Rugani Petra, Luschin Gero, Jakse Norbert, Kirnbauer Barbara, Lang Uwe, Acham Stephan
Department of Oral Surgery and Radiology, Medical University of Graz, Auenbruggerplatz 12, 8036, Graz, Austria,
Clin Oral Investig. 2014;18(2):401-7. doi: 10.1007/s00784-013-1012-5. Epub 2013 Jun 10.
The definite incidence rate of bisphosphonate-related osteonecrosis of the jaws (BRONJ) is still unknown. The aim of this study was to investigate prevalence of BRONJ in a group of breast cancer patients applying the classification of the Association of Oral and Maxillofacial Surgeons 2009.
Between 2000 and 2008, 63 premenopausal early breast cancer patients who were free of metastases were treated with 4 mg zoledronic acid every 6 months over 3 years as participants of a multicenter, randomized, controlled, adjuvant breast cancer medication trial. Patients were not informed about the risk of jaw necrosis. None reported tooth or jaw complaints during the breast cancer follow-up examinations. In 2010, 48 patients of this cohort were investigated concerning BRONJ by clinical and radiological examinations.
No advanced stages (AAOMS 2009)were detected. However, five patients (10.4%) presented purulent (2) and nonpurulent (3) fistulas and radiological signs correlating to BRONJ stage 0.
Although no case of advanced BRONJ was detected, the study revealed a high prevalence of BRONJ stage 0. This supports the need for tight cooperation between dentists and medical specialists prescribing bisphosphonates including dental pre-therapeutic and follow-up examinations. Adaption of the BRONJ classification taking account to bone exposure via fistulas is recommended.
BRONJ is said to be a complication linked to high-dosage bisphosphonate therapy. The study demonstrates that even after application of zoledronate in a low-dose protocol, early BRONJ occurred. Radiological signs solely are not sufficient to confirm BRONJ; clinical signs are mandatory.
双膦酸盐相关颌骨坏死（BRONJ）的确切发病率仍不清楚。本研究的目的是采用口腔颌面外科协会2009年的分类方法，调查一组乳腺癌患者中BRONJ的患病率。
2000年至2008年期间，63例无转移的绝经前早期乳腺癌患者作为一项多中心、随机、对照、辅助性乳腺癌药物试验的参与者，每6个月接受4mg唑来膦酸治疗，为期3年。患者未被告知颌骨坏死的风险。在乳腺癌随访检查期间，无人报告牙齿或颌骨问题。2010年，通过临床和影像学检查对该队列中的48例患者进行了BRONJ调查。
未检测到晚期病例（AAOMS 2009）。然而，5例患者（10.4%）出现了化脓性（2例）和非化脓性（3例）瘘管以及与BRONJ 0期相关的影像学表现。
尽管未检测到晚期BRONJ病例，但该研究显示BRONJ 0期的患病率很高。这支持了牙医与开具双膦酸盐药物的医学专家之间紧密合作的必要性，包括牙科治疗前和随访检查。建议根据通过瘘管的骨暴露情况对BRONJ分类进行调整。
BRONJ被认为是与高剂量双膦酸盐治疗相关的一种并发症。该研究表明，即使在低剂量方案应用唑来膦酸后，仍会发生早期BRONJ。仅靠影像学表现不足以确诊BRONJ；临床体征必不可少。
