Otto Sven, Hafner Sigurd, Mast Gerson, Tischer Thomas, Volkmer Elias, Schieker Matthias, Stürzenbaum Stephen R, von Tresckow Emmo, Kolk Andreas, Ehrenfeld Michael, Pautke Christoph
Department of Oral and Maxillofacial Surgery, Ludwig Maximilians University of Munich, Munich, Germany.
J Oral Maxillofac Surg. 2010 May;68(5):1158-61. doi: 10.1016/j.joms.2009.07.079.
Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a side effect of bisphosphonate therapy, primarily diagnosed in patients with cancer and metastatic bone disease and receiving intravenous administrations of nitrogen-containing bisphosphonates. If diagnosis or treatment is delayed, BRONJ can develop to a severe and devastating disease. Numerous studies have focused on BRONJ, with possible pathomechanisms identified to be oversuppression of bone turnover, ischemia due to antiangiogenetic effects, local infections, or soft tissue toxicity. However, the precise pathogenesis largely remains elusive and questions of paramount importance await to be answered, namely 1) Why is only the jaw bone affected? 2) Why and how do the derivatives differ in their potency to induce a BRONJ? and 3) Why and when is BRONJ manifested? The present perspective reflects on existing theories and introduces the hypothesis that local tissue acidosis in the jaw bone offers a conclusive pathogenesis model and may prove to be the missing link in BRONJ.
双膦酸盐相关颌骨坏死（BRONJ）是双膦酸盐治疗的一种副作用，主要在患有癌症和转移性骨病且接受含氮双膦酸盐静脉给药的患者中诊断出来。如果诊断或治疗延迟，BRONJ可能发展成一种严重且具有破坏性的疾病。许多研究都聚焦于BRONJ，已确定的可能发病机制包括骨转换过度抑制、抗血管生成作用导致的缺血、局部感染或软组织毒性。然而，确切的发病机制在很大程度上仍然难以捉摸，一些至关重要的问题有待解答，即：1）为什么仅颌骨会受到影响？2）为什么以及衍生物诱导BRONJ的效力如何不同？3）BRONJ为什么以及何时会表现出来？本观点对现有理论进行了反思，并提出假说，即颌骨局部组织酸中毒提供了一个确凿的发病机制模型，可能是BRONJ中缺失的环节。
