Departments of Oral Maxillofacial Surgery, Theagenio Cancer Hospital, Thessaloniki, Greece.
J Clin Oncol. 2009 Nov 10;27(32):5356-62. doi: 10.1200/JCO.2009.21.9584. Epub 2009 Oct 5.
The reported incidence of osteonecrosis of the jaw (ONJ) ranges from 0.94% to 18.6%. This cohort study aimed to calculate the incidence of and identify the risk factors for ONJ in patients with cancer treated with intravenous zoledronate, ibandronate, and pamidronate.
Data analyzed included age, sex, smoking status, underlying disease, medical and dental history, bisphosphonates (BP) type, and doses administered. Relative risks, crude and adjusted odds ratios (aORs), and cumulative hazard ratios for ONJ development were calculated.
We included 1,621 patients who received 29,006 intravenous doses of BP, given monthly. Crude ONJ incidence was 8.5%, 3.1%, and 4.9% in patients with multiple myeloma, breast cancer, and prostate cancer, respectively. Patients with breast cancer demonstrated a reduced risk for ONJ development, which turned out to be nonsignificant after adjustment for other variables. Multivariate analysis demonstrated that use of dentures (aOR = 2.02; 95% CI, 1.03 to 3.96), history of dental extraction (aOR = 32.97; 95% CI, 18.02 to 60.31), having ever received zoledronate (aOR = 28.09; 95% CI, 5.74 to 137.43), and each zoledronate dose (aOR = 2.02; 95% CI, 1.15 to 3.56) were associated with increased risk for ONJ development. Smoking, periodontitis, and root canal treatment did not increase risk for ONJ in patients receiving BP.
The conclusions of this study validated dental extractions and use of dentures as risk factors for ONJ development. Ibandronate and pamidronate at the dosages and frequency used in this study seem to exhibit a safer drug profile concerning ONJ complication; however, randomized controlled trials are needed to validate these results. Before initiation of a bisphosphonate, patients should have a comprehensive dental examination. Patients with a challenging dental situation should have dental care attended to before initiation of these drugs.
报道的颌骨骨坏死（ONJ）发生率为 0.94%至 18.6%。本队列研究旨在计算接受静脉唑来膦酸、伊班膦酸和帕米膦酸治疗的癌症患者中 ONJ 的发生率，并确定其危险因素。
分析的数据包括年龄、性别、吸烟状况、基础疾病、医疗和牙科史、双膦酸盐（BP）类型和给药剂量。计算了 ONJ 发生的相对风险、粗和调整后的比值比（aOR）以及累积危险比。
我们纳入了 1621 名接受了 29006 次静脉 BP 治疗的患者，每月给药 1 次。多发性骨髓瘤、乳腺癌和前列腺癌患者的 ONJ 发生率分别为 8.5%、3.1%和 4.9%。乳腺癌患者的 ONJ 发病风险降低，但在调整其他变量后无统计学意义。多变量分析表明，使用义齿（aOR=2.02；95%CI，1.03 至 3.96）、有牙科拔牙史（aOR=32.97；95%CI，18.02 至 60.31）、曾接受唑来膦酸治疗（aOR=28.09；95%CI，5.74 至 137.43）和每次唑来膦酸剂量（aOR=2.02；95%CI，1.15 至 3.56）与 ONJ 发病风险增加相关。在接受 BP 治疗的患者中，吸烟、牙周炎和根管治疗并未增加 ONJ 的风险。
本研究的结论证实了牙科拔牙和使用义齿是 ONJ 发病的危险因素。伊班膦酸和帕米膦酸在本研究中使用的剂量和频率似乎表现出对 ONJ 并发症更安全的药物特征；然而，需要随机对照试验来验证这些结果。在开始使用双膦酸盐之前，患者应进行全面的牙科检查。有挑战性的牙科情况的患者应在开始使用这些药物之前进行牙科护理。
