Nomura Takeshi, Shibahara Takahiko, Uchiyama Takeshi, Yamamoto Nobuharu, Shibui Takeo, Yakushiji Takashi, Watanabe Akira, Muramatsu Kyotaro, Ogane Satoshi, Murayama Masato, Sekine Riyo, Nakata Erika, Fujimoto Yuko
Department of Oral and Maxillofacial Surgery, Tokyo Dental College, 1-2-2 Masago, Mihama-ku, Chiba 261-8502, Japan.
Bull Tokyo Dent Coll. 2013;54(2):117-25. doi: 10.2209/tdcpublication.54.117.
Bisphosphonate-related osteonecrosis of the jaw (BRONJ) affects quality of life and is an important problem for dentists. A Japanese position paper on BRONJ was published in 2010. The purpose of this study was to review clinical data on the treatment of BRONJ obtained at the Clinic of Oral and Maxillofacial Surgery, Tokyo Dental College, Chiba Hospital to further our understanding of this disease. A total of 13 patients (6 men and 7 women) were included. All the patients included in this study had received Bisphosphonate (BP) therapy and had BRONJ. Five of them (38.5%) had received oral BP therapy for osteoporosis, while the remaining 8 (61.5%) had received parenteral BP therapy for bone metastases from breast or prostate cancer. Osteoporosis patients were treated with risedronate or alendronate. Breast or prostate cancer patients were treated with zoledronate. Two patients with rheumatoid arthritis were treated with corticosteroid. Three patients had diabetes mellitus. Eleven patients were treated with antibiotics, while 5 underwent surgical treatment. Discontinuation of BP was recorded in 7 patients during dental treatment. Sequestration was observed in 6 patients during an 11-month follow-up. Eventually, healing and improvement of the oral mucosa were observed in 3 patients. The current standard treatment for BRONJ does not always provide good results. It is necessary to accumulate further clinical data to establish more effective treatment strategies for BRONJ.
双膦酸盐相关颌骨坏死（BRONJ）影响生活质量，对牙医来说是一个重要问题。一份关于BRONJ的日本立场文件于2010年发表。本研究的目的是回顾在东京齿科大学千叶医院口腔颌面外科诊所获得的BRONJ治疗临床数据，以加深我们对这种疾病的理解。共纳入13例患者（6例男性和7例女性）。本研究纳入的所有患者均接受过双膦酸盐（BP）治疗并患有BRONJ。其中5例（38.5%）因骨质疏松接受口服BP治疗，其余8例（61.5%）因乳腺癌或前列腺癌骨转移接受肠外BP治疗。骨质疏松患者接受利塞膦酸盐或阿仑膦酸盐治疗。乳腺癌或前列腺癌患者接受唑来膦酸盐治疗。2例类风湿性关节炎患者接受皮质类固醇治疗。3例患者患有糖尿病。11例患者接受抗生素治疗，5例接受手术治疗。7例患者在牙科治疗期间记录了BP停药情况。在11个月的随访期间，6例患者观察到死骨形成。最终，3例患者观察到口腔黏膜愈合和改善。目前BRONJ的标准治疗并不总是能取得良好效果。有必要积累更多临床数据，以建立更有效的BRONJ治疗策略。
