Merigo E, Manfredi M, Meleti M, Corradi D, Vescovi P
Dipartimento di Scienze Otorino-Odonto-Oftalmologiche e Cervico-Facciali, Sezione di Odontostomatologia, Università degli Studi di Parma, Parma, Italy.
J Oral Pathol Med. 2005 Nov;34(10):613-7. doi: 10.1111/j.1600-0714.2005.00351.x.
Jaw bone necrosis is a clinical condition associated with defects in vascularization of the maxilla or the mandibular bone, usually present following head and neck radiotherapy and/or oral surgical interventions. Bisphosphonates are synthetic analogues of pyrophosphate used in the treatment of patients with hypercalcemia as a result of malignancy, bone metastasis and for the treatment of other disorders such as metabolic bone diseases, Paget's disease and osteoporosis. Over last 10 years, cases of jaw bone necrosis have been associated with the use of bisphosphonate therapy. In particular, Ruggiero et al. (J Oral Maxillofac Surg 2004; 62: 527-534) in 2004 described a large group of patients (63) with jaw bone necrosis probably related to the use of these drugs. It should be noted that all the patients in the group described either underwent head and neck radiotherapy or had a dental extraction while taking bisphosphonates. In the present study, we reported four cases of jawbone necrosis in patients taking pamidronate (Aredia) and zoledronate (Zometa) without having undergone any kind of radiotherapy or dental surgery. All the patients were females between the ages of 56 and 71 years; three were treated with bisphosphonates for bone metastasis and one for multiple myeloma. All the patients received surgical treatment with bone curettage, with partial and/or temporary improvement of the lesions. Although a treatment for bisphosphonate-induced bone lesions has not yet been established, we suggest careful evaluation of the patients' oral health before prescribing bisphosphonate treatment.
颌骨坏死是一种与上颌骨或下颌骨血管化缺陷相关的临床病症，通常在头颈部放疗和/或口腔外科手术后出现。双膦酸盐是焦磷酸盐的合成类似物，用于治疗因恶性肿瘤、骨转移导致的高钙血症患者，以及治疗其他疾病，如代谢性骨病、佩吉特病和骨质疏松症。在过去10年中，颌骨坏死病例与双膦酸盐治疗有关。特别是，Ruggiero等人（《口腔颌面外科杂志》2004年；62：527 - 534）在2004年描述了一大组（63例）可能与使用这些药物有关的颌骨坏死患者。应该注意的是，该组中所有患者要么接受了头颈部放疗，要么在服用双膦酸盐时进行了拔牙。在本研究中，我们报告了4例服用帕米膦酸（阿可达）和唑来膦酸（择泰）的患者发生颌骨坏死，且未接受任何放疗或牙科手术。所有患者均为56至71岁的女性；3例因骨转移接受双膦酸盐治疗，1例因多发性骨髓瘤接受治疗。所有患者均接受了骨刮除术的手术治疗，病变有部分和/或暂时改善。尽管尚未确立双膦酸盐诱导骨病变的治疗方法，但我们建议在开双膦酸盐治疗处方前仔细评估患者的口腔健康状况。
