Bisphosphonate-related osteonecrosis of the jaws: a potential alternative to drug holidays

Self-Instruction Exercise No. 334
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Exercise No. 334
Subject Code: 016
Pharmacotherapeutics

The 15 questions for this exercise are based on the article, “Bisphosphonate-related osteonecrosis of the jaws: a potential alternative to drug holidays”, on pages 33-38. This exercise was developed by Thomas C. Johnson, DMD, MAGD, in association with the General Dentistry Self-Instruction committee.

Reading the article and successfully completing this exercise will enable you to understand the:

  • risks and benefits of a drug holiday;
  • pharmacokinetics of amino bisphosphonates (nBP); and
  • problems caused by concentration of nBP into surgical sites.

Answers for this exercise must be received by July 31, 2014.
  1. What is the percentage of women with osteoporosis who fracture their hip and do not survive?

    A. 10
    B. 20
    C. 30
    D. 40

  2. What is the percentage of men with osteoporosis who fracture their hip and regain full function?

    A. 25
    B. 45
    C. 65
    D. 80

  3. Within hours of intake, 50% of the dose of an aminobisphosphonate (nBP) is excreted by the kidneys. The remainder is broken down by liver enzymes.

    A. Both statements are true.
    B. The first statement is true; the second is false.
    C. The first statement is false; the second is true.
    D. Both statements are false.

  4. Osteoclasts have the highest affinity for nBP, ________ times that of resting bone.

    A. 2
    B. 4
    C. 8
    D. 10

  5. The long-term reservoir of nBP is a result of action by which cells?

    A. Adipocytes
    B. Osteocytes
    C. Osteoclasts
    D. Osteoblasts

  6. Once deposited, nBP has a half-life of approximately 8 years. Deposition of nBP is uniform, not concentrated.

    A. Both statements are true.
    B. The first statement is true; the second is false.
    C. The first statement is false; the second is true.
    D. Both statements are false.

  7. Which of the following effects are observed with low levels of nBP?

    A. Osteoclastic apoptosis
    B. Inhibited formation of new osteoclasts
    C. Diminished osteoclastic collagen degradation
    D. Accelerated angiogenesis

  8. Woven bone forms with the initial healing of an osteotomy for implant placement. Numerous basic multicellular units (BMUs) or “cutting cones” burrow through the granulation tissue to form the woven bone.

    A. Both statements are true.
    B. The first statement is true; the second is false.
    C. The first statement is false; the second is true.
    D. Both statements are false.

  9. A generous blood supply facilitates the formation of new bone in a healing surgical site. nBP will not affect angiogenesis or the actions of the osteoblasts.

    A. Both statements are true.
    B. The first statement is true; the second is false.
    C. The first statement is false; the second is true.
    D. Both statements are false.

  10. The patient in the case report was diagnosed with bisphosphonate-related osteonecrosis and had all of the following symptoms or findings except one. Which is the exception?

    A. Radiolucent-radiopaque mixed radiographic appearance
    B. Mandibular pain
    C. Taking oral risedronate
    D. Exposed necrotic bone

  11. The patient in the case report had diffuse necrosis of the bone away from the extraction sites. What did the authors state was the cause of this?

    A. nBP’s effect on angiogenesis
    B. nBP’s effect on osteoclasts
    C. Mucogingival surgery for periodontitis
    D. nBP’s effect on osteoblasts

  12. The amount of free nBP in the serum should be extremely low after a drug free period of _________ month(s).

    A. 1
    B. 2
    C. 4
    D. 6

  13. Patients with osteopenia, who according to the FRAX have a risk of hip fracture of at least _________ %, should have therapy to improve low bone mass.

    A. 3
    B. 5
    C. 10
    D. 20

  14. Which of the following increases the number and survival of osteoblasts, thus improving bone density?

    A. Denosumab
    B. Raloxifene
    C. Teriparitide
    D. Zoledronic acid

  15. Which of the following is not incorporated into bone, as is nBP, and yet still is associated with osteonecrosis?

    A. Denosumab
    B. Raloxifene
    C. Teriparitide
    D. Zoledronic acid

Evaluation
Please respond to the statements below, using the following scale:
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Benefit to your clinical practice 1 2 3 4 5
Quality of illustrations 1 2 3 4 5
Clarity of objectives 1 2 3 4 5
Clarity of exercise questions 1 2 3 4 5
Relevance of exercise questions 1 2 3 4 5
 
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