Woo Sook-Bin, Hellstein John W, Kalmar John R
Brigham and Women's Hospital and Harvard School of Dental Medicine, Boston, Massachusetts 02115, USA.
Ann Intern Med. 2006 May 16;144(10):753-61. doi: 10.7326/0003-4819-144-10-200605160-00009.
Osteonecrosis of the jaws is a recently described adverse side effect of bisphosphonate therapy. Patients with multiple myeloma and metastatic carcinoma to the skeleton who are receiving intravenous, nitrogen-containing bisphosphonates are at greatest risk for osteonecrosis of the jaws; these patients represent 94% of published cases. The mandible is more commonly affected than the maxilla (2:1 ratio), and 60% of cases are preceded by a dental surgical procedure. Oversuppression of bone turnover is probably the primary mechanism for the development of this condition, although there may be contributing comorbid factors. All sites of potential jaw infection should be eliminated before bisphosphonate therapy is initiated in these patients to reduce the necessity of subsequent dentoalveolar surgery. Conservative débridement of necrotic bone, pain control, infection management, use of antimicrobial oral rinses, and withdrawal of bisphosphonates are preferable to aggressive surgical measures for treating this condition. The degree of risk for osteonecrosis in patients taking oral bisphosphonates, such as alendronate, for osteoporosis is uncertain and warrants careful monitoring.
颌骨骨坏死是双膦酸盐治疗最近被描述的一种不良副作用。接受静脉注射含氮双膦酸盐治疗的多发性骨髓瘤和骨转移癌患者发生颌骨骨坏死的风险最高；这些患者占已发表病例的94%。下颌骨比上颌骨更常受累（比例为2:1），60%的病例在牙科手术之前出现。骨转换过度抑制可能是这种情况发生的主要机制，尽管可能有其他合并因素。在这些患者开始双膦酸盐治疗之前，应消除所有潜在的颌部感染部位，以减少随后牙槽外科手术的必要性。对于治疗这种情况，坏死骨的保守清创、疼痛控制、感染管理、使用抗菌口腔含漱液以及停用双膦酸盐比积极的手术措施更可取。服用口服双膦酸盐（如阿仑膦酸钠）治疗骨质疏松症的患者发生骨坏死的风险程度尚不确定，需要仔细监测。
