Thakkar S G, Isada C, Smith J, Karam M A, Reed J, Tomford J W, Englund K, Richmond M, Licata A, Hatch C, Hussein M A
Multiple Myeloma Multidisciplinary Clinical Research Program-R35, Cleveland Clinic Foundation 9500 Euclid Avenue, OH 44195,
Med Oncol. 2006;23(1):51-6. doi: 10.1385/MO:23:1:51.
Osteonecrosis of the jaw has been linked with bisphosphonate use in breast cancer and multiple myeloma patients. We report 17 cases of patients with plasma cell dyscrasia being treated with bisphosphonate who developed osteonecrosis/osteomyelitis of the jaw. Seventeen patients evaluated at our institution between 1998 and 2005 are reported. All were being treated with bisphosphonates for a median of 5 mo prior to the onset of jaw symptoms. Sixteen of the 17 patients are 51 yr or older. None of the patients had been irradiated in the jaw nor had obvious osseous manifestation of multiple myeloma in the jaw. Thirteen patients were receiving zoledronic acid and four patients were receiving pamidronate at the onset of jaw symptoms. Six of the 17 did receive both agents at some time and all of these individuals were receiving zoledronic acid at diagnosis. Microorganisms were isolated in 7/17 patients with the most common organism being actinomycosis. We have initiated the following guidelines in an effort to ameliorate the incidence of this complication. Patients should have a full dental examination at the time of diagnosis of the plasma cell dyscrasia especially if bisphosphonates are to be considered as part of the therapy. In addition, bisphosphonates are held for a period of 3 mo prior to invasive dental procedures to allow for the osteoclastic recovery, therefore enhanced debris removal and lessening the chance of creating a fertile bacterial medium. Following the dental procedure we would re-introduce bisphosphonates only after the healing process is complete. Finally, multiple myeloma patients diagnosed with jaw osteonecrosis probably have a concurrent infection and should be aggressively treated with antibiotics.
颌骨坏死与乳腺癌和多发性骨髓瘤患者使用双膦酸盐有关。我们报告了17例接受双膦酸盐治疗的浆细胞异常增生患者发生颌骨坏死/骨髓炎的病例。本文报告了1998年至2005年间在我们机构评估的17例患者。所有患者在出现颌部症状前接受双膦酸盐治疗的中位时间为5个月。17例患者中有16例年龄在51岁及以上。所有患者颌部均未接受过放射治疗，颌部也没有明显的多发性骨髓瘤骨表现。13例患者在出现颌部症状时正在接受唑来膦酸治疗，4例患者正在接受帕米膦酸治疗。17例患者中有6例在某些时候同时接受了这两种药物治疗，所有这些患者在诊断时都在接受唑来膦酸治疗。17例患者中有7例分离出微生物，最常见的微生物是放线菌。我们已制定以下指南，以努力降低这种并发症的发生率。患者在诊断浆细胞异常增生时应进行全面的牙科检查，特别是如果考虑将双膦酸盐作为治疗的一部分。此外，在进行侵入性牙科手术前3个月停用双膦酸盐，以促进破骨细胞恢复，从而增强碎屑清除并减少形成肥沃细菌培养基的机会。牙科手术后，只有在愈合过程完成后才重新使用双膦酸盐。最后，诊断为颌骨坏死的多发性骨髓瘤患者可能同时存在感染，应积极使用抗生素治疗。
