Dimopoulos M A, Kastritis E, Bamia C, Melakopoulos I, Gika D, Roussou M, Migkou M, Eleftherakis-Papaiakovou E, Christoulas D, Terpos E, Bamias A
Department of Clinical Therapeutics, Medical School, University of Athens, Greece.
Ann Oncol. 2009 Jan;20(1):117-20. doi: 10.1093/annonc/mdn554. Epub 2008 Aug 9.
Osteonecrosis of the jaw (ONJ) is a well-described complication of bisphosphonates use in patients with multiple myeloma (MM). We investigated whether the occurrence of ONJ decreased after the implementation of preventive measures in 128 patients with MM who received zoledronic acid.
Patients with MM who received zoledronic acid were included in this analysis. Patients with a previous use of other bisphosphonates were excluded; patients were stratified into group A (n=38) and group B (n=90) if treatment was started before or after the implementation of preventive measures.
One hundred and twenty-eight patients were included in this analysis. Sixteen patients (12.5%) developed ONJ--group A: 8 (26.3%), group B: 2 (6.7%) (P=0.002). The incidence rate (IR) was 0.671/100 person-months for group A and 0.230/100 person-months for group B [IR ratio 2.92, P=0.029, 95% confidence interval 1.06-8.03]. No patient in group B developed stage III ONJ.
In conclusion, the risk of developing ONJ after treatment of zoledronic acid is reduced (but not deleted) by the implementation of preventive measures.
颌骨坏死（ONJ）是多发性骨髓瘤（MM）患者使用双膦酸盐类药物时一种已被充分描述的并发症。我们调查了在128例接受唑来膦酸治疗的MM患者中实施预防措施后ONJ的发生率是否降低。
接受唑来膦酸治疗的MM患者纳入本分析。排除既往使用过其他双膦酸盐类药物的患者；如果治疗在预防措施实施之前或之后开始，患者被分为A组（n = 38）和B组（n = 90）。
128例患者纳入本分析。16例患者（12.5%）发生ONJ——A组：8例（26.3%），B组：2例（6.7%）（P = 0.002）。A组的发病率（IR）为0.671/100人月，B组为0.230/100人月[IR比值2.92，P = 0.029，95%置信区间1.06 - 8.03]。B组无患者发生III期ONJ。
总之，实施预防措施可降低（但未消除）唑来膦酸治疗后发生ONJ的风险。
