Kim Kyoung Min, Rhee Yumie, Kwon Yong-Dae, Kwon Tae-Geon, Lee Jeong Keun, Kim Deog-Yoon
Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
J Bone Metab. 2015 Nov;22(4):151-65. doi: 10.11005/jbm.2015.22.4.151. Epub 2015 Nov 30.
Bisphosphonates are the most widely prescribed drugs for the treatment of osteoporosis, and are also used in malignant bone metastases, multiple myeloma, and Paget's disease, and provide therapeutic efficacy on those diseases. However, it was reported that occurrence of osteonecrosis of the jaw (ONJ) could be related with bisphosphonate exposures, and there have been many cases regarding this issue. Therefore, a clearer definition and treatment guidelines were needed for this disease. The American Society for Bone and Mineral Research (ASBMR) and American Association of Oral and Maxillofacial Surgeons (AAOMS) reported statements on bisphosphonate-related ONJ (BRONJ), and a revised version was recently presented. In the revised edition, the diagnosis BRONJ was changed to medication-related ONJ (MRONJ), which reflects a consideration of the fact that ONJ also occurs for denosumab, a bone resorption inhibitor of the receptor activator of nuclear factor-kappa B ligand (RANKL) antibody family, and bevacizumab, an anti-angiogenesis inhibitor. In 2009, a statement on ONJ was also reported locally by a relevant organization, which has served as basis for clinical treatment in Korea. In addition to the new official stance of the AAOMS and ASBMR, with an increasing pool of ONJ clinical experience, a revised version of the 2009 local statement is needed. As such, the Korean Society for Bone and Mineral Research (KSBMR) and the Korean Association of Oral and Maxillofacial Surgeons (KAOMS) have collectively formed a committee for the preparation of an official statement on MRONJ, and have reviewed recent local and international data to propose guidelines customized for the local Korean situation.
双膦酸盐是治疗骨质疏松症最常用的药物,也用于恶性骨转移、多发性骨髓瘤和佩吉特病,并对这些疾病具有治疗效果。然而,有报道称颌骨坏死(ONJ)的发生可能与双膦酸盐暴露有关,并且关于这个问题已经有很多病例。因此,需要对这种疾病有更明确的定义和治疗指南。美国骨与矿物质研究学会(ASBMR)和美国口腔颌面外科医师协会(AAOMS)发表了关于双膦酸盐相关ONJ(BRONJ)的声明,并且最近公布了修订版。在修订版中,BRONJ的诊断被改为药物相关ONJ(MRONJ),这反映了考虑到ONJ也会发生在核因子κB受体活化剂配体(RANKL)抗体家族的骨吸收抑制剂地诺单抗以及抗血管生成抑制剂贝伐单抗的使用中。2009年,一个相关组织也在当地发表了关于ONJ的声明,这一直是韩国临床治疗的依据。除了AAOMS和ASBMR的新官方立场外,随着ONJ临床经验的不断积累,需要对2009年的当地声明进行修订。因此,韩国骨与矿物质研究学会(KSBMR)和韩国口腔颌面外科医师协会(KAOMS)共同成立了一个委员会,负责编写关于MRONJ的官方声明,并审查了近期的当地和国际数据,以提出针对韩国当地情况定制的指南。