Arrain Yazdana, Masud Tahir
University of Birmingham School of Dentistry, St. Chad's Queensway, Birmingham B4 6N, UK.
Dent Update. 2009 Sep;36(7):415-9. doi: 10.12968/denu.2009.36.7.415.
Bisphosphonates are increasingly being used in a number of bone conditions, including osteoporosis and metastatic cancer. As a consequence, the reported cases of bisphosphonate-related osteonecrosis of the jaw (BONJ) have increased. BONJ remains rare in patients being treated for osteoporosis, but is commoner in cancer patients where the bisphosphonate doses are much higher and mode of delivery is intravenous. Recently, much more is known about classification and mode of action of the bisphosphonates. The potency of the various nitrogen-containing bisphosphonates is dependent on a number of factors including bone binding, zeta potential and inhibition of the enzyme farnesyl pyrophosphate synthase. There is current debate on why BONJ affects the jaw, particularly in relation to whether the jaw has high bone turnover or not. More is being learnt about the micro-organisms involved in the pathogenesis of BONJ and there is increasing evidence on the role of surgical treatment of this disabling condition.
Dentists should be aware of the association of bisphosphonates and BONJ. This paper provides recent knowledge on bisphosphonate action, pathogenesis of BONJ and its treatment.
双膦酸盐越来越多地用于多种骨病，包括骨质疏松症和转移性癌症。因此，双膦酸盐相关颌骨坏死（BONJ）的报告病例有所增加。BONJ在骨质疏松症治疗患者中仍然罕见，但在癌症患者中更常见，这些患者的双膦酸盐剂量更高且给药方式为静脉注射。最近，人们对双膦酸盐的分类和作用方式有了更多了解。各种含氮双膦酸盐的效力取决于多种因素，包括与骨的结合、ζ电位以及对法尼基焦磷酸合酶的抑制。目前对于BONJ为何影响颌骨存在争议，特别是关于颌骨是否具有高骨转换率。人们对参与BONJ发病机制的微生物有了更多了解，并且越来越多的证据表明手术治疗在这种致残性疾病中的作用。
牙医应了解双膦酸盐与BONJ的关联。本文提供了关于双膦酸盐作用、BONJ发病机制及其治疗的最新知识。
