Kim Yun-Ho, Park Han-Kyul, Choi Na-Rae, Kim Seong-Won, Kim Gyoo-Cheon, Hwang Dae-Seok, Kim Yong-Deok, Shin Sang-Hun, Kim Uk-Kyu
Department of Oral and Maxillofacial Surgery, School of Dentistry, Pusan National University, Yangsan, Korea.
Department of Oral Anatomy, School of Dentistry, Pusan National University, Yangsan, Korea.
J Korean Assoc Oral Maxillofac Surg. 2017 Feb;43(1):16-22. doi: 10.5125/jkaoms.2017.43.1.16. Epub 2017 Feb 20.
Bisphosphonate is the primary cause of bisphosphonate-related osteonecrosis of the jaw (BRONJ). Bisphosphonates are eliminated from the human body by the kidneys. It is anticipated that bisphosphonate levels in the body will increase if the kidney is in a weak state or if there is systemic disease that affects kidney function. The aim of this study was to analyze the relevance of renal function in the severity of BRONJ.
Ninety-three patients diagnosed with BRONJ in Pusan National University Dental Hospital from January 2012 to December 2014 were included in this study. All patients underwent a clinical exam, radiographs, and serologic lab test, including urine analysis. The patient's medical history was also taken, including the type of bisphosphonate drug, the duration of administration and drug holiday, route of administration, and other systemic diseases. In accordance with the guidelines of the 2009 position paper of American Association of Oral and Maxillofacial Surgeons, the BRONJ stage was divided into 4 groups, from stage 0 to 3, according to the severity of disease. IBM SPSS Statistics version 21.0 (IBM Co., USA) was used to perform regression analysis with a 0.05% significance level.
BRONJ stage and renal factor (estimated glomerular filtration rate) showed a moderate statistically significant correlation. In the group with higher BRONJ stage, the creatinine level was higher, but the increase was not statistically significant. Other factors showed no significant correlation with BRONJ stage. There was a high statistically significant correlation between BRONJ stage and 'responder group' and 'non-responder group,' but there was no significant difference with the 'worsened group.' In addition, the age of the patients was a relative factor with BRONJ stage.
With older age and lower renal function, BRONJ is more severe, and there may be a decrease in patient response to treatment.
双膦酸盐是双膦酸盐相关颌骨坏死（BRONJ）的主要病因。双膦酸盐通过肾脏从人体排出。预计如果肾脏功能较弱或存在影响肾功能的全身性疾病，体内双膦酸盐水平将会升高。本研究的目的是分析肾功能与BRONJ严重程度之间的相关性。
本研究纳入了2012年1月至2014年12月在釜山国立大学牙医院诊断为BRONJ的93例患者。所有患者均接受了临床检查、影像学检查以及血清学实验室检测，包括尿液分析。还记录了患者的病史，包括双膦酸盐药物类型、给药持续时间和药物假期、给药途径以及其他全身性疾病。根据美国口腔颌面外科医师协会2009年立场文件的指南，根据疾病严重程度将BRONJ分期分为0至3期4组。使用IBM SPSS Statistics 21.0版软件（美国IBM公司）进行回归分析，显著性水平为0.05%。
BRONJ分期与肾脏因素（估计肾小球滤过率）显示出中度统计学显著相关性。在BRONJ分期较高的组中，肌酐水平较高，但升高无统计学显著性。其他因素与BRONJ分期无显著相关性。BRONJ分期与“反应者组”和“无反应者组”之间存在高度统计学显著相关性，但与“病情恶化组”无显著差异。此外，患者年龄是与BRONJ分期相关的一个因素。
随着年龄增长和肾功能下降，BRONJ更严重，并且患者对治疗的反应可能会降低。
