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Interventions for treating bisphosphonate-related osteonecrosis of the jaw (BRONJ)

Overview of attention for article published in Cochrane database of systematic reviews, February 2016
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  • In the top 5% of all research outputs scored by Altmetric
  • High Attention Score compared to outputs of the same age (95th percentile)
  • High Attention Score compared to outputs of the same age and source (81st percentile)

Mentioned by

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2 blogs
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49 tweeters
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3 Facebook pages

Citations

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25 Dimensions

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222 Mendeley
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Title
Interventions for treating bisphosphonate-related osteonecrosis of the jaw (BRONJ)
Published in
Cochrane database of systematic reviews, February 2016
DOI 10.1002/14651858.cd008455.pub2
Pubmed ID
Authors

Victoria Rollason, Alexandra Laverrière, Laura CI MacDonald, Tanya Walsh, Martin R Tramèr, Nicole B Vogt-Ferrier

Abstract

Bisphosphonate drugs can be used to prevent and treat osteoporosis and to reduce symptoms and complications of metastatic bone disease; however, they are associated with a rare but serious adverse event: osteonecrosis of the maxillary and mandibular bones. This condition is called bisphosphonate-related osteonecrosis of the jaw or BRONJ. BRONJ is diagnosed when people who are taking, or have previously taken, bisphosphonates have exposed bone in the jaw area for more than eight weeks in the absence of radiation treatment. There is currently no "gold standard" of treatment for BRONJ. The three broad categories of intervention are conservative approaches (e.g. mouth rinse, antibiotics), surgical interventions and adjuvant non-surgical strategies (e.g. hyperbaric oxygen therapy, platelet-rich plasma), which can be used in combination. To determine the efficacy and safety of any intervention aimed at treating BRONJ. We searched the following databases to 15 December 2015: the Cochrane Oral Health Group Trials Register, the Cochrane Breast Cancer Group Trials Register (20 September 2011), the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE via Ovid, EMBASE via Ovid, CancerLit via PubMed, CINAHL via EBSCO and AMED via Ovid. We scanned the references cited in retrieved articles and contacted experts in the field, the first authors of included papers, study sponsors, other bisphosphonates investigators and pharmaceutical companies. We searched for ongoing trials through contact with trialists and by searching the US National Institutes of Health Trials Register (clinicaltrials.gov) and the World Health Organization Clinical Trials Registry Platform. We also conducted a grey literature search to September 2015. Randomised controlled trials (RCTs) comparing the effects of any treatment for BRONJ with another treatment or placebo. Two review authors independently screened the search results, assessed the risk of bias in the included trials and extracted data. When in dispute, we consulted a third review author. One small trial at high risk of bias met the inclusion criteria. The trial randomised 49 participants, most of whom had cancer. It compared standard care (defined as surgery, antibiotics and oral rinses at the discretion of the oral-maxillofacial surgeon) to standard care plus hyperbaric oxygen therapy (2 atmospheres twice a day for 40 treatments). The trial measured the percentage of participants who improved or healed at three, six, 12 and 18 months and last contact. It also measured mean weekly pain scores.At three months, the study found that the participants in intervention group were more likely to have an improvement in their osteonecrosis than the standard care group participants (risk ratio (RR) 1.94, 95% confidence interval (CI) 1.01 to 3.74). There was no clear difference between the groups for the outcome 'healed' at three months (RR 3.60, 95% CI 0.87 to 14.82). There was no clear difference between the groups for improvement or healing when they were evaluated at six, 12 and 18 months and last contact.The study did not give any information on adverse events.Although the findings suggest adjunctive hyperbaric oxygen improved BRONJ, the quality of the evidence is very low since the only study was underpowered and was at high risk of bias due to lack of blinding, cross-over of participants between groups and very high attrition (50% at 12 months and 80% at 18 months in this study, which was designed for an intended follow-up of 24 months). There is a lack of evidence from randomised controlled trials to guide treatment of bisphosphonate-related osteonecrosis of the jaw (BRONJ). One small trial at high risk of bias evaluated hyperbaric oxygen therapy (HBO) as an adjunct to "standard" care and could not confirm or refute the effectiveness of HBO. There are two ongoing trials of teriparatide treatment for BRONJ. We found no randomised controlled trials of any other BRONJ treatments. High quality randomised controlled trials are needed. We provide recommendations for their focus and design.

Twitter Demographics

The data shown below were collected from the profiles of 49 tweeters who shared this research output. Click here to find out more about how the information was compiled.

Mendeley readers

The data shown below were compiled from readership statistics for 222 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
Germany 1 <1%
Italy 1 <1%
South Africa 1 <1%
Canada 1 <1%
New Zealand 1 <1%
Japan 1 <1%
Unknown 216 97%

Demographic breakdown

Readers by professional status Count As %
Student > Master 44 20%
Researcher 26 12%
Student > Ph. D. Student 21 9%
Student > Bachelor 20 9%
Student > Postgraduate 16 7%
Other 52 23%
Unknown 43 19%
Readers by discipline Count As %
Medicine and Dentistry 121 55%
Nursing and Health Professions 11 5%
Social Sciences 6 3%
Agricultural and Biological Sciences 6 3%
Psychology 5 2%
Other 22 10%
Unknown 51 23%

Attention Score in Context

This research output has an Altmetric Attention Score of 44. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 09 October 2019.
All research outputs
#423,034
of 14,104,168 outputs
Outputs from Cochrane database of systematic reviews
#1,186
of 10,849 outputs
Outputs of similar age
#12,752
of 267,109 outputs
Outputs of similar age from Cochrane database of systematic reviews
#33
of 182 outputs
Altmetric has tracked 14,104,168 research outputs across all sources so far. Compared to these this one has done particularly well and is in the 96th percentile: it's in the top 5% of all research outputs ever tracked by Altmetric.
So far Altmetric has tracked 10,849 research outputs from this source. They typically receive a lot more attention than average, with a mean Attention Score of 21.6. This one has done well, scoring higher than 89% of its peers.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 267,109 tracked outputs that were published within six weeks on either side of this one in any source. This one has done particularly well, scoring higher than 95% of its contemporaries.
We're also able to compare this research output to 182 others from the same source and published within six weeks on either side of this one. This one has done well, scoring higher than 81% of its contemporaries.