Favia Gianfranco, Tempesta Angela, Limongelli Luisa, Crincoli Vito, Maiorano Eugenio
Quintessence Int. 2016;47(5):433-40. doi: 10.3290/j.qi.a35263.
Medication-related osteonecrosis of the jaw (MRONJ) is a commonly reported side effect of antiresorptive drugs prescribed for osteoporosis. Oral bisphosphonates (BPs) are the most frequently administered antiresorptive drugs for osteoporosis, but because of low compliance of the patients with this treatment, which may require weekly or monthly administration, a new formulation (once a year) of zoledronic acid for intravenous infusion has been recently introduced. Although MRONJ has been repeatedly reported in oncologic patients treated with multiple infusions of zoledronic acid, to date MRONJ occurring in patients undergoing once-a-year infusion of zoledronic acid for osteoporosis has been described very rarely. The aim of this study was to report our experience with eight such patients.
Eight osteoporotic female patients came to our attention for intraoral necrotic bone exposures with subsequent diagnosis of MRONJ; they had a history of long-term oral antiresorptive therapy but soon developed MRONJ after the shift to once-a-year infusion of zoledronic acid. Consequently, the patients firstly underwent prolonged antibiotic therapy, then surgical removal of the necrotic bone was performed.
Following antibiotic and surgical treatments, all the patients healed without complications or recurrence.
These cases suggest that, although rare and not yet well documented, MRONJ related to yearly infusion of zoledronic acid may occur in association with significant morbidity and should not be overlooked by either medical or dental clinicians.
颌骨药物相关性坏死（MRONJ）是治疗骨质疏松症的抗吸收药物常见的不良反应。口服双膦酸盐（BPs）是治疗骨质疏松症最常用的抗吸收药物，但由于患者对这种可能需要每周或每月给药的治疗依从性较低，最近引入了一种新的唑来膦酸静脉输注制剂（每年一次）。尽管多次输注唑来膦酸治疗的肿瘤患者中反复出现MRONJ，但迄今为止，很少有关于接受每年一次唑来膦酸输注治疗骨质疏松症的患者发生MRONJ的报道。本研究的目的是报告我们对8例此类患者的治疗经验。
8例骨质疏松女性患者因口腔内坏死骨暴露前来就诊，随后被诊断为MRONJ；她们有长期口服抗吸收治疗史，但在改用每年一次唑来膦酸输注后很快发生了MRONJ。因此，患者首先接受了长期抗生素治疗，然后进行了坏死骨的手术切除。
经过抗生素和手术治疗，所有患者均愈合，无并发症或复发。
这些病例表明，虽然与每年一次唑来膦酸输注相关的MRONJ罕见且尚未有充分记录，但可能会发生且伴有明显的发病率，医学和牙科临床医生均不应忽视。
