bệnh hoại tử loét da ra do mô mỡ hoặc do dùng nhiều loại thuốc như Alendronate và Bisphosphonate chống loãng xương

Khoét hàm. Khoét vị trí hoại tử không phải ung thư

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Alendronic acid

https://www.hoanmyvinh.com/luu-y-ve-hoi-chung-fhc-nguy-hiem-nhung-de-bi-nham-lan.html

Bisphosphonate

_{https://www.nof.org/patients/treatment/medicationadherence/side-effects-of-bisphosphonates-alendronate-ibandronate-risedronate-and-zoledronic-acid/}

_{https://www.hoanmysaigon.com/lam-dung-thuoc-phong-loang-xuong-rat-nguy-hiem.html}

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https://www.google.com/search?q=osteonecrosis+of+the+jaw,&tbm=isch&chips=q:osteonecrosis+of+the+jaw,g_1:bisphosphonates:21P6xdGrA0o%3D&hl=en-US&sa=X&ved=2ahUKEwj76ajArMrvAhXuzYsBHR3YBQsQ4lYoAHoECAEQFw&biw=1349&bih=654&sfr=vfe

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Experimental studies on osteoporosis USC researchers and collaborators report a breakthrough to prevent damage to the jaw, a side effect suffered by some people undergoing treatment for cancer or osteoporosis.

The newly published research is an important step toward a cure for osteonecrosis of the jaw, which is a rare side effect caused by drugs commonly used to combat bone loss. It causes severe and persistent inflammation leading to loss of bone from the jaw and has no effective prevention or cure. The risk, though small, deters people from taking drugs needed to fight bone cancer or prevent fractures due to loss of bone density.

USC scientist Charles McKenna said the successful animal experiment, conducted by researchers at USC and UCLA, raises hope that physicians could adapt the new method to treat the condition in people.

"This is a condition that has been excruciatingly painful and difficult to treat for more than a decade," said McKenna, a professor of chemistry in the USC Dornsife College of Letters, Arts and Sciences and adjunct professor of pharmacology and pharmaceutical sciences in the USC School of Pharmacy. "We think our new approach may provide hope for the future," he said.

The new published findings appear in Bone. The authors are affiliated with the USC Center for Drug Discovery and Development at the Michelson Center for Convergent Bioscience, the UCLA School of Dentistry and a Pasadena-based startup biotech company, BioVinc LLC.

For years, physicians have prescribed a class of drugs called bisphosphonates (BPs) for metastatic bone cancer patients and to maintain bone density in osteoporosis patients. BPs include a range of compounds that share a remarkable ability to stick to bone like Velcro.

But when used in high doses in the cancer clinic, BP drugs sometimes have a terrible side effect causing necrosis in the jaw. The problem often occurs after a tooth is removed, the gap doesn't heal and the jaw begins to deteriorate.

Although the condition is very rare at the lower BP doses used to combat osteoporosis, many patients are avoiding the drugs altogether for fear of the side effects. The risk is low as the National Osteoporosis Foundation estimates incidence of osteonecrosis of the jaw due to BP used to treat osteoporosis to be between 1 in 10,000 and 1 in 100,000 people annually. Risk has been estimated to be much higher, about 3 percent of patients, at the BP dose used to treat cancer, McKennna said.

Nonetheless, more and more osteoporosis patients are willing to take their chances with the disease rather than risk the side effects. Surveys have shown the recent trend in reduced hip fractures among post-menopausal women may be reversing due to BP drug aversion.

"The fear factor of this condition has led to severe underuse of bisphosphonates for osteoporosis so much so that we're seeing a rise in hip fractures in elderly people, aversion to bisphosphonates in oncology clinics and liability concerns in the dental office," McKenna said.

To solve the problem, McKennna devised an elegant solution. The research team used a different BP compound, an inactive compound that could be used locally in the mouth to push the BP drug from the jawbone while leaving undisturbed the useful drug in the rest of the skeleton.

Said McKenna: "Think of it as a way to fight fire with fire."

The scientists involved in the study used mice to test different BPs attached to fluorescent dyes. One color label coded the BP zoledronate, which is administered systemically to treat osteoporosis and cancer, while a different color labeled "rescue BP" coded a BP compound with similar bone affinity, but no biological activity. The researchers discovered that rescue BP injected into the jaw removed most of the BP drug causing the jaw bone tissue damage, clearing the way for the animal's natural healing process to repair the extraction site.

The new technique isn't ready for clinical use in humans yet. McKenna said BioVinc, which provided funding for the study via a National Institutes of Health small business research grant, will be responsible for advancing the treatment to commercial clinical use. Several of the authors of the study disclose a financial interest in BioVinc, a company specializing in "bone targeted therapeutics and diagnostics." McKenna is the company's academic founder.

Story Source:

Materials provided by University of Southern California. Note: Content may be edited for style and length.

Journal Reference:

Akishige Hokugo, Keiichi Kanayama, Shuting Sun, Kenzo Morinaga, Yujie Sun, QingQing Wu, Hodaka Sasaki, Hiroko Okawa, Courtney Evans, Frank H. Ebetino, Mark W. Lundy, Keivan Sadrerafi, Charles E. McKenna, Ichiro Nishimura. Rescue bisphosphonate treatment of alveolar bone improves extraction socket healing and reduces osteonecrosis in zoledronate-treated mice. Bone, 2019; 123: 115 DOI: 10.1016/j.bone.2019.03.027

Osteonecrosis
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Osteonecrosis is bone death caused by poor blood supply. It is most common in the hip and shoulder, but can affect other large joints such as the knee, elbow, wrist and ankle.
Causes

Osteonecrosis occurs when part of the bone does not get blood and dies. After a while, the bone can collapse. If osteonecrosis is not treated, the joint deteriorates, leading to severe arthritis.

Osteonecrosis can be caused by disease or by severe trauma, such as a fracture or dislocation, that affects the blood supply to the bone. Osteonecrosis can also occur without trauma or disease. This is called idiopathic -- meaning it occurs without any known cause.

The following are possible causes:

    Using oral or intravenous steroids
    Excessive alcohol use
    Sickle cell disease
    Dislocation or fractures around a joint
    Clotting disorders
    HIV or taking HIV drugs
    Radiation therapy or chemotherapy
    Gaucher disease (disease in which harmful substance build up in the certain organs and the bone)
    Systemic lupus erythematosus (an autoimmune disease in which the body's immune system mistakenly attacks healthy tissue such as the bone)
    Legg-Calve-Perthes disease (childhood disease in which the thigh bone in the hip doesn't get enough blood, causing the bone to die)
    Decompression sickness from a lot of deep sea diving

When osteonecrosis occurs in the shoulder joint, it is usually due to long-term treatment with steroids, a history of trauma to the shoulder, or the person has sickle cell disease.
Symptoms

There are no symptoms in the early stages. As bone damage worsens, you may have the following symptoms:

    Pain in the joint that may increase over time and becomes severe if the bone collapses
    Pain that occurs even at rest
    Limited range of motion
    Groin pain, if the hip joint is affected
    Limping, if the condition occurs in the leg
    Difficulty with overhead movement, if the shoulder joint is affected

Exams and Tests

Your health care provider will do a physical exam to find out if you have any diseases or conditions that may affect your bones. You will be asked about your symptoms and medical history.

Be sure to let your provider know about any medicines or vitamin supplements you are taking, even over-the-counter medicine.

After the exam, your provider will order one or more of the following tests:

    X-ray
    MRI
    Bone scan
    CT scan

Treatment

If your provider knows the cause of osteonecrosis, part of the treatment will be aimed at the underlying condition. For example, if a blood clotting disorder is the cause, treatment will consist, in part, of clot-dissolving medicine.

If the condition is caught early, you will take pain relievers and limit use of the affected area. This may include using crutches if your hip, knee, or ankle is affected. You may need to do range-of-motion exercises. Nonsurgical treatment can often slow the progression of osteonecrosis, but most people will need surgery.

Surgical options include:

    A bone graft
    A bone graft along with its blood supply (vascularized bone graft)
    Removing part of the inside of the bone (core decompression) to relieve pressure and allow new blood vessels to form
    Cutting the bone and changing its alignment to relieve stress on the bone or joint (osteotomy)
    Total joint replacement

Support Groups

You can find more information and support resources at the following organization:

    National Institute of Arthritis and Musculoskeletal and Skin Diseases -- www.niams.nih.gov/health-topics/osteonecrosis
    The Arthritis Foundation -- www.arthritis.org

Outlook (Prognosis)

How well you do depends on the following:

    The cause of the osteonecrosis
    How severe the disease is when diagnosed
    Amount of bone involved
    Your age and overall health

Outcome may vary from complete healing to permanent damage in the affected bone.
Possible Complications

Advanced osteonecrosis can lead to osteoarthritis and permanent decreased mobility. Severe cases may require joint replacement.
When to Contact a Medical Professional

Call your provider if you have symptoms.
Prevention

Many cases of osteonecrosis do not have a known cause, so prevention may not be possible. In some cases, you can reduce your risk by doing the following:

    Avoid drinking excessive amounts of alcohol.
    When possible, avoid high doses and long-term use of corticosteroids.
    Follow safety measures when diving to avoid decompression sickness.

Alternative Names

Avascular necrosis; Bone infarction; Ischemic bone necrosis; AVN; Aseptic necrosis
Images

    Aseptic necrosisAseptic necrosis

References

McAlindon T, Ward RJ. Osteonecrosis. In: Hochberg MC, Gravallese EM, Silman AJ, Smolen JS, Weinblatt ME, Weisman MH, eds. Rheumatology. 7th ed. Philadelphia, PA: Elsevier; 2019:chap 206.

Whyte MP. Osteonecrosis, osteosclerosis/hyperostosis, and other disorders of the bone. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 248.
Review Date 4/21/2019

Updated by: C. Benjamin Ma, MD, Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery, San Francisco, CA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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