Pelaz Alejandro, Junquera Luis, Gallego Lorena, García-Consuegra Luis, García-Martínez Lucía, Cutilli Tommaso, Olay Sonsoles
Servicio de Cirugía Oral y Maxilofacial, Hospital de Cabueñes, Gijón, Asturias, España.
Servicio de Cirugía Oral y Maxilofacial, Hospital Universitario Central de Asturias, Universidad de Oviedo, Oviedo, España.
Acta Otorrinolaringol Esp. 2015 May-Jun;66(3):139-47. doi: 10.1016/j.otorri.2014.06.003. Epub 2014 Oct 11.
Bisphosphonates are widely prescribed drugs whose principal capacity is inhibiting the osteoclast function. In 2003 a complication related to their administration, bisphosphonate-related osteonecrosis of the jaw (BRONJ), was described. The objectives of this study were to identify diagnosed cases of BRONJ in a third-level hospital over 8 years, evaluating the main features in relation to the disease, the bisphosphonate and the presence of local or general risk factors that could trigger the BRONJ.
Patients diagnosed with BRONJ in a centre of reference for a population of 1,100,000 inhabitants were selected. Variables analysed were classified into 3 groups: patients, bisphosphonate (focusing on dose and weighting dose/potency) and osteonecrosis.
Seventy cases were studied -44 women and 26 men-, with a mean age of 66.8 years. Eighteen patients received bisphosphonates orally and 52, intravenously. The mean time of administration was 26.53 months. In 67.1% of the patients it was possible to identify a local trigger, with the most common being tooth extraction (48.6%). Bone exposure was present in 89.2% of the cases, while 12 patients developed BRONJ without exposed bone, with only pain and/or chronic sinus tracts. Complete resolution was achieved in 58.6% of the patients, with a mean time of control of 16.28 months.
25% of the BRONJ cases were related to the administration of oral bisphosphonates, especially alendronate. Zoledronic acid was the bisphosphonate that required the fewest milligrams to induce osteonecrosis. Single bone exposure was the most common clinical finding, especially in the molar mandibular region in patients with metastatic disease.
双膦酸盐是广泛应用的药物，其主要作用是抑制破骨细胞功能。2003年，一种与双膦酸盐给药相关的并发症——双膦酸盐相关颌骨坏死（BRONJ）被描述。本研究的目的是确定一家三级医院8年期间确诊的BRONJ病例，评估与该疾病、双膦酸盐以及可能引发BRONJ的局部或全身危险因素相关的主要特征。
选取在一个拥有110万居民的参考中心被诊断为BRONJ的患者。分析的变量分为3组：患者、双膦酸盐（关注剂量和剂量/效力权重）和骨坏死。
共研究了70例患者，其中44例女性，26例男性，平均年龄66.8岁。18例患者口服双膦酸盐，52例静脉注射。平均给药时间为26.53个月。67.1%的患者可确定有局部诱发因素，最常见的是拔牙（48.6%）。89.2%的病例存在骨暴露，而12例患者在无骨暴露的情况下发生BRONJ，仅有疼痛和/或慢性窦道。58.6%的患者实现了完全缓解，平均控制时间为16.28个月。
25%的BRONJ病例与口服双膦酸盐的给药有关，尤其是阿仑膦酸盐。唑来膦酸是诱导骨坏死所需毫克数最少的双膦酸盐。单一骨暴露是最常见的临床表现，尤其是在转移性疾病患者的下颌磨牙区。
