Taguchi Akira, Shiraki Masataka, Sugimoto Toshitsugu, Ohta Hiroaki, Soen Satoshi
a Department of Oral and Maxillofacial Radiology , School of Dentistry, Matsumoto Dental University , Nagano , Japan ;
b Research Institute and Practice for Involutional Diseases , Nagano , Japan ;
Curr Med Res Opin. 2016 Jul;32(7):1261-8. doi: 10.1185/03007995.2016.1170005. Epub 2016 Apr 19.
Our previous questionnaire-based survey suggested that discontinuation of antiresorptive agents before tooth extraction may increase adverse events and disturb osteoporosis treatment without completely preventing osteonecrosis of the jaw (O.N.J.). We also found little cooperation between physicians and dentists in Japan. However, limitations of our previous study included a survey of doctors belonging to small clinics and a small sample size. Our current study aimed to confirm the results of our previous survey in doctors mainly belonging to academia.
A structured questionnaire including 14 key clinical queries was sent to 1812 physicians of the Japan Osteoporosis Society, and 629 responses were received.
Dentists requested discontinuation of many medications that were not associated with the incidence of O.N.J. A total of 523 respondents had received discontinuation requests from dentists. Of these, 97 respondents experienced 119 adverse events including 25 fractures and seven incidences of O.N.J. The ratios of valid responses for fractures were 3.6% and 5.3% in patients with a discontinuation of <3 and ≥3 months, respectively. Those for O.N.J. were 0.7% and 1.6%, respectively. Respondents who refused discontinuation requests reported no cases of O.N.J. Approximately 17% of respondents had patients who discontinued osteoporosis treatment following a requested drug discontinuation after tooth extraction. Approximately 62% of respondents did not request oral health care by a dentist before antiresorptive therapy, and 72% reported no cooperation between physicians and dentists in their region.
This study reconfirms the results of our previous survey. Discontinuation of antiresorptive treatment may increase both fractures and O.N.J. Immediate development of a strategy for sharing information about O.N.J. among physicians, dentists, and patients is required to reduce the incidence of both O.N.J. and skeletal events in osteoporosis treatment. Study limitations were selection bias due to low response rate and possible inaccurate responses to the questionnaire.
我们之前基于问卷调查的研究表明，拔牙前停用抗吸收药物可能会增加不良事件的发生，并干扰骨质疏松症的治疗，且不能完全预防颌骨坏死（ONJ）。我们还发现日本医生和牙医之间的合作很少。然而，我们之前研究的局限性包括对小型诊所医生的调查以及样本量较小。我们当前的研究旨在在主要来自学术界的医生中证实我们之前调查的结果。
向日本骨质疏松症协会的1812名医生发送了一份包含14个关键临床问题的结构化问卷，共收到629份回复。
牙医要求停用许多与ONJ发病率无关的药物。共有523名受访者收到了牙医的停药要求。其中，97名受访者经历了119次不良事件，包括25例骨折和7例ONJ。停药时间<3个月和≥3个月的患者中，骨折的有效回复率分别为3.6%和5.3%。ONJ的有效回复率分别为0.7%和1.6%。拒绝停药要求的受访者未报告ONJ病例。约17%的受访者有患者在拔牙后因要求停药而中断骨质疏松症治疗。约62%的受访者在抗吸收治疗前未要求牙医进行口腔保健，72%的受访者报告其所在地区的医生和牙医之间没有合作。
本研究再次证实了我们之前调查的结果。停用抗吸收治疗可能会增加骨折和ONJ的发生。需要立即制定一项策略，在医生、牙医和患者之间共享关于ONJ的信息，以降低骨质疏松症治疗中ONJ和骨骼事件的发生率。研究的局限性是由于回复率低导致的选择偏倚以及对问卷的回答可能不准确。
