College of Dentistry, University of Tennessee Memphis, Tennessee, USA.
J Am Geriatr Soc. 2011 Dec;59(12):2350-5. doi: 10.1111/j.1532-5415.2011.03713.x. Epub 2011 Nov 8.
Bisphosphonates are used worldwide as a successful treatment for people with osteoporosis, which is the major underlying cause of fractures in postmenopausal women and older adults. These agents are successful at increasing bone mass and bone trabecular thickness, decreasing the risk of fracture, and decreasing bone pain, enabling individuals to have better quality of life. Bisphosphonates are also used to treat multiple myeloma, bone metastasis, and Paget's disease; however, bisphosphonate treatment may result in negative side effects, including osteonecrosis of the jaw (ONJ). ONJ involves necrotic, exposed bone in the jaw, pain, possible secondary infection, swelling, painful lesions, and various dysesthesias, although less-severe cases may be asymptomatic. First-generation bisphosphonates, which do not contain nitrogen, are metabolized into a nonfunctional, cytotoxic analogue of adenosine triphosphate and cause osteoclast death by starvation. Second-generation bisphosphonates are nitrogen-containing agents; these inhibit osteoclast vesicular trafficking, membrane ruffling, morphology, and cytoskeletal arrangement by inhibiting farnesyl diphosphate synthase in the mevalonate pathway. Physicians treating older adults with osteoporosis and cancer should work together with dental practitioners, pharmacists, and other clinicians to inform individuals receiving bisphosphonates of their possible side effects and to suggest precautionary steps that may minimize the risk of osteonecrosis, particularly of the jaw. These include practicing good oral hygiene; scheduling regular dental examinations and cleanings; and cautioning people who are scheduling treatment for periodontal disease, oral and maxillofacial therapy, endodontics, implant placement, restorative dentistry, and prosthodontics. Recommendations for management of people with ONJ include an oral rinse, such as chlorhexidine, and antibiotics.
双膦酸盐在全球范围内被用作治疗骨质疏松症的有效方法，而骨质疏松症是绝经后妇女和老年人骨折的主要潜在原因。这些药物在增加骨量和骨小梁厚度、降低骨折风险和减轻骨痛方面非常有效，使患者能够拥有更好的生活质量。双膦酸盐也被用于治疗多发性骨髓瘤、骨转移和佩吉特病；然而，双膦酸盐治疗可能会导致负面副作用，包括下颌骨坏死（ONJ）。ONJ 涉及颌骨的坏死、暴露的骨骼、疼痛、可能的继发感染、肿胀、疼痛性病变和各种感觉异常，尽管较轻的病例可能无症状。不含氮的第一代双膦酸盐被代谢成非功能性的、细胞毒性的三磷酸腺苷类似物，通过饥饿导致破骨细胞死亡。第二代双膦酸盐是含氮的药物；它们通过抑制法呢基二磷酸合酶抑制甲羟戊酸途径中的破骨细胞囊泡转运、细胞膜皱襞、形态和细胞骨架排列来抑制破骨细胞。治疗骨质疏松症和癌症的老年患者的医生应与牙科医生、药剂师和其他临床医生合作，向接受双膦酸盐治疗的患者告知其可能的副作用，并建议采取预防措施，最大程度地降低骨坏死的风险，尤其是下颌骨坏死的风险。这些措施包括保持良好的口腔卫生；定期进行牙科检查和清洁；并提醒正在接受牙周病、口腔颌面治疗、牙髓病学、种植牙、修复牙科和义齿修复治疗的患者注意。ONJ 患者的管理建议包括使用洗必泰等口腔漱口水和抗生素。
