Saia Giorgia, Blandamura Stella, Bettini Giordana, Tronchet Anita, Totola Andrea, Bedogni Giorgio, Ferronato Giuseppe, Nocini Pier Francesco, Bedogni Alberto
Unit of Maxillofacial Surgery, University of Padova, Padua, Italy.
J Oral Maxillofac Surg. 2010 Apr;68(4):797-804. doi: 10.1016/j.joms.2009.10.026.
To evaluate the occurrence of bisphosphonate-related osteonecrosis of the jaw (BRONJ) in patients exposed to nitrogen-containing bisphosphonates (NBPs) requiring surgical tooth extraction.
Sixty high-risk patients exposed to NBPs underwent surgical tooth extraction with bone biopsy and were treated with a 7-day cycle of oral antibiotics and discontinuation of NBPs for 1 month. BRONJ was defined as the occurrence of any BRONJ stage (0-3) at 3, 6, or 12 months of follow-up. Inferential analysis was performed on a per-bone (maxilla and/or mandible) basis (n = 72). The time to BRONJ was calculated, and age, gender, cancer diagnosis, and baseline osteomyelitis were evaluated as potential predictors. Exact logistic regression was used to model the time-to-outcome relationship, and hazard rates were calculated from logistic probabilities.
BRONJ was detected at 3 months' follow-up in 4 bones and at 6 months in 1 further bone. In the whole cohort of bones, the hazard rate of BRONJ was 5.6% at 3 months and 1.5% at 6 months. Baseline osteomyelitis was a strong risk factor for BRONJ development (odds ratio, 156.96; exact 95% confidence interval, 18.99 to infinity; exact P < .0001).
In this 12-month follow-up study, BRONJ was a rare outcome in high-risk NBP users who underwent surgical tooth extraction. Moreover, baseline osteomyelitis was a very strong risk factor for BRONJ development.
评估接受含氮双膦酸盐（NBP）治疗且需要进行外科拔牙的患者发生双膦酸盐相关颌骨坏死（BRONJ）的情况。
60例暴露于NBP的高危患者接受了外科拔牙及骨活检，并接受为期7天的口服抗生素治疗，同时停用NBP 1个月。BRONJ定义为在随访3、6或12个月时出现任何BRONJ分期（0 - 3期）。基于每块骨（上颌骨和/或下颌骨）进行推断性分析（n = 72）。计算BRONJ的发生时间，并评估年龄、性别、癌症诊断和基线骨髓炎作为潜在预测因素。采用精确逻辑回归对结局时间关系进行建模，并根据逻辑概率计算风险率。
在随访3个月时，4块骨检测到BRONJ，6个月时又有1块骨检测到。在整个骨队列中，BRONJ的风险率在3个月时为5.6%，6个月时为1.5%。基线骨髓炎是BRONJ发生的一个强风险因素（优势比，156.96；精确95%置信区间，18.99至无穷大；精确P <.0001）。
在这项为期12个月的随访研究中，接受外科拔牙的高危NBP使用者中BRONJ是一种罕见的结局。此外，基线骨髓炎是BRONJ发生的一个非常强的风险因素。
