Dehari Hironari, Tomihara Kei, Ueda Megumi, Shimanishi Makoto, Ono Masayuki, Sasaki Takanori, Igarashi Tomohiro, Shiratori Kaori, Abe Masato, Ogi Kazuhiro, Nakamori Kenji, Miyazaki Akihiro, Nagai Itaru, Hiratsuka Hiroyoshi
Dept. of Oral Surgery, Sapporo Medical University School of Medicine.
Gan To Kagaku Ryoho. 2009 Dec;36(13):2587-92.
We examined the clinical features of bisphosphonate(BP)-related osteonecrosis of the jaws(BRONJ), a serious complication resulting from intravenous BP treatment for multiple myeloma and malignant tumors with bone metastasis. We retrospectively reviewed the medical records of 36 patients who received intravenous BP therapy for the above-mentioned conditions, at Sapporo Medical University Hospital between July 2006 and October 2008. BP therapy caused BRONJ in 7 of 24 patients, but did not affect the bones of the other 17 patients. The other 12 of the 36 patients involved in the study were prescribed BP only after they had undergone an oral examination and treatment for dental inflammation. Of these patients, 7 developed BRONJ with BP treatment, after tooth extraction or acute dental inflammation. Treating dental inflammation before prescribing BP prevented the development of BRONJ. BRONJ is highly intractable and does not resolve with the standard treatment for osteomyelitis. Therefore, preventive therapy, which can be achieved by cooperation between medical doctors and dentists, is currently the most effective strategy for BRONJ. Conservative treatment with antibiotics may also be useful for maintaining or improving the quality of life of BRONJ patients.
我们研究了双膦酸盐（BP）相关颌骨骨坏死（BRONJ）的临床特征，这是一种因静脉注射BP治疗多发性骨髓瘤和伴有骨转移的恶性肿瘤而导致的严重并发症。我们回顾性分析了2006年7月至2008年10月期间在札幌医科大学医院接受上述静脉BP治疗的36例患者的病历。BP治疗导致24例患者中的7例发生BRONJ，但对其他17例患者的骨骼未产生影响。参与研究的36例患者中的另外12例仅在接受口腔检查和治疗牙齿炎症后才使用BP。在这些患者中，7例在拔牙或急性牙齿炎症后因BP治疗而发生BRONJ。在开BP之前治疗牙齿炎症可预防BRONJ的发生。BRONJ极难治疗，采用骨髓炎的标准治疗方法无法治愈。因此，目前通过医生和牙医合作实现的预防性治疗是BRONJ最有效的策略。使用抗生素进行保守治疗可能也有助于维持或改善BRONJ患者的生活质量。
