Taguchi Akira, Shiraki Masataka, Tsukiyama Mayumi, Miyazaki Teruhiko, Soen Satoshi, Ohta Hiroaki, Nakamura Toshitaka, Orimo Hajime
Department of Oral and Maxillofacial Radiology, School of Dentistry, Matsumoto Dental University, 1780 Gobara, Hirooka, Shiojiri, Nagano, 399-0781, Japan.
Research Institute and Practice for Involutional Diseases, 1610-1 Meisei, Misato, Azumino, Nagano, 399-8101, Japan.
Calcif Tissue Int. 2015 Dec;97(6):542-50. doi: 10.1007/s00223-015-0045-y. Epub 2015 Jul 26.
Dentists request a discontinuation of antiresorptive agents, such as bisphosphonate, before and after tooth extractions to prevent osteonecrosis of the jaw (ONJ). However, little is known about how this affects ONJ and osteoporosis treatment and how medical professionals and dentists cooperate to treat ONJ in patients with osteoporosis. This study aimed to clarify the impact of ONJ on osteoporosis treatment in Japan. A structured questionnaire including 14 key clinical queries was sent to 488 medical professionals as part of the Japanese Osteoporosis Intervention Trial (JOINT)-04, and 206 responses were received. A total of 173 respondents had received discontinuation requests from dentists. Of these, 28 respondents experienced 30 adverse events including ten fractures and one incidence of ONJ. The respondents who refused discontinuation requests observed no cases of ONJ. Approximately 16 % of respondents had patients who discontinued osteoporosis treatment, following a requested drug discontinuation, after tooth extraction. Dentists requested discontinuations for many medications that were not associated with the incidence of ONJ. Approximately 76 % of respondents had never requested oral health care from dentists before osteoporosis treatment and 72 % reported no cooperation between dentists and medical professionals in their region. Our results suggest that drug discontinuation may increase adverse events and disturb osteoporosis treatment without completely preventing ONJ. Currently, both medical professionals and dentists in Japan still continue to recommend their own treatment position. A forum to share information about ONJ among medical professionals, dentists, and patients is required.
牙医要求在拔牙前后停用抗吸收剂，如双膦酸盐，以预防颌骨坏死（ONJ）。然而，对于这如何影响ONJ和骨质疏松症治疗，以及医学专业人员和牙医如何合作治疗骨质疏松症患者的ONJ，人们知之甚少。本研究旨在阐明ONJ对日本骨质疏松症治疗的影响。作为日本骨质疏松症干预试验（JOINT）-04的一部分，向488名医学专业人员发送了一份包含14个关键临床问题的结构化问卷，共收到206份回复。共有173名受访者收到了牙医的停药要求。其中，28名受访者经历了30起不良事件，包括10起骨折和1起ONJ病例。拒绝停药要求的受访者未观察到ONJ病例。约16%的受访者有患者在拔牙后应要求停药，随后停止了骨质疏松症治疗。牙医要求停用许多与ONJ发病率无关的药物。约76%的受访者在骨质疏松症治疗前从未向牙医寻求过口腔保健，72%的受访者表示所在地区的牙医和医学专业人员之间没有合作。我们的结果表明，停药可能会增加不良事件并干扰骨质疏松症治疗，而不能完全预防ONJ。目前，日本的医学专业人员和牙医仍继续推荐各自的治疗立场。需要一个在医学专业人员、牙医和患者之间分享ONJ相关信息的论坛。
