Krueger Courtney D, West Patricia M, Sargent Matthew, Lodolce Amy E, Pickard A Simon
Department of Pharmacy Practice, College of Pharmacy, University of Illinois at Chicago, Chicago, IL 60612, USA.
Ann Pharmacother. 2007 Feb;41(2):276-84. doi: 10.1345/aph.1H521. Epub 2007 Feb 13.
To review the risk of osteonecrosis of the jaw associated with bisphosphonates.
A MEDLINE search (1966-January 2007) and a search of International Pharmaceutical Abstracts (1970-January 2007) were conducted to identify relevant literature. Additional references were reviewed from selected articles.
Articles related to bisphosphonate-induced osteonecrosis of the jaw were reviewed and summarized. Inclusion criteria required that articles be either case studies or case series that were reporting actual cases linking osteonecrosis of the jaw with bisphosphonate use. Articles that addressed sites of osteonecrosis not involving the jaw, teaching cases (fictitious patients), and a retrospective claims analysis paper were excluded from consideration.
Bisphosphonates have recently been linked to osteonecrosis of the jaw, with the greatest incidence seen with the intravenous preparations zoledronic acid and pamidronate. Osteonecrosis refers to death of a part of the bone, resulting in decreased bone density. Although the majority of occurrences have been associated with the intravenous bisphosphonates, oral bisphosphonates have also been implicated. Other risk factors noted from reported cases include dental extraction or trauma to the jaw exposing part of the bone. It is difficult to determine an exact incidence of osteonecrosis of the jaw in the general population of patients prescribed bisphosphonates; however, the incidence in cancer patients is approximately 6-7%.
Although discontinuation of intravenous bisphosphonates in cancer patients has been recommended, stopping oral bisphosphonates prior to dental work cannot be universally endorsed at this time, since it is unknown whether this is effective in reducing the risk of osteonecrosis of the jaw. Treatment of this condition is not well established; therefore, efforts should be directed toward prevention. Pharmacists may further counsel patients to practice good oral hygiene and regularly follow up with their dentist during therapy. Current evidence suggests limited surgical debridement with systemic and local antibiotics as treatments.
回顾与双膦酸盐相关的颌骨坏死风险。
进行了MEDLINE检索（1966年1月至2007年1月）以及国际药学文摘检索（1970年1月至2007年1月）以识别相关文献。从选定文章中查阅了其他参考文献。
对与双膦酸盐诱导的颌骨坏死相关的文章进行了综述和总结。纳入标准要求文章为病例研究或病例系列，报告将颌骨坏死与双膦酸盐使用联系起来的实际病例。涉及非颌骨部位的骨坏死、教学病例（虚构患者）以及回顾性索赔分析论文的文章被排除在考虑范围之外。
双膦酸盐最近与颌骨坏死相关，静脉制剂唑来膦酸和帕米膦酸的发生率最高。骨坏死是指骨的一部分死亡，导致骨密度降低。尽管大多数病例与静脉用双膦酸盐有关，但口服双膦酸盐也有牵连。报告病例中指出的其他风险因素包括拔牙或颌骨创伤导致部分骨暴露。在开具双膦酸盐的患者总体人群中，很难确定颌骨坏死的确切发生率；然而，癌症患者中的发生率约为6 - 7%。
尽管已建议癌症患者停用静脉用双膦酸盐，但目前不能普遍认可在牙科治疗前停用口服双膦酸盐，因为尚不清楚这是否能有效降低颌骨坏死的风险。这种情况的治疗方法尚未明确确立；因此，应致力于预防。药剂师可进一步建议患者保持良好的口腔卫生，并在治疗期间定期与牙医随访。目前的证据表明，全身和局部使用抗生素的有限手术清创术可作为治疗方法。
