[O3-5] Update on the oral-medical consortium for the frail elderly in Taiwan: a 2020- update using oral-systemic health and regional MRONJ as examples
Background: Oral-health care and overall medical services have been challenged by the dilemma of growing epidemic in the frail elderly with complex systemic disorders and physical/mental aspects of the comorbidity on ageing (geriatric syndrome), whose evident links vary considerably.
Methods: We employed the extracted 42 regional reports and surveys from national health-care database of Taiwan via key outcome measures of comorbidity & poly-pharmacy, etc., including >280 MRONJ patients from university hospitals (34% cancer survivors, 43% osteoporosis & 23% arthritis; M: 62±4.7yrs&F: 65±5.6yrs) with clinical data retrieved, whose anti-resorptives were dichotomized for on/off holidays (i.e., 4-48 months), timing of drugs-vs.-treatments and the effects as the variables for statistical correlations. Student t-test was to compare treatment variables over MRONJ-staging & timing, and the one-way ANOVA was for clinical (co)-variables among drugs to address for summing up the relative risks of the frail geriatric over the comorbidities vs. mortalities in targeted subsets. Level of significance was set at p<0.05, via SAS8.2.
Results: Our frail elderly have been impeded by: i) severe burdens of systemic illnesses with high incidences (by 2016), as <12% being completely healthy; in parallel to top-rated diabetes-associated renal dialysis, colon, breast & lung cancers, naso-gastric tubing in long-term care facilities on mortality, and the psychiatric/stress medications, etc.; whereas 85% of them taking >5 medication and notably, 1/4-1/3 vs. 30-40% of the frail elders carried high rates total edentulism vs. untreated oral diseases, respectively, regardless their socio-economic status; in addition, ii) the population collectively signified worsening rates of oral diseases (i.e., caries>43%, periodontal diseases>80%, massive missing teeth >86% and dysphagia/ chewing difficulty >30%, etc.); iii) upon hospitals-derived data-sets, there were significant differences (p<0.03, t-test) regarding the on/off-holidayed drugs over MRONJ incidences detected in cancer-survivors (i.e., 0.15-2.93%) and severe arthritis subjects (i.e., 1.75-8.76%), but not in subjects of osteoporosis (i.e., 0.3-3.69%) and such on/off-holidays (i.e., Xgeva/Prolia) was detected more effective in alleviating MRONJ episodes (p<0.05, t-test) in cancer- bearing and osteoarthritis subjects, than those with osteoporosis, respectively; iv) certain manifests associated with diabetes, renal dialysis and bleeding complications rendered the common outcomes from overall dental treatments often ineffective.
Conclusions: Herein, we summarized to report that: i) as modern oral health-care and therapies involve more than the concerning matters illustrated above; we must carefully incorporate the risk assessments and outcome-oriented analyses for the frail elderly regarding oro-systemic medical links to ensuring their safety & health capacities; ii) variations on choosing on/off holidays regarding anti-resorptives for time-intervals & outcomes measured are likely influenced by the underlying causes distinctive to alveolar bone/mucosal remodeling in MRONJ subjects during clinical progressions, whose molecular mechanisms, once revealed, will facilitate the development of new treatment protocols.
[Project IRB approval: #KMUH-E(I)-20200129]
The author’s declaration: No conflict of interest (NOI), in any way
Methods: We employed the extracted 42 regional reports and surveys from national health-care database of Taiwan via key outcome measures of comorbidity & poly-pharmacy, etc., including >280 MRONJ patients from university hospitals (34% cancer survivors, 43% osteoporosis & 23% arthritis; M: 62±4.7yrs&F: 65±5.6yrs) with clinical data retrieved, whose anti-resorptives were dichotomized for on/off holidays (i.e., 4-48 months), timing of drugs-vs.-treatments and the effects as the variables for statistical correlations. Student t-test was to compare treatment variables over MRONJ-staging & timing, and the one-way ANOVA was for clinical (co)-variables among drugs to address for summing up the relative risks of the frail geriatric over the comorbidities vs. mortalities in targeted subsets. Level of significance was set at p<0.05, via SAS8.2.
Results: Our frail elderly have been impeded by: i) severe burdens of systemic illnesses with high incidences (by 2016), as <12% being completely healthy; in parallel to top-rated diabetes-associated renal dialysis, colon, breast & lung cancers, naso-gastric tubing in long-term care facilities on mortality, and the psychiatric/stress medications, etc.; whereas 85% of them taking >5 medication and notably, 1/4-1/3 vs. 30-40% of the frail elders carried high rates total edentulism vs. untreated oral diseases, respectively, regardless their socio-economic status; in addition, ii) the population collectively signified worsening rates of oral diseases (i.e., caries>43%, periodontal diseases>80%, massive missing teeth >86% and dysphagia/ chewing difficulty >30%, etc.); iii) upon hospitals-derived data-sets, there were significant differences (p<0.03, t-test) regarding the on/off-holidayed drugs over MRONJ incidences detected in cancer-survivors (i.e., 0.15-2.93%) and severe arthritis subjects (i.e., 1.75-8.76%), but not in subjects of osteoporosis (i.e., 0.3-3.69%) and such on/off-holidays (i.e., Xgeva/Prolia) was detected more effective in alleviating MRONJ episodes (p<0.05, t-test) in cancer- bearing and osteoarthritis subjects, than those with osteoporosis, respectively; iv) certain manifests associated with diabetes, renal dialysis and bleeding complications rendered the common outcomes from overall dental treatments often ineffective.
Conclusions: Herein, we summarized to report that: i) as modern oral health-care and therapies involve more than the concerning matters illustrated above; we must carefully incorporate the risk assessments and outcome-oriented analyses for the frail elderly regarding oro-systemic medical links to ensuring their safety & health capacities; ii) variations on choosing on/off holidays regarding anti-resorptives for time-intervals & outcomes measured are likely influenced by the underlying causes distinctive to alveolar bone/mucosal remodeling in MRONJ subjects during clinical progressions, whose molecular mechanisms, once revealed, will facilitate the development of new treatment protocols.
[Project IRB approval: #KMUH-E(I)-20200129]
The author’s declaration: No conflict of interest (NOI), in any way