Calvo-Villas José Manuel, Tapia Torres Maria, Govantes Rodríguez José, Carreter de Granda Elena, Sicilia Guillén Francisco
Servico de Hematología. Hospital General de Lanzarote. Arrecife de Lanzarote. Las Palmas. España.
Med Clin (Barc). 2006 Oct 21;127(15):576-9. doi: 10.1016/s0025-7753(06)72338-7.
To analyze the incidence, the clinical features, and the factors associated with the development of osteonecrosis of the jaw (ONJ) in patients with multiple myeloma (MM) treated with zoledronic acid.
Sixty-four patients diagnosed with MM and treated with zoledronic acid between August 1996 and March 2006 were included. Demographic data, predisposing factors, the type of antineoplastic therapy received and the infusions of biophosphonate were recorded. The main characteristics of the seven patients with ONJ, including clinical and physical examinations data, diagnostic methods and treatment established were reported.
The overall incidence of ONJ was 7 out of 64 patients (10.93%). A recent oral surgical procedure has been associated with the ONJ (p < 0.0001). The mean of infusions of zoledronic acid before onset of osteonecrosis (standard deviation) was 30 (7.04) in contrast to 19.5 (11.8) cycles (p = 0.03) in the patients who did not present this complication. The cumulative risk increased from 6.7% after 20 treatments with zoledronic acid up to 31.7% at 36 infusions. Three patients exhibited ONJ after discounting zoledronic acid.
The ONJ in patients with MM who underwent dental or oral surgery appears to be associated with long term exposure to zoledronic acid. The long-lasting bone effect of biophosphonate could explain the appearance of osteonecrotic lesions after discontinuing treatment with biphosphonate.
分析接受唑来膦酸治疗的多发性骨髓瘤（MM）患者颌骨坏死（ONJ）的发生率、临床特征及相关因素。
纳入1996年8月至2006年3月间诊断为MM并接受唑来膦酸治疗的64例患者。记录人口统计学数据、易感因素、接受的抗肿瘤治疗类型及双膦酸盐输注情况。报告7例ONJ患者的主要特征，包括临床和体格检查数据、诊断方法及确立的治疗方案。
64例患者中ONJ的总发生率为7例（10.93%）。近期口腔外科手术与ONJ相关（p < 0.0001）。骨坏死发生前唑来膦酸的平均输注次数（标准差）为30次（7.04），而未出现此并发症的患者为19.5次（11.8）周期（p = 0.03）。唑来膦酸治疗20次后的累积风险从6.7%增至36次输注时的31.7%。3例患者在停用唑来膦酸后出现ONJ。
接受牙科或口腔手术的MM患者发生ONJ似乎与长期暴露于唑来膦酸有关。双膦酸盐的长期骨效应可解释停用双膦酸盐治疗后骨坏死病变的出现。
