Search

Since Marx reported on osteonecrosis of the jaw caused by the injectable bisphosphonates (BPs) pamidronate and zoledronate, there have been numerous reports not only in Western countries, but in Japan as well, of bisphosphonate-related osteonecrosis of the jaw (BRONJ) as a pathology similar to radiation-related osteonecrosis/osteomyelitis of the jaw, which is accompanied by exposure of the bone. Osteonecrosis of the jaw similar to that occurring with BPs is also produced with the anti-receptor activator of nuclear factor kappa-Β ligand (RANKL) antibody denosumab, a bone resorption inhibitor that has a different mode of action from BPs, and there is also a report of osteonecrosis of the jaw related to bevacizumab, an angiogenic inhibitor. Because of this, in its newest position paper (2014), the AAOMS changed the nomenclature from BRONJ to "medication-related osteonecrosis of the jaw" (MRONJ). This article presents an overview of the position paper on medication-related osteonecrosis of the jaw and the current status of the MRONJ in Japan. [ABSTRACT FROM AUTHOR]

The incidence of thyroid carcinoma has been increasing worldwide. This is interpreted as an increase in the incidental detection of papillary thyroid microcarcinomas (PTMCs). However, mortality has not changed, suggesting overdiagnosis and overtreatment. Prospective clinical trials of active surveillance for low-risk PTMC (T1aN0M0) have been conducted in two Japanese institutions since the 1990s. Based on the favorable outcomes of these trials, active surveillance has been gradually adopted worldwide. A task force on the management of PTMC in adults organized by the Japan Thyroid Association therefore conducted a systematic review and has produced the present position paper based on the scientific evidence concerning active surveillance. This paper indicates evidence for the increased incidence of PTMC, favorable surgical outcomes for low-risk PTMC, recommended criteria for diagnosis using fine needle aspiration cytology, and evaluation of lymph node metastasis (LNM), extrathyroidal extension (ETE) and distant metastasis. Active surveillance has also been reported with a low incidence of disease progression and no subsequent recurrence or adverse events on survival if conversion surgery was performed at a slightly advanced stage. Active surveillance is a safe and valid strategy for PTMC, because it might preserve physical quality of life and reduce 10-year medical costs. However, some points should be noted when performing active surveillance. Immediate surgery is needed for PTMC showing high-risk features, such as clinical LNM, ETE or distant metastasis. Active surveillance should be performed under an appropriate medical team and should be continued for life.