Park Wonse, Lee Soo-Hyung, Park Kyung-Ran, Rho Seung-Hee, Chung Won-Yoon, Kim Hyung Jun
Department of Advanced General Dentistry, College of Dentistry, Yonsei University, Seoul, South Korea.
J Craniofac Surg. 2012 Sep;23(5):e510-4. doi: 10.1097/SCS.0b013e31825b33f6.
Renal transplantation is the definitive treatment of chronic renal failure, and osteoporosis in patients after renal transplantation is caused by the use of high-dose corticosteroids, reduced renal function, and the use of immunosuppressant. While bisphosphonates inhibit osteoclastic activities, they are the drug of choice for the treatment and prevention of osteoporosis. Bisphosphonate-related osteonecrosis of the jaw (BRONJ) becomes a problematic issue. There are few reports on BRONJ in patients after renal transplantation, so many oral bisphosphonates commonly prescribed in patients after renal transplantation to prevent osteoporosis have no warning of BRONJ. We analyzed the records of patients with BRONJ from January 2009 to December 2010. Among the patients with BRONJ, we selected patients who underwent transplantation of the kidney. Demographic data, drug-related factors, and clinical characteristics were evaluated using chart review. A total of 128 patients were categorized as having BRONJ, and there were 3 patients with a history of kidney transplantation. The average age was 54.6 years, and 2 victims were men. All patients received oral bisphosphonates for more than 2 years (range, 2-7 y; average, 58.6 mo). All patients had hypertension, diabetes mellitus, history of high-dose corticosteroids, and taking immunosuppressant drugs. Bisphosphonate-related osteonecrosis of the jaw occurred in the maxilla in all patients, which is classified as stage 3 because of the involved sinus. Extraction was the main provoking factor in all patients. In conclusion, even at a relatively young age, BRONJ in the maxilla can be developed by intake of oral bisphosphonate after kidney transplantation. Dental care for patients before and after undergoing renal transplantation should be emphasized to reduce the risk of BRONJ.
肾移植是慢性肾衰竭的确定性治疗方法，肾移植患者的骨质疏松是由大剂量使用皮质类固醇、肾功能减退以及使用免疫抑制剂引起的。双膦酸盐可抑制破骨细胞活性，是治疗和预防骨质疏松的首选药物。双膦酸盐相关颌骨坏死（BRONJ）成为一个有问题的问题。肾移植患者中关于BRONJ的报道很少，因此肾移植患者中常用的许多口服双膦酸盐在预防骨质疏松时没有BRONJ的警示。我们分析了2009年1月至2010年12月BRONJ患者的记录。在BRONJ患者中，我们选择了接受肾移植的患者。通过病历回顾评估人口统计学数据、药物相关因素和临床特征。共有128例患者被归类为患有BRONJ，其中有3例有肾移植病史。平均年龄为54.6岁，2例为男性。所有患者口服双膦酸盐超过2年（范围2 - 7年；平均58.6个月）。所有患者均患有高血压、糖尿病、有大剂量皮质类固醇使用史且服用免疫抑制药物。所有患者的颌骨坏死均发生在上颌骨，由于累及鼻窦，分类为3期。拔牙是所有患者的主要诱发因素。总之，即使在相对年轻的年龄，肾移植后口服双膦酸盐也可导致上颌骨发生BRONJ。应强调肾移植患者术前和术后的口腔护理，以降低BRONJ的风险。
