MD, PhD, Institute of Endocrinology, Diabetes, Metabolism, Department of Internal Medicine C, Rambam Medical Center and RB Rappaport Faculty of Medicine Technion, 12 Halia Street, Samy Ofer Tower no. 8 Fl, Haifa, 31096, Israel.
J Clin Endocrinol Metab. 2013 Nov;98(11):E1807-12. doi: 10.1210/jc.2013-2434. Epub 2013 Sep 13.
Bisphosphonate-related osteonecrosis of the jaws (BRONJ) is a severe bone disease for which the exact pathogenesis mechanisms are not fully understood.
The objective of the study is to investigate a possible contribution of diabetes and microvascular disease to the pathophysiology of BRONJ.
We identified 46 patients treated with bisphosphonates who were diagnosed with BRONJ based on their medical history during 2009 to 2012 and invited them for a dental assessment to confirm the diagnosis. Diabetes diagnosis was based on the American Diabetes Association criteria. The study group was compared to a control group of 38 patients treated with bisphosphonates without evidence of BRONJ.
The study was conducted at Rambam Health Care Campus, a referral center, Haifa, Israel.
The results of our study showed that of the 46 patients with BRONJ, 31 (67.4%) had diabetes or impaired fasting glucose. The proportion with diabetes (37%) was higher than in the control group (26.3%; P = .009). The presence of diabetes or impaired fasting glucose increased the association with BRONJ by 2.78-fold (confidence interval = 1.27-6.07, P = .009). The prevalence of microvascular disease (neuropathy, retinopathy, nephropathy) was significantly higher in the BRONJ than in the control group (P = .01). The presence of diabetic nephropathy increased the association with BRONJ by 3.9-fold (confidence interval = 1.12-13.52, P = .02).
This retrospective study suggests an association between diabetes, perhaps mediated through microvascular complications, and the development of BRONJ.
双膦酸盐相关性颌骨骨坏死（BRONJ）是一种严重的骨骼疾病，其确切发病机制尚未完全阐明。
本研究旨在探讨糖尿病和微血管病变是否可能对 BRONJ 的病理生理学产生影响。
我们鉴定了在 2009 年至 2012 年期间因病史被诊断为 BRONJ 而接受双膦酸盐治疗的 46 名患者，并邀请他们进行牙科评估以确认诊断。糖尿病的诊断依据美国糖尿病协会的标准。研究组与未发生 BRONJ 的 38 名接受双膦酸盐治疗的对照组患者进行比较。
本研究在以色列海法的 Rambam 医疗保健园区的转诊中心进行。
我们的研究结果显示，在 46 名 BRONJ 患者中，31 名（67.4%）患有糖尿病或空腹血糖受损。患有糖尿病的比例（37%）高于对照组（26.3%；P =.009）。存在糖尿病或空腹血糖受损会使 BRONJ 的发生风险增加 2.78 倍（置信区间=1.27-6.07，P =.009）。BRONJ 患者微血管疾病（神经病、视网膜病变、肾病）的患病率明显高于对照组（P =.01）。糖尿病肾病的存在使 BRONJ 的发生风险增加 3.9 倍（置信区间=1.12-13.52，P =.02）。
这项回顾性研究提示糖尿病可能通过微血管并发症与 BRONJ 的发生相关。
