Division of Periodontology, University of Minnesota School of Dentistry, Minneapolis, USA.
Am J Clin Oncol. 2012 Aug;35(4):386-92. doi: 10.1097/COC.0b013e3182155fcb.
To evaluate the frequency, risk factors, and clinical presentation of bisphosphonate (BP)-related osteonecrosis of the jaw (BRONJ).
We performed a retrospective analysis of 576 patients with cancer treated with intravenous pamidronate and/or zoledronate between January, 2003 and December, 2007 at the University of Minnesota Masonic Cancer Center and Park Nicollet Institute.
Eighteen of 576 identified patients (3.1%) developed BRONJ including 8 of 190 patients (4.2%) with breast cancer, 6 of 83 patients (7.2%) with multiple myeloma, 2 of 84 patients (2.4%) with prostate cancer, 1 of 76 patients (1.3%) with lung cancer, 1 of 52 patients (1.9%) with renal cell carcinoma, and in none of the 73 patients with other malignancies. Ten patients (59%) developed BRONJ after tooth extraction, whereas 7 (41%) developed it spontaneously (missing data for 1 patient). The mean number of BP infusions (38.1 ± 19.06 infusions vs. 10.5 ± 12.81 infusions; P<0.001) and duration of BP treatment (44.3 ± 24.34 mo vs. 14.6 ± 18.09 mo; P<0.001) were significantly higher in patients with BRONJ compared with patients without BRONJ. Multivariate Cox proportional hazards regression analysis showed that diabetes [hazard ratio (HR)=3.40; 95% confidence interval (CI), 1.14-10.11; P=0.028], hypothyroidism (HR=3.59; 95% CI, 1.31-9.83; P=0.013), smoking (HR=3.44; 95% CI, 1.28-9.26; P=0.015), and higher number of zoledronate infusions (HR=1.07; 95% CI, 1.03-1.11; P=0.001) significantly increased the risk of developing BRONJ.
Increased cumulative doses and long-term BP treatment are the most important risk factors for BRONJ development. Type of BP, diabetes, hypothyroidism, smoking, and prior dental extractions may play a role in BRONJ development.
评估双膦酸盐（BP）相关下颌骨坏死（BRONJ）的发生频率、风险因素和临床表现。
我们对 2003 年 1 月至 2007 年 12 月期间在明尼苏达大学梅奥癌症中心和帕克尼科莱特研究所接受静脉帕米膦酸盐和/或唑来膦酸盐治疗的 576 例癌症患者进行了回顾性分析。
在 576 例患者中，18 例（3.1%）发生 BRONJ，其中乳腺癌患者 8 例（4.2%），多发性骨髓瘤患者 6 例（7.2%），前列腺癌患者 2 例（2.4%），肺癌患者 1 例（1.3%），肾细胞癌患者 1 例（1.9%），其他恶性肿瘤患者均无 BRONJ。10 例（59%）患者在拔牙后发生 BRONJ，7 例（41%）患者自发性发生 BRONJ（1 例患者数据缺失）。BRONJ 组患者的 BP 输注次数（38.1±19.06 次 vs. 10.5±12.81 次；P<0.001）和 BP 治疗持续时间（44.3±24.34 个月 vs. 14.6±18.09 个月；P<0.001）显著高于无 BRONJ 组患者。多变量 Cox 比例风险回归分析显示，糖尿病[风险比（HR）=3.40；95%置信区间（CI），1.14-10.11；P=0.028]、甲状腺功能减退（HR=3.59；95%CI，1.31-9.83；P=0.013）、吸烟（HR=3.44；95%CI，1.28-9.26；P=0.015）和唑来膦酸盐输注次数较高（HR=1.07；95%CI，1.03-1.11；P=0.001）显著增加了发生 BRONJ 的风险。
累积剂量增加和长期 BP 治疗是 BRONJ 发展的最重要危险因素。BP 类型、糖尿病、甲状腺功能减退、吸烟和先前的牙科拔牙可能在 BRONJ 发展中起作用。
