Department of Otolaryngological/Dental/Ophthalmological and Cervico-Facial Sciences, University of Parma, Parma, Italy.
Oral Oncol. 2011 Mar;47(3):191-4. doi: 10.1016/j.oraloncology.2010.11.007. Epub 2011 Feb 2.
Invasive local procedures are often reported in clinical history of patients suffering from Bisphosphonates-Related Osteonecrosis of the Jaws (BRONJ) but over 40% of spontaneous forms have been also described in literature. We compared age, gender, underlying bone disorders, bisphosphonate therapy, clinical features and surgical outcome of 205 cases (36.2%) of BRONJ non surgery-triggered (group 1) with 362 (63.8%) cases of surgery-triggered forms (group 2). Differences between group 1 and 2 were analysed using Mann-Whitney U and χ(2) tests. Statistical analysis was performed using STATA 8. Zoledronate was the most used type of bisphosphonate (63.4% versus 69.0%) and the mandible was the most frequently involved site (63.9% versus 63.4%) in both groups. BRONJ in group 1 was more frequently multicentric (9.3% versus 5%, p<0.05), had a lower clinical stage (45.9% versus 13.8% in stage 1, p<0.01) and had a better outcome after surgical therapy (improvement in 74.1% versus 58.6%, p<0.05). The high prevalence of non surgery-triggered forms of BRONJ should be considered by oncologists, haematologists and general physicians who are advised to inform their patients regarding the importance of preventive dental protocols to control the possible causes of osteonecrosis not related to dental invasive procedures.
患有 bisphosphonates-related osteonecrosis of the jaws (BRONJ) 的患者的临床病史中常报告有侵袭性局部操作，但文献中也描述了超过 40%的自发性形式。我们比较了 205 例（36.2%）非手术触发 BRONJ（第 1 组）和 362 例（63.8%）手术触发形式（第 2 组）的患者的年龄、性别、潜在骨疾病、双膦酸盐治疗、临床特征和手术结果。使用 Mann-Whitney U 和 χ(2)检验分析组 1 和 2 之间的差异。使用 STATA 8 进行统计分析。唑来膦酸盐是最常用的双膦酸盐类型（63.4%比 69.0%），下颌骨是最常受累的部位（63.9%比 63.4%）在两组中。第 1 组的 BRONJ 更常为多中心（9.3%比 5%，p<0.05），临床分期较低（第 1 期 45.9%比 13.8%，p<0.01），手术后治疗效果更好（改善 74.1%比 58.6%，p<0.05）。非手术触发形式的 BRONJ 高患病率应引起肿瘤学家、血液学家和普通内科医生的关注，建议他们告知患者有关预防牙科方案的重要性，以控制与牙科侵袭性操作无关的可能导致坏死的原因。
