Osteopenic consequences of botulinum toxin injections in the masticatory muscles: A pilot study

Karen Raphael, A. Tadinada, J. M. Bradshaw, M. N. Janal, David Sirois, K. C. Chan, A. G. Lurie

Research output: Contribution to journalArticle

Abstract

Summary: Patients with temporomandibular muscle and joint disorder (TMJD) increasingly seek and receive treatment for their pain with botulinum toxin (BoNTA; botulinum toxin A). Used intramuscularly in therapeutic doses, it produces localised paresis. Such paresis creates risk of reduced bone mineral density, or 'disuse osteopenia'. Animal studies have frequently used BoNTA as a model of paralysis to induce bone changes within short periods. Osteopenic effects can be enduring in animals but have yet to be studied in humans. This is the first study in humans to examine bone-related consequences of BoNTA injections in the masticatory muscles, comparing oral and maxillofacial radiologists' ratings of trabecular bone patterns in the condyles of patients with TMJD exposed to multiple masticatory muscle injection sessions with BoNTA to a sample of patients with TMJD unexposed to masticatory muscle injections with BoNTA. Cone-beam computed tomography (CBCT)-derived images of bilateral condyles were evaluated in seven patients with TMJD receiving 2+ recent BoNTA treatment sessions for facial pain and nine demographically matched patients with TMJD not receiving BoNTA treatment. Two oral and maxillofacial radiologists evaluated CBCT images for evidence of trabecular changes consistent with osteopenia. Both evaluators noted decreased density in all participants exposed to BoNTA and in none of the unexposed participants (P < 0·001). No other abnormalities associated with reduced loading were detected. These findings need replication in a larger sample and over a longer time period, to ensure safety of patients with TMJD receiving multiple BoNTA injections for their pain.

Original languageEnglish (US)
Pages (from-to)555-563
Number of pages9
JournalJournal of Oral Rehabilitation
Volume41
Issue number8
DOIs
StatePublished - 2014

Fingerprint

Masticatory Muscles
Temporomandibular Joint Disorders
Botulinum Toxins
Muscular Diseases
Injections
Bone and Bones
Cone-Beam Computed Tomography
Metabolic Bone Diseases
Paresis
Pain
Facial Pain
Type A Botulinum Toxins
Therapeutics
Patient Safety
Paralysis
Bone Density

Keywords

  • Bone density
  • Bone remodelling
  • Botulinum toxin
  • Osteopenia
  • Temporo-mandibular joint
  • Temporomandibular disorders

ASJC Scopus subject areas

  • Dentistry(all)
  • Medicine(all)

Cite this

Osteopenic consequences of botulinum toxin injections in the masticatory muscles : A pilot study. / Raphael, Karen; Tadinada, A.; Bradshaw, J. M.; Janal, M. N.; Sirois, David; Chan, K. C.; Lurie, A. G.

In: Journal of Oral Rehabilitation, Vol. 41, No. 8, 2014, p. 555-563.

Research output: Contribution to journalArticle

Raphael, Karen ; Tadinada, A. ; Bradshaw, J. M. ; Janal, M. N. ; Sirois, David ; Chan, K. C. ; Lurie, A. G. / Osteopenic consequences of botulinum toxin injections in the masticatory muscles : A pilot study. In: Journal of Oral Rehabilitation. 2014 ; Vol. 41, No. 8. pp. 555-563.
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