particular case reports includedone case of BRONJ associated to osteonecrosis of left thumb [41], BRONJ diagnosis years3
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