Osteonecrosis

Osteonecrosis is a disease caused by reduced blood flow to bones in the joints, including the hip, knee, shoulder, and ankle. The disease, which is usually progressive and leads to joint failure, occurs in young adults aged from their twenties to their fifties. The pathogenesis of osteonecrosis is still unclear, and treatment remains controversial. This textbook provides up-to-date and comprehensive information on the pathophysiology, etiology, diagnosis, classification, and treatment of osteonecrosis. The role of various imaging modalities is considered, and both non-surgical and surgical treatment approaches are clearly explained. The contributions, all from experts in the field, are based on presentations at leading international meetings during the past 10 years and on peer-reviewed papers. The book will be of interest not only to clinical practitioners but also to those engaged in basic research.

Osteonecrosis of the jaws is a well-known side-effect of antiresorptive therapy that predominantly occurs in patients suffering from malignant diseases and receiving intravenous administrations of nitrogen-containing bisphosphonates or subcutaneous administrations of denosumab, a monoclonal antibody. Less frequently it may also be observed in patients with osteoporosis who are being treated with these antiresorptive drugs This textbook provides detailed, up-to-date information on all aspects of medication-related osteonecrosis of the jaws, including clinical features, pathogenesis, treatment options, and preventive measures. It also explains safe prevention and treatment strategies for patients receiving antiresorptive drugs who require extractions, implant insertions, and other dento-alveolar surgeries. This book will be of major interest for medical and dental students, dentists, and oral and maxillofacial surgeons as well as osteologists and oncologists.

Osteonecrosis is bone death caused by poor blood supply to the area. It is most common in the hip and shoulder, but can affect other large joints such as knee, elbow, wrist and ankle (PubMed Health). This book is a comprehensive guide to osteonecrosis, explaining the etiopathology of the disease and covering numerous diseases and disorders associated with it, with emphasis on femoral head necrosis, the most commonly affected area. Classification and staging are discussed at length with reference to treatment planning and correlation to prognosis. Diagnostic tools including X-Ray, CT scan, MRI and bone scan are also described in detail. Nearly 400 illustrations, clinical pictures and radiographic images are included to enhance learning. Key points Comprehensive guide to diagnosis and treatment of osteonecrosis Emphasis on femoral head necrosis Discusses numerous surgical techniques for treatment Includes nearly 400 illustrations, clinical pictures and radiographic images

Developed by the American Orthopaedic Association and published by AAOS. This unique book addresses virtually every aspect of nontraumatic osteonecrosis. Osteonecrosis documents cutting-edge developments in diagnosis and treatment. Its highly clinical focus helps physicians identify and treat this "silent" disease before major damage occurs. It also enables surgeons to evaluate treatment alternatives, such as core decompression, osteotomy, bone grafting, and arthroplasty. Important research into free vascularized grafting is detailed, including methodology and results from studies carried out in medical centers in the U.S., Canada, Greece, and Italy. The research covers more than 1,300 cases followed up for a minimum of two years. The incidence of osteonecrosis is on the rise, due largely to the increasing use of corticosteroids. Other leading causes include excessive alcohol intake, trauma, blood dyscrasias, hypercoagulability, and dysbaria. Most forms of the disease affect adults under the age of 50. Osteonecrosis brings together the research and discussion of more than 70 physicians and scientists from the U.S. and around the world. Its articles were originally presented at an AOA workshop held at Duke University in November 1996.

In this book there are chapters written by great specialists, both doctors and dentists, addressing a very important subject for clinical practice and research: osteonecrosis. In addition to a general review of the subject matter in the introduction, you will find in it some subjects little discussed in other textbooks, such as osteonecrosis of the mandible and osteonecrosis of the spinal vertebrae.

Editor Salvatore Ruggiero, DMD, MD and authors review the Diagnosis, Management and Prevention of Medication-related Osteonecrosis of the Jaw. Articles will include: Osteoporosis and bone modulation therapies: indications and outcomes; Antiresorptive therapies for the treatment of malignant osteolytic bone disease; Clinical presentation and staging of antiresorptive agent-induced osteonecrosis of the jaw; Epidemiology and risk factors of antiresorptive agent-induced osteonecrosis of the jaw; Basic science research of antiresorptive agent-induced osteonecrosis of the jaw: an update; Pathophysiology of antiresorptive agent-induced osteonecrosis of the jaw: what we know and what we don’t know; The genetics of osteonecrosis of the jaw; Preventive strategies for patients at risk of antiresorptive agent-induced osteonecrosis of the jaw; Non-operative and operative therapies for treatment of antiresorptive agent-induced osteonecrosis of the jaw; The role of anti-angiogenic therapy in the development of osteonecrosis of the jaw; Antiresorptive therapies: what they are and how do they work, and more!

During the early 19th century, it was discovered that adding yellow (now called white) phosphorous to matchstick heads made it easier to ignite matches. The phosphorous vapors were breathed in by workers and combined with other chemicals in the body to produce a potent nitrogen-containing bisphosphonate. Today's oral nitrogen-containing bisphosphonates and intravenous nitrogen-containing bisphosphonates circulate around the body the same way as the phosphorous vapors, and are absorbed into bone and ingested by osteoclasts. When this unique binding process of bisphosphonates to bone occurs, osteoclasts are poisoned, and this reduces or eliminates bone turnover. Alveolar bone in the mandible and maxilla turns over more rapidly than in long bones, so the jaws are a better target for bisphosphonate toxicity. It wasn't until 2003 that today's intravenous and oral nitrogen-containing bisphosphonate medications were implicated as major risk factors in the development of exposed necrotic bone of the jaws. Most of the researchers who reported cases of bisphosphonate-induced osteonecrosis of the jaw found that these patients were treated with zoledronate, pamidronate, or a combination of these drugs, which are commonly used for treating breast cancer or myeloma. In about 5% of cases, subjects with BIONJ were being treated for osteoporosis. Precipitating events that contribute to BIONJ are tooth extractions (about 50% of cases), mandibular exostoses, periodontal disease, and local trauma from ill-fitting dentures. It is not known if the placement of dental implants is a precipitating factor. The book aims to meet the need of medical practitioners working in all fields that use bisphosphonates, and to present the conservative and surgical treatment methods currently in use. There will also be detailed information on the literature relating to dental implants in patients treated with bisphosphonates.