Oral Surgery Department and the Stomatology and Maxillofacial Surgery Department, and INSERM, UMR-S 606, Hôpital Lariboisière, Pitié-Salpêtrière University Hospital, Paris Diderot University, Paris, France.
J Rheumatol. 2013 Jun;40(6):781-6. doi: 10.3899/jrheum.120810. Epub 2013 Mar 15.
To review cases of bisphosphonate-related osteonecrosis of the jaw (BRONJ) occurring in association with benign disease and to describe and compare the clinical course and outcome for patients with BRONJ and rheumatoid arthritis (RA) or osteoporosis.
We retrospectively reviewed observations of all patients referred for treatment and followup for BRONJ from January 2007 to December 2011. Only patients with malignant disease were excluded. Demographic data, medical history, maxillofacial findings, BRONJ treatment, and followup were reviewed for each case.
Over a 5-year period, we diagnosed 112 patients with BRONJ. Among these patients, 15 received bisphosphonate (BP) treatment for nonmalignant disease (mean age 65.7 ± 19.8 yrs, 80% women). Patients received BP for a variety of reasons: 8 (53%) to prevent osteoporosis in association with underlying RA; 6 (40%) to prevent idiopathic osteoporosis; and 1 (7%) to treat ankle algodystrophy. The mean oral BP exposure period was 48.4 months (median 36 mo). In 13 cases (86.6%), BRONJ was diagnosed following dental extraction. Of the 8 patients with RA, 5 (62.5%) were taking prednisone at the time of the discovery of BRONJ. Major surgery, sequestrectomy, or alveolectomy was performed in 9 patients (60%), all of whom healed within 3 to 36 months (mean 11.5 mo). Comparative analysis of all the variables showed no statistically significant differences between patients with RA and others.
ONJ is a rare adverse effect of BP therapy, especially when administered orally. Within the limits of our study, we were unable to demonstrate a difference in BRONJ disease spectrum, clinical course, or outcome between patients with and those without RA.
回顾与良性疾病相关的双膦酸盐相关性颌骨坏死（BRONJ）病例，并描述和比较患有 BRONJ 和类风湿关节炎（RA）或骨质疏松症患者的临床过程和结局。
我们回顾性分析了 2007 年 1 月至 2011 年 12 月期间因 BRONJ 接受治疗和随访的所有患者的观察结果。仅排除患有恶性疾病的患者。对每个病例的人口统计学数据、病史、颌面表现、BRONJ 治疗和随访进行了回顾。
在 5 年期间，我们诊断出 112 例 BRONJ 患者。在这些患者中，有 15 例因非恶性疾病接受双膦酸盐（BP）治疗（平均年龄 65.7±19.8 岁，80%为女性）。患者接受 BP 治疗的原因各不相同：8 例（53%）用于预防与潜在 RA 相关的骨质疏松症；6 例（40%）用于预防特发性骨质疏松症；1 例（7%）用于治疗踝部痛性痉挛。BP 口服暴露期平均为 48.4 个月（中位数 36 个月）。在 13 例（86.6%）中，BRONJ 在拔牙后诊断。在 8 例 RA 患者中，有 5 例（62.5%）在发现 BRONJ 时正在服用泼尼松。9 例（60%）患者进行了大手术、清创术或牙槽切除术，所有患者均在 3 至 36 个月（平均 11.5 个月）内愈合。对所有变量的比较分析表明，RA 患者和其他患者之间在 BRONJ 疾病谱、临床过程或结局方面没有统计学上的显著差异。
ONJ 是 BP 治疗的罕见不良反应，尤其是口服时。在我们的研究范围内，我们无法证明患有和不患有 RA 的患者之间的 BRONJ 疾病谱、临床过程或结局存在差异。
