Tohashi Kazuhito, Nakabayashi Motoki, Kodani Isamu, Kidani Kazunori, Ryoke Kazuo
Division of Oral and Maxillofacial Biopathological Surgery, Department of Medicine of Sensory and Motor Organs, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8504, Japan.
Division of Oral and Maxillofacial Biopathological Surgery, Department of Medicine of Sensory and Motor Organs, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8504, Japan; †Department of Oral and Maxillofacial Surgery, Matsue Red Cross Hospital, Matsue 690-8506, Japan.
Yonago Acta Med. 2016 Mar;59(1):45-53. Epub 2016 Apr 1.
Some previous studies have examined anti-resorptive agent-related osteonecrosis of the jaw (ARONJ) prediction using systemic markers of bone turnover as risk factors. Radiographic imaging is also effective at detecting ARONJ. In this study, computed tomography (CT)-derived bone mineral density (BMD) values and the levels of systemic markers of bone turnover were evaluated, and then each parameter was compared between patients that developed ARONJ and those who did not after treatment with systemic anti-resorptive agents. The aim of this study was to determine whether systemic markers of bone turnover and/or BMD values can be used to predict the risk of ARONJ.
The subjects' serum levels of cross-linked N-terminal telopeptide of type I collagen (NTX) and bone alkaline phosphatase (BAP) (systemic markers of bone turnover) were measured. BMD was calibrated to CT values using a medical imaging phantom. Then, the subjects' BMD were assessed using quantitative computed tomography. Fifty-six patients who had received systemic anti-resorptive agents were included in this study. Thirty-two of the patients developed ARONJ after receiving the drugs whereas the remaining 24 did not.
No correlation was observed between the serum levels of the systemic markers of bone turnover and the incidence of ARONJ. On the other hand, the ARONJ patients exhibited higher mandibular BMD values than the control group. BMD was not associated with healing or the clinical stage of ARONJ.
These results suggest that increased mandibular BMD values are associated with ARONJ. Furthermore, mandibular BMD might serve as a novel marker for predicting the risk of ARONJ in patients that are taking anti-resorptive agents and are about to undergo tooth extraction. Accordingly, mandibular BMD could be a useful tool for aiding risk assessments and guiding treatment decisions.
此前一些研究已探讨使用骨转换的全身标志物作为风险因素来预测抗吸收剂相关的颌骨坏死（ARONJ）。影像学检查在检测ARONJ方面也很有效。在本研究中，评估了计算机断层扫描（CT）得出的骨密度（BMD）值和骨转换的全身标志物水平，然后比较了接受全身抗吸收剂治疗后发生ARONJ的患者与未发生ARONJ的患者之间的各项参数。本研究的目的是确定骨转换的全身标志物和/或BMD值是否可用于预测ARONJ的风险。
测量受试者血清中I型胶原交联N末端肽（NTX）和骨碱性磷酸酶（BAP）（骨转换的全身标志物）的水平。使用医学影像体模将BMD校准为CT值。然后，使用定量计算机断层扫描评估受试者的BMD。本研究纳入了56例接受全身抗吸收剂治疗的患者。其中32例患者在用药后发生了ARONJ，其余24例未发生。
未观察到骨转换的全身标志物血清水平与ARONJ发生率之间存在相关性。另一方面，ARONJ患者的下颌骨BMD值高于对照组。BMD与ARONJ的愈合或临床分期无关。
这些结果表明下颌骨BMD值升高与ARONJ有关。此外，下颌骨BMD可能作为一种新的标志物，用于预测正在服用抗吸收剂且即将接受拔牙的患者发生ARONJ的风险。因此，下颌骨BMD可能是辅助风险评估和指导治疗决策的有用工具。
