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Azienda Ospedaliera Nazionale“SS. Antonio e Biagio e Cesare Arrigo”Working Paper of Public Healthnr. 12/2012Italian CongressesBeside capillary local/regional dentist conferences (mostly organized by ANDI, the ItalianNational Dentist Association) and local medical oncology/haematology symposia, we foundONJ-dedicated sessions or presentations in national congresses of several societies. Italiansocieties of maxillofacial surgeons (SICMF), oral pathologists and care specialists (SIPMO),oncologists (AIOM), haematologists (SIE) organized oral presentations, issue symposia andabstract discussion sessions in their congresses in latest years. Furtherly, dozens of abstractsand posters about BRONJ have been offered by scholars and students at annual meetings ofthe Italian college of oral care teachers (“Collegio dei Docenti di Odontoiatria”).Moreover, some specific-issue national conferences (Alessandria 2007, Messina 2008,Alessandria 2008-2009-2010) were organized, with dozens of abstracts and reports fromcenters of all the Italian regions (only minimally later published as full papers). Highlights ofthose national congresses have been diffused by Italian language newsletters [133] and mostof contributions are available on a website (www.reteoncologica.it.) [134].European and International CongressesAbstracts from Italian Authors about ONJ appeared in the acta of many international societycongresses, such as ASH (American Society of Haematology), ASCO (American Society ofClinical Oncology), EHA (European Haematology Association), ESMO (European Societyof Medical Oncology), ECCO (European Cancer Organization), EAOM (European OralMedicine Association), EACMFS (European Association of Maxillo-Facial Surgeons), andinternational conferences (for example SABCS, San Antonio annual breast cancersymposium).Recommendations, guidelines, position papersBeside an official recommendation by Italian Health Minister [135], documents about ONJwere approved and diffused (or are going to be published) by several Italian societies andstudy groups: SICMF-SIPMO panel (an expert panel organized by Italian societies ofmaxillofacial surgeons and oral medicine specialists), AIOM (oncologists), SIF(pharmacologists), SIOMMMS (bone disease specialists), GISBI (BP study group), PROOF(dental legal experts), Rete Oncologica Piemonte-VdA (multidisciplinary study group aboutBP prescription in cancer and myeloma), etc.6
Azienda Ospedaliera Nazionale“SS. Antonio e Biagio e Cesare Arrigo”Working Paper of Public Healthnr. 12/2012Epidemiologic dataSystematic BRONJ case collection has been pursued on two regional area.In Piemonte – Valle d’Aosta (4.3 million population), inside a regional oncology network(Rete Oncologica Piemonte Valle d’Aosta), on November 2005 a BRONJ multidisciplinarystudy group was created, after observation of 60 cases in few referral centers [136];enlargement of the group to 37 oncology / haematology regional units and 19 oral care unitspushed a systemic collection up to 247 cases on December 2008 [60] .In Sicily, a local drug side-effect surveillance system (hospital pharmacist network) hascollected 102 cases in 3 referral centers of two cities (Palermo and Messina) on years 2008-2009 [137] and is enlarging to all the region.4. DiscussionIn recent years many Italian groups have published a large amount of articles about severalaspects of ONJ in English language peer-reviewed journals, reporting an high number ofobserved patients. An even larger amount of ONJ cases (mostly BRONJ in cancer andmyeloma patients, but with increasing number in not malignant diseases) has been illustratedin national and international congresses and conferences. We calculated that Italian authorshave reported between 2005 and 2009, either in congresses, dedicated annual meetings [133-134] and/or peer-reviewed journals, at least 1,200 different ONJ cases (among which are 672cases from a multicenter survey, whose results are only partially published) [61]. Everyonecould imagine that many other cases have not been reported at all.Projecting to whole Italian population (58 million) the number of BRONJ cases (247)observed in Piemonte-Valle d’Aosta (4.3 million) in years 2004-2008 [60] , one couldspeculate that more than 3000 BRONJ cases have occurred in Italy in those years.Why so many BRONJ cases in Italy, especially among cancer and myeloma patients?Looking for the main reasons, we invite readers to consider several possible facts. Firstly, onthe basis of prescriptions in years 2002-2008 of zoledronic acid (the mostly administered ivBP, largely replacing pamidronate ) (fig 1), we can consider that iv BP consumption rate inmetastatic bone and myeloma patients in recent years was higher in Italy than in otherEuropean countries (with exception of Belgium) (AIFA personal communication) (fig 2);drug therapy is largely covered by the national public Italian Health System (SSN, SistemaSanitario Nazionale), and this is totally free for oncology and haematology patients , in years7
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