Osteonecrosis of the Jaw Associated with Pamidronate Therapy.
Bibliographic record
Abstract
Abstract BACKGROUND: Bisphosphonates, as a class of medication, fulfill an essential role serving to modify the natural history of bone disease associated with multiple myeloma and other neoplasms that infiltrate bone. They are also commonly used for the prevention and treatment of osteoperosis. Bisphosphonates are generally well tolerated and associated with minimal adverse effects; however, there exists a growing concern that bisphosphonate use may be associated with osteonecrosis of the jaw. CASE PRESENTATION: We report the occurrence of osteonecrosis of the jaw associated with pamidronate therapy in 4 patients undergoing treatment for multiple myeloma. At the onset of jaw osteonecrosis, pamidronate therapy was the single medication common to all 4 patients. The duration of therapy varied from 18 to 65 months before osteonecrosis was observed. All cases involved the posterior mandible and have been refractory to a variety of medical therapies including surgical debridement and systemic antibiotics. Biopsies available from two patients revealed inflammation consistent with osteomyelitis. In one biopsy Actinomyces spp. were recovered from culture, but treatment with an extended course of clindamycin conferred no clinical benefit. The persistence of exposed bone remains a significant source of morbidity and pain for each patient. Discontinuation of pamidronate therapy has not helped to reverse the presence of osteonecrosis and surgical manipulation of the involved site appears to worsen the underlying bone pathology. CONCLUSIONS: Osteonecrosis of the jaw is an important adverse outcome associated with bisphosphonate therapy. The unremitting nature of this clinical development, and the long lasting morbidity associated with it suggests that patients should be counseled regarding the possible occurrence of osteonecrosis prior to initiating therapy with pamidronate.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".