OrthO-rheumatO | VOL 11 | Nr 1 | 2013
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Osteonecrose van de kaak is een mogelijke maar zeldzame
bijwerking van antiresorptieve therapie met bisfosfonaten
of denosumab. Een analyse van Duitse patiëntenregister
in Berlijn bracht aan het licht dat de prevalentie 1 op
79.800 bedraagt bij patiënten behandeld met bisfosfona-
ten, tegenover 1 op 525.000 bij patiënten met osteoporose
en 1 op 2.723.333 in de totale populatie ouder dan vijftig
jaar (Tabel 1) (25).
Een slecht begrepen bijwerking zijn atypische femur-
fracturen, die na langdurige behandeling, na vijf tot acht jaar,
kunnen optreden. Ook die zijn volgens Dieter Felsenberg
behoorlijk zeldzaam.
tabel 1: prevalentie van osteonecrose van de kaak bij patiënten met osteoporose in duitsland in 2009.
populatie 2009
grootte van de populatie
prevalentie
relatieve prevalentie (%)
per 100.000
totale populatie > 50 jaar
32.680.000
1:2.723.333
0,0000367
0,0367
osteoporosepatiënten
6.300.000
1:525.000
0,00019
0,19
patiënten met bisfosfonaatbehandeling
957.600
1:79.800
0,00125
1,25
referenties:
1. Cuthbertson d, smith k, babraj j, et al. anabolic signaling deficits underlie amino acid
resistance of wasting, aging muscle. faseb j 2005;19(3):422-4.
2. burd na, Tang je, moore dr, Philips sm. exercise training and protein metabolism:
influences of contraction, protein intake, and sex-based differences. j appl Physiol
2009;106(5):1692-701.
3. Van loon lj, boirie y, gijsen aP, et al. The production of intrinsically labeled milk protein
provides a functional tool for human nutrition research. j dairy sci 2009;92(10):4812-22.
4. koopman r, Crombach n, gijsen aP, et al. ingestion of a protein hydrolysate is
accompanied by an accelerated in vivo digestion and absorption rate when compared
with its intact protein. am j Clin nutr 2009;90(1):106-15.
5. Pennings b, boirie y, senden jm, et al. whey protein stimulates postprandial muscle
protein accretion more effectively than do casein and casein hydrolysate in older men.
am j Clin nutr 2011;93(5):997-1005.
6. Pennings b, groen b, de lange a, et al. amino acid absorption and subsequent muscle
protein accretion following graded intakes of whey protein in elderly men. am j Physiol
endocrin metab 2012;302(8):e992-9.
7. wall bT, hamer hm, de lange a, et al. leucine co-ingestion improves post-prandial
muscle protein accretion in elderly men. Clin nutr 2012 sep 20. [epub ahead of print]
8. Pennings b, koopman r, beelen m, et al. exercising before protein intake allows for
greater use of dietary protein-derived amino acids for de novo muscle protein synthesis
in both young and elderly men. am j Clin nutr 2011;93(2):322-31.
9. Tieland m, dirks ml, van der Zwaluw n, et al. Protein supplementation increases muscle
mass gain during prolonged resistance-type exercise training in frail elderly people: a
randomized, double-blind, placebo-controlled trial. j am med dir assoc 2012;13(8):713-9.
10. Cermak nm, res PT, de groot lC, saris wh, van loon lj. Protein supplementation
augments the adaptive response of skeletal muscle to resistance-type exercise training: a
meta-analysis. am j Clin nutr 2012;96(6):1454-64.
11. riggs bl, melton iii lj 3rd, robb ra, et al. Population-based study of age and sex
differences in bone volumetric density, size, geometry, and structure at different skeletal
sites. j bone miner res 2004;19(12):1945-54.
12. mayhew Pm, Thomas Cd, Clement jg, et al. relation between age, femoral neck cortical
stability, and hip fracture risk. lancet 2005;366(9480):129-35.
13. Poole ke, mayhew Pm, rose Cm, Changing structure of the femoral neck across the adult
female lifespan. j bone miner res 2010;25(3):482-91.
14. black dm, greensspan sl, ensrud ke, et al. The effects of parathyroid hormone and
alendronate alone or in combination in postmenopausal osteoporosis. n engl j med
2003;349(13):1207-15.
15. boutroy s, bouxsein ml, munoz f, delmas Pd. in vivo assessment of trabecular bone
microarchitecture by high-resolution peripheral quantitative computed tomography. j
Clin endocrinol metab 2005;90(12):6508-15.
16. Putman m, yu e, schindler e, et al. differences in skeletal micor-architecture in african-
american and Caucasian women. asmbr 2011. abstract su0043.
17. burghardt aj, issever as, schwartz aV, et al. high-resolution peripheral quantitative
computed tomographic imaging of cortical and trabecular bone microarchitecture in
patients with type 2 diabetes mellitus. j Clin endocrinol metab 2010;95(11):5045-55.
18. Cody dd, gross gj, hou fj, spencer hj, goldstein sa, fyhrie dP. femoral strenght is better
predicted by finite element models than QCT and dXa. biomech 1999;32(10):1013-20.
19. Pistoia w, van rietbergen b, lochmüller em, lill Ca, eckstein f, rüegsegger P. estimation
of distal radius failure load with micro-finite element analysis models based on
three-dimensional peripheral quantitative computed tomography images. bone
2002;30(6):842-8.
20. keaveny Tm, kopperdahl dl, melton lj 3rd, et al. age-dependence of femoral strenght in
white women and men. j bone miner res 2010;25(5):994-1001.
21. wang X, sanyal a, Cawthon Pm, et al. Prediction of new clinical vertebral fractures in
elderly men using finite element analysis of CT scans. j bone miner res 2012;27(4):808-
16.
22. marcus r, wong m, heath 3rd, stock jl. antiresorptive treatment of postmenopausal
osteoporosis: comparison of study designs and outcomes in large clinical trials with
fracture as an endpoint. endocr rev 2002;23(1):16-37.
23. Pistoia w, van rietbergen b, rüegsegger P. mechanical consequences of different
scenarios for simulated bone atrophy and recovery in the distal radius. bone
2003;33(6):937-45.
24. genant hk, engelke k, hanley da, et al. denosumab improves density and strenght
parameters as measured by QCT of the radius in postmenopausal women with low bone
mineral density. bone 2010;47(1):131-9.
25. felsenberg d, lopez s, gabbert T, hoffmeister b. osteonecrosis of the jaw in patients with
osteoporosis bisphosphonate therapy, risk factors, clinical symptomatology, initial
interventions and recommendations. osteologie 2012;21(3):207-12.
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