UNASSIGNED: To provide a critical update identifying the knowledge gaps and controversies in medication-related osteonecrosis of the jaw (MRONJ) within the Belgian healthcare context and outline opportunities for improvement and research in these areas.
UNASSIGNED: A literature review was performed to identify guidelines from international clinical societies in oncology or oral and maxillofacial surgery on diagnosing, preventing, and treating MRONJ. The recommendations were critically assessed in light of recent developments in the field and confronted with the clinical experience of experts.
UNASSIGNED: Despite progress in the diagnostic criteria of MRONJ, the continued need for an 8-week timeout period should be reconsidered. Furthermore, 3D imaging techniques should be introduced to improve diagnosis and staging. The staging system remains ambiguous regarding Stage 0 MRONJ, and ongoing confusion exists regarding the term non-exposed MRONJ. The prevention of MRONJ should be tailored, considering the individual patient\'s risk of MRONJ, frailty, and life expectancy. More research seems needed into the efficacy and safety of drug holidays, considering the risks of rebound remodeling on fractures. With renewed interest in surgical and adjunct management techniques, adequately designed clinical studies are needed to help translate trial outcomes into universally applicable treatment guidelines taking into account individual patient characteristics.
UNASSIGNED: Important knowledge gaps remain and hamper the development of clinical guidelines. Several controversies were identified where consensus is lacking, and further harmonization between stakeholders is necessary. Finally, the need for randomized controlled comparative clinical trials in MRONJ resonates harder than ever to identify the best treatment for individual patients.

OBJECTIVE: Patients taking antiresorptive medications in dental clinics are at risk of medication-related osteonecrosis of the jaw (MRONJ), which poses daily challenges for their clinicians. This paper aimed to summarize and revisit the three most recognized practice guidelines for the management and prevention of MRONJ, which were proposed by the American Association of Oral and Maxillofacial Surgeons (AAOMS), and presented by the Journal of Bone and Mineral Research (JBMR) and the Journal of Clinical Oncology (JCO). Results and case studies: The AAOMS position paper focused on risk stratification by different medications, management decision trees, risk factors, pathophysiology, and disease staging. The JBMR international consensus presented eight focused questions, which were addressed by systematic reviews. The JCO clinical practice guideline presented six clinical questions, and each concluded with practical recommendations. Practical information was summarized and converted into an adoptable patient care workflow for clinicians to follow and apply in daily practice. Three case studies presented were treated following these guidelines. Each patient underwent advanced surgeries including alveoloplasty, tooth extraction, implant placement, and particulate bone grafting. Some of the considerations not fully informed were discussed and illustrated in each step of the patient care workflow, which included specifics for risk communication, updates on the use of antibiotics, biomarkers, and drug holidays.
CONCLUSIONS: Structured risk communication with official informed consent documentation should be considered before initiating invasive treatments. Disease control phase with home care therapy should be provided prior to staged reconstructive therapy. Drug holidays and antibiotics coverage can be customized based on individual conditions and related procedures with interprofessional coordination.

Medication-related osteonecrosis of the jaw (MRONJ) is a serious adverse event related to administration of antiresorptive or antiangiogenic medications. With the increasing usage of bone-modifying agents in cancer therapy, the incidence of MRONJ enhanced gradually, which affects the life quality of patients and interferes with cancer therapy. In 2019, Multinational Association of Supportive Care in Cancer (MASCC), International Society of Oral Oncology (ISOO) and American Society of Clinical Oncology (ASCO) convened a multidisciplinary Expert Panel to evaluate the evidence and formulate recommendations on practices in the prevention and management of MRONJ in patients with cancer. The present article made an interpretation of Medication-Related Osteonecrosis of the Jaw: MASCC/ISOO/ASCO Clinical Practice Guideline so as to provide clinicians with diagnostic and therapeutic approaches for cancer patients with MRONJ.
药物相关性颌骨坏死（medication-related osteonecrosis of the jaw，MRONJ）是与抗骨吸收药物或抗血管生成药物等相关的颌骨不良反应。随着癌症治疗过程中骨改良药物使用的增加，MRONJ的发生率越来越高，不仅干扰肿瘤的正常治疗，也影响患者的生命质量。2019年，癌症支持疗法多国学会（Multinational Association of Supportive Care in Cancer，MASCC）/国际口腔肿瘤学会（International Society of Oral Oncology，ISOO）及美国临床肿瘤协会（American Society of Clinical Oncology，ASCO）对2003至2017年间癌症患者的MRONJ相关文献进行了分析，共纳入系统评价、随机对照试验、前瞻性研究及回顾性研究等132项，形成《MASCC/ISOO/ASCO药物相关性颌骨坏死临床实践指南》。本文就该指南进行解读，旨在为诊治癌症患者的MRONJ提供参考。.

Osteonecrosis of the femoral head (ONFH) is a devastating disease frequently leading to femoral head collapse and hip arthritis. Specifically, non-traumatic ONFH primarily affects young and middle-aged adults. Although compromised local circulation of the femoral head seems to be pathognomonic for the disease, the pathogenesis is perplexing and continues to be an area of scrutiny and research. Comprehension of the pathogenesis is of crucial importance for developing and guiding treatments for the disease. Therefore, we provide an up-to-date consensus on the pathogenesis of non-traumatic ONFH.

暂无摘要。

Novel coronavirus pneumonia is a new type of respiratory infectious disease that has rapidly spread in many countries or regions around the world. The World Health Organization (WHO) named it \"coronavirus disease 2019 (COVID-19)\". Glucocorticoids (GC) have certain application value in patients with COVID-19, but they need to be used with caution and strict indications and dosage. Application of large doses of GC can also cause osteonecrosis of femoral head (ONFH). On the basis of the latest literature and evidence-based medical evidence on the fight against COVID-19 epidemic and steroid ONFH diagnosis and treatment, the Bone Circulation and Osteonecrosis Professional Committee, Shockwave Medical Specialty Committee of Chinese Research Hospital Association organized Chinese bone necrosis related experts to jointly write this consensus, focusing on the prevention strategy and the protective management measures in the ONFH diagnosis and treatment process during the prevention and control of COVID-19, which can provide reference for hospitals at all levels to carry out early prevention and treatment of ONFH.
新型冠状病毒性肺炎是一种新型呼吸道传染病，目前已在全球很多国家或地区迅速蔓延。世界卫生组织（WHO）将其命名为“2019 年冠状病毒疾病（COVID-19）”。糖皮质激素（glucocorticoids，GC）在 COVID-19 患者中具有一定应用价值，但需谨慎使用，严格把握适应证和用量。应用大剂量 GC 也会引起股骨头坏死（osteonecrosis of femoral head，ONFH）。结合目前国内外关于抗击 COVID-19 疫情以及激素性 ONFH 诊治原则的最新文献和循证医学证据，由中国研究型医院学会冲击波医学专业委员会骨循环与骨坏死专家委员会组织国内骨坏死相关专家共同撰写本共识，重点介绍在 COVID-19 疫情防控期间 ONFH 防治策略及其诊治流程中的防护管理措施，为各级医院开展 ONFH 早期防治处理提供参考意见。.

Introduction: The presumably multifactorial pathomechanisms of medication-related osteonecrosis of the jaws have not been fully elucidated so far. Management of this rare but serious side effect is a real challenge and requires a multidisciplinary approach. Aim: The aim of the authors was to take stock of our present knowledge about the pathogenesis, risk factors, clinical manifestations and the possibilities of prevention and treatment in the medication-related osteonecrosis of the jaws. In addition, the available international guidelines are compared and the evidence-based, stage-specific conservative and adjuvant therapeutic approaches are also reviewed, having regard to special aspects of medical and dental care. Method: In the last 5 years - due to the increasing number of disorder-oriented database - the number of available systematic reviews, recommendations and meta-analyses has escalated significantly which we reviewed and compared. Results: Since the last Position Paper published by the taskforce of the American Association of Oral and Maxillofacial Surgeons, novel pharmacological groups with the potential to induce osteonecrosis have come in the clinical scope, further elaborating the nomenclature of the disease and further specifying patient groups. The sphere of patients at risk has broadened and novel patient groups (rheumatologic-osteological, immunosuppressed, transplanted or oncological patients treated with monoclonal antibody, known as \'target therapy\') are expected to develop this serious side effect. Conclusion: Although a number of issues are still open regarding the treatment of the disorder, evidence-based, individualized, stage-adapted therapeutic approaches have replaced the previous empirical treatment. Orv Hetil. 2020; 161(6): 214-223.
Absztrakt: Bevezetés: A multifaktoriális, nem teljesen tisztázott patomechanizmusú, gyógyszer okozta állcsontelhalás kezelése napjainkban is nagy kihívást jelent a maxillofacialis sebészek és fogorvosok, valamint az onkológiai és oszteológiai gyógyszert felíró kezelőorvosok számára. Célkitűzés: Közleményünkben célul tűztük ki, hogy az aktuális szakirodalom áttekintését követően bemutassuk a változásokat a gyógyszer okozta állcsontelhalások patogenezisének, rizikótényezőinek, klinikai megjelenési formáinak, illetve a megelőzési és az új terápiás lehetőségeknek a tekintetében. Az elérhető nemzetközi ajánlások összehasonlításán, a nem sebészi és a sebészi, valamint a stádiumspecifikus kezelési módok evidenciaalapú bemutatásán túl a különböző orvosi-fogorvosi diszciplinákat érintő specifikumok bemutatására is törekszünk. Módszer: Az elmúlt 5 évben – az egyre növekvő számú betegségorientált adatbázisnak köszönhetően – a szakirodalomban megnőtt a szisztematikus szakirodalmi áttekintések (systematic reviews), ajánlások és metaanalízisek száma; ezek áttekintését és összehasonlító elemzését végeztük el a kitűzött célok vonatkozásában. Eredmények: Az American Association of Oral and Maxillofacial Surgeons munkacsoportjának legutóbbi ajánlása óta eltelt 4 évben is számos új gyógyszerhatástani csoport került a klinikusok látókörébe mint osteonecrosist indukáló potenciális ágens, így a betegség nómenklatúrája tovább cizellálódott, a betegcsoportok tovább specifikálódtak. A rizikóbetegek köre kiszélesedett, új betegpopulációknak (reumatológiai-oszteológiai betegek, immunszupprimáltak, transzplantáltak, új onkológiai ’target’ [célzott] terápiában részesülők) kell a súlyos mellékhatás kialakulásával számolniuk. Következtetés: Noha a betegcsoport kezelésében számos kérdés továbbra is nyitva áll, a korábbi empirikus kezelési formák helyett egyre erősebb evidenciákon alapuló, egyénspecifikus, stádiumadaptált terápiás megoldások körvonalazódnak. Orv Hetil. 2020; 161(6): 214–223.

Whole-body MRI is an imaging method that uses advanced modern MRI equipment to provide high-resolution images of the entire body. The goal of these guidelines is to specify the indications for which whole-body MRI can be recommended in children and adolescents and to describe the necessary technical requirements. CITATION FORMAT: · Schaefer JF, Berthold LD, Hahn G et al. Whole-Body MRI in Children and Adolescents - S1 Guidelines. Fortschr Röntgenstr 2019; 191: 618 - 625.
Die Ganzkörper-Magnetresonanztomografie (GK-MRT) ist eine bildgebende Methode, welche unter Nutzung fortgeschrittener Verfahren moderner MRT-Geräte eine hochaufgelöste Darstellung des gesamten Körpers ermöglicht. Ziel dieser Leitlinie ist es, Indikationen zu benennen, bei denen die GK-MRT im Kindes- und Jugendalter empfohlen werden kann, und dafür notwendige, technische Voraussetzungen zu beschreiben. ZITIERWEISE: · Schaefer JF, Berthold LD, Hahn G et al. Whole-Body MRI in Children and Adolescents – S1 Guidelines. Fortschr Röntgenstr 2019; 191: 618 – 625.

Aims: The purpose of this study was to assess the relationship between genetic variants and steroid-induced osteonecrosis of the femoral head (SONFH) in steroid use populations. Methods: We searched the public databases up to April 15, 2018. This study analyzed only the single-nucleotide polymorphisms (SNPs) that have appeared in more than three studies and assessed the level of evidence by classifying the outcomes according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. Results: The ABCB1 rs1045642 C>T mutation had a protective effect against SONFH in the allelic model (I 2 = 50.2%; OR: 0.74; 95% CI: 0.55-1.00; p = 0.046). The rs2032582 mutation in the ABCB1 gene showed no relationship to SONFH (allelic model: I 2 = 63.4%; OR: 0.85; 95% CI: 0.58-1.23; p = 0.382). In ApoB rs693, four models showed that mutations can increase SONFH risk, but the allelic model did not. The ApoB rs1042031 mutation increased SONFH risk in the dominant model (I 2 = 50.3%; OR: 2.90; 95% CI: 1.49-5.66; p = 0.002). Conclusion: An allelic model of ABCB1 rs1045642 showed that mutations have a protective effect against SONFH at a very low level of evidence. The mutations in ApoB rs693 and rs1042031 increase the SONFH risk with moderate levels of evidence.

Total knee arthroplasty (TKA) is one of the most frequent surgical procedures in orthopaedic surgery. Until now there have not been any standardized indication criteria, which might contribute to the large geographical differences in the frequency of TKA. This guideline aims to consent minimal requirements (main criteria), additional important aspects (minor criteria), as well as relative and absolute contraindications for TKA. The following main criteria have been consented: knee pain, radiological confirmation of osteoarthritis or osteonecrosis, inadequate response to conservative treatment, adverse impact of knee disease on the patient\'s quality of life and the burden of suffering due to the knee disease. Relative contraindications have been consented as severe general disease with reduced life expectancy and a BMI ≥40; absolute contraindications are an active infection and if the patient is not able to undergo major surgery.