Cetiner Sedat, Sucak Gulsan Turkoz, Kahraman Sevil Altundag, Aki Sahika Zeynep, Kocakahyaoglu Benay, Gultekin Sibel Elif, Cetiner Mustafa, Haznedar Rauf
Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Gazi University, Ankara, Turkey.
J Bone Miner Metab. 2009;27(4):435-43. doi: 10.1007/s00774-009-0047-9. Epub 2009 Feb 26.
Intravenous bisphosphonates-the potent inhibitors of osteoclast-mediated bone resorption are among the most commonly prescribed drugs in the management of multiple myeloma (MM). Zoledronic acid (ZA) is a new generation potent intravenous bisphosphonate that has been approved for the treatment and prevention of bone lesions, and/or hypercalcemia associated with MM. Osteonecrosis of the jaw (ONJ) is an emerging serious side effect of the new generation bisphosphonates with a growing number of reports related to this pathological entity. ONJ usually appears following oral surgical and dental procedures but sometimes occur spontaneously. These cases are mostly seen and treated by dentists and oral surgeons. The aim of this study was to discuss the frequency, characteristics, risk factors, management and histopathological features of ZA induced ONJ based on the literature and illustrated with five own cases. Thirty-two patients with MM who received ZA for a median period of 26.5 +/- 18.7 months (min: 5 months, max: 76 months) were evaluated. ONJ was detected in five patients and mean drug duration time was 34 months. The frequency was 15% and the patients were usually symptomatic. There was no significant difference in terms of the duration of ZA in patients with and without ONJ. Management of these established cases were performed with medical treatment, minor debridement, sequestrectomy, and combining bone resection with autologous platelet rich plasma. Our data indicate that ZA therapy has a major role in the development of ONJ a fact that should be considered by physicians treating MM patients.
静脉注射双膦酸盐——破骨细胞介导的骨吸收的强效抑制剂，是多发性骨髓瘤（MM）治疗中最常用的药物之一。唑来膦酸（ZA）是新一代强效静脉注射双膦酸盐，已被批准用于治疗和预防与MM相关的骨病变和/或高钙血症。颌骨骨坏死（ONJ）是新一代双膦酸盐新出现的一种严重副作用，与这种病理实体相关的报道越来越多。ONJ通常在口腔外科手术和牙科手术后出现，但有时也会自发发生。这些病例大多由牙医和口腔外科医生诊治。本研究的目的是基于文献并结合5例自身病例，探讨ZA诱导的ONJ的发生率、特征、危险因素、治疗及组织病理学特征。对32例接受ZA治疗的MM患者进行了评估，中位治疗时间为26.5±18.7个月（最短：5个月，最长：76个月）。5例患者检测到ONJ，平均用药时间为34个月。发生率为15%，患者通常有症状。发生ONJ和未发生ONJ的患者在ZA用药时间方面无显著差异。对这些确诊病例采用药物治疗、轻微清创、死骨切除术以及骨切除联合自体富血小板血浆进行治疗。我们的数据表明，ZA治疗在ONJ的发生中起主要作用，治疗MM患者的医生应考虑这一事实。
