Oral Medicine Unit, School of Medicine and Dentistry, University of Santiago de Compostela-Spain, 15782-Santiago de Compostela, Spain.
Med Oral Patol Oral Cir Bucal. 2012 Sep 1;17(5):e751-8. doi: 10.4317/medoral.18041.
The objective of this study was to define the clinical characteristics of osteonecrosis of the jaws (ONJ) induced by oral bisphosphonates in a series of patients from a circumscribed area in northwest Spain.
A retrospective multicentre study was undertaken in 3 hospitals in an area with a radius less than 100 km in the Autonomous Community of Galicia (Spain). The medical records were reviewed and an oral examination was performed of patients diagnosed with oral bisphosphonate-related ONJ in the previous 3 years.
We detected 20 cases of ONJ (24 lesions) related to oral bisphosphonates (alendronate [16 patients] and ibandronate [4 patients]), which were mainly administered as treatment for osteoporosis (17 patients). The mean interval between initiation of treatment and confirmation of a diagnosis of ONJ was 66±43 months (range, 6-132 months); in 7 patients (35%) the interval was less than 36 months. The past history revealed hypertension in 13 cases (65%) and diabetes in 4 (20%); 7 patients (35%) were on corticosteroid treatment. Oral surgery had been previously performed in 13 patients (65%) and the remaining 7 patients (35%) had removable dental prostheses. The lesions most frequently affected the posterior mandible (62.5%). The majority of the lesions (75%) were classified as stage 2, although lesions were identified in all established clinical stages (including 2 stage 0 lesions).
In conclusion, in the present series, ONJ induced by oral bisphosphonates typically develops in women around 70 years of age, taking alendronate, that underwent oral surgery. Most lesions are located in the posterior mandible and are classified as stage 2 at diagnosis. Some patients presented no known risk factors, suggesting that there may be risk factors still to be identified. There are well-defined patterns of clinical presentation that can facilitate early diagnosis of ONJ.
本研究旨在对西班牙西北部一个特定地区的一系列患者的颌骨骨坏死（ONJ）的临床特征进行定义，这些患者均接受过口服双膦酸盐治疗。
对加利西亚自治区（西班牙）内半径小于 100 公里的 3 家医院进行了回顾性多中心研究。对过去 3 年内诊断为与口服双膦酸盐相关的 ONJ 的患者的病历进行了审查，并进行了口腔检查。
我们共发现 20 例与口服双膦酸盐（阿仑膦酸钠[16 例]和伊班膦酸钠[4 例]）相关的 ONJ（24 个病灶），主要用于治疗骨质疏松症（17 例）。开始治疗与确诊 ONJ 之间的平均间隔时间为 66±43 个月（范围为 6-132 个月）；7 例（35%）患者的间隔时间小于 36 个月。过去的病史显示 13 例（65%）患者患有高血压，4 例（20%）患者患有糖尿病；7 例（35%）患者正在接受皮质类固醇治疗。13 例（65%）患者曾进行过口腔手术，其余 7 例（35%）患者佩戴有活动义齿。病变最常累及下颌后牙（62.5%）。大多数病变（75%）为 2 期，尽管在所有既定的临床分期（包括 2 期 0 病变）中都发现了病变。
总之，在本系列研究中，口服双膦酸盐诱导的 ONJ 主要发生在 70 岁左右的女性，服用阿仑膦酸钠，并接受过口腔手术。大多数病变位于下颌后牙区，初诊时分类为 2 期。一些患者无已知的危险因素，表明可能存在尚未确定的危险因素。存在明确的临床表现模式，有助于早期诊断 ONJ。
