Damm Douglas D, Jones David M
Department of Oral Health Sciences, Division of Oral Pathology, College of Dentistry, University of Kentucky, Lexington, Kentucky, USA.
Gen Dent. 2013 Aug;61(5):33-8.
In 2011, the American Dental Association Council on Scientific Affairs released an update by their expert panel on managing the care of patients receiving antiresorptive therapy for the prevention and treatment of osteoporosis. In this report, the panel found no study results that confirmed the effectiveness of drug holidays to prevent antiresorptive agent-induced osteonecrosis of the jaws without increasing the risks of low bone mass. The purpose of this article is to provide suggestions for a pattern of patient care for individuals who desire or require an invasive surgical procedure of the jaws, but who also have a skeleton that is at risk for osteoporotic fracture. The authors reviewed pertinent literature related to basic bone histology, the pharmacokinetics of the aminobisphosphonates (nBP), diagnostic criteria for osteopenia/osteoporosis, and clinical applications of the antiresorptive agents. The skeletal system demonstrates a mixture of resting surfaces (osteocytes, 85%), resorbing surfaces (osteoclasts, 2%), and forming surfaces (osteoblasts, 10%-12%). Deposition of nBP is not uniform, and is highly concentrated in areas of bone remodeling. A full understanding of bone remodeling and the pharmacokinetics of nBP allow for the modification of the antiresorptive therapy and the timing of the oral surgical procedure in a manner that minimizes the prevalence of osteonecrosis while at the same time continuing to protect the patient's skeleton from osteoporotic fracture. The lack of support for drug holidays by the ADA's expert panel is strongly consistent with the science behind bone remodeling and nBP pharmacokinetics. In spite of this, creative interdisciplinary patient care has the potential to dramatically reduce the prevalence of bisphosphonate-related osteonecrosis (BRON), while at the same time continuing to protect the skeleton of the osteoporotic patient. Creative interdisciplinary patient care may prove to be an effective intervention to reduce the prevalence of BRON of the jaws.
2011年，美国牙科协会科学事务委员会发布了其专家小组关于管理接受抗吸收治疗以预防和治疗骨质疏松症患者护理的最新报告。在这份报告中，专家小组未发现任何研究结果能证实药物假期在不增加低骨量风险的情况下预防抗吸收剂引起的颌骨坏死的有效性。本文的目的是为那些希望或需要进行颌骨侵入性外科手术，但骨骼又有骨质疏松性骨折风险的个体提供一种患者护理模式建议。作者回顾了与基本骨组织学、氨基双膦酸盐（nBP）的药代动力学、骨质减少/骨质疏松症的诊断标准以及抗吸收剂的临床应用相关的文献。骨骼系统呈现出静止表面（骨细胞，85%）、吸收表面（破骨细胞，2%）和成骨表面（成骨细胞，10%-12%）的混合状态。nBP的沉积并不均匀，且高度集中在骨重塑区域。全面了解骨重塑和nBP的药代动力学，有助于以一种将骨坏死发生率降至最低的方式调整抗吸收治疗和口腔外科手术的时机，同时继续保护患者的骨骼免受骨质疏松性骨折的影响。美国牙科协会专家小组对药物假期缺乏支持与骨重塑和nBP药代动力学背后的科学原理高度一致。尽管如此，创造性的跨学科患者护理有可能显著降低双膦酸盐相关骨坏死（BRON）的发生率，同时继续保护骨质疏松患者的骨骼。创造性的跨学科患者护理可能被证明是一种有效的干预措施，可降低颌骨BRON的发生率。
