Brigham and Women's Hospital, Division of Oral Medicine and Dentistry, One Brigham Circle, Suite 3-028, Boston, MA 02120, United States; Harvard School of Dental Medicine, Department of Oral Medicine, Infection, and Immunity, 188 Longwood Avenue, Boston, MA 02115, United States.
Dana-Farber Cancer Institute, Department of Medical Oncology, 450 Brookline Avenue, Boston, MA 02215-5450, United States.
Oral Oncol. 2013 Sep;49(9):977-983. doi: 10.1016/j.oraloncology.2013.05.012. Epub 2013 Jul 3.
Bisphosphonate-related osteonecrosis of the jaws is a well-established disorder in which patients treated with bisphosphonates develop exposed necrotic bone in the oral cavity. The objective of this study was to report staging and treatment outcomes in a large cohort of patients with bisphosphonate-related osteonecrosis of the jaws managed primarily with non-surgical measures.
A retrospective medical record review was conducted from 1998 to 2010 of all patients referred for the management of bisphosphonate-related osteonecrosis of the jaws. Clinical findings and staging were assessed at initial consultation and each follow-up visit. Management was provided to minimize symptoms and/or achieve resolution of lesions. Treatment responses were defined based on symptoms and/or change in staging.
There were 120 records reviewed and 97 patients seen for follow-up (median 12months); 90% were cancer patients. Bisphosphonate-related osteonecrosis of the jaws was managed with observation (16%), antibiotics (55%), non-surgical sequestrectomy±antibiotics (14%), or surgery±antibiotics (14%). There were 14 patients (12%) who presented with stage 0 disease; 41%, 43%, and 5% of patients presented at stages 1, 2, and 3, respectively. Greater than 70% of patients improved, remained asymptomatic, and/or showed complete re-epithelialization when evaluated at 0-3, 3-6, 6-9, 9-12, and/or >12months. Seventeen patients developed non-infectious complications of BONJ including neuropathy (N=9), painful tongue ulcers (N=7), or pathologic fracture (N=1). Twelve patients with multiple myeloma underwent hematopoietic cell transplantation without infectious complications.
A primarily non-surgical approach appears to be a successful management strategy for bisphosphonate-related osteonecrosis of the jaws. Overall, 71-80% of patients improved or remained asymptomatic with a median follow-up of 12months.
双膦酸盐相关性颌骨骨坏死是一种已确立的疾病，接受双膦酸盐治疗的患者会在口腔中出现暴露的坏死骨。本研究的目的是报告大量接受双膦酸盐相关性颌骨骨坏死患者的分期和治疗结果，这些患者主要通过非手术措施进行治疗。
对 1998 年至 2010 年间所有因双膦酸盐相关性颌骨骨坏死而接受治疗的患者进行回顾性病历审查。在初次就诊和每次随访时评估临床发现和分期。管理措施旨在减轻症状和/或使病变得到缓解。根据症状和/或分期变化来定义治疗反应。
共回顾了 120 份记录，并对 97 名患者进行了随访（中位数为 12 个月）；90%为癌症患者。双膦酸盐相关性颌骨骨坏死的治疗方法包括观察（16%）、抗生素（55%）、非手术性清创术+抗生素（14%）或手术+抗生素（14%）。有 14 名患者（12%）表现为 0 期疾病；41%、43%和 5%的患者分别处于 1 期、2 期和 3 期。在 0-3、3-6、6-9、9-12 和/或>12 个月时进行评估时，超过 70%的患者得到改善、保持无症状和/或出现完全上皮化。17 名患者发生了双膦酸盐相关性颌骨骨坏死的非感染性并发症，包括神经病变（9 例）、疼痛性舌溃疡（7 例）或病理性骨折（1 例）。12 名多发性骨髓瘤患者接受了造血细胞移植，无感染性并发症。
主要采用非手术方法似乎是治疗双膦酸盐相关性颌骨骨坏死的成功策略。总体而言，71%-80%的患者在中位随访 12 个月时得到改善或保持无症状。
