Fassio A, Bertoldo F, Idolazzi L, Viapiana O, Rossini M, Gatti D
Department of Medicine, Rheumatology Unit, University of Verona.
Reumatismo. 2017 May 22;69(1):9-15. doi: 10.4081/reumatismo.2017.983.
Osteonecrosis of the jaw (ONJ) is a rare adverse event of antiresorptive drugs such as bisphosphonates (BP) and denosumab (DMAb). The diagnosis of ONJ is considered in cases where exposed bone in the maxillofacial region does not heal within 8 weeks in a patient previously treated with an antiresorptive agent. In patients with osteoporosis, ONJ is reported as a very rare adverse event while in oncologic patients with bone metastases or malignant hypercalcemia the incidence is significantly higher (up to the 1-10% of the patients). The pathophysiology of ONJ is still not completely understood but it is multi-factorial. ONJ is a condition associated with poor oral health, oral surgery, and use of antiresorptive agents. Prevention is of paramount importance especially in cancer patients, in whom the large majority of cases of ONJ (>90%) are reported, but it should also be considered in osteoporotic patients, especially during dental surgical procedure. Some simple prevention procedures are effective in reducing the risk of its appearance. When ONJ unfortunately occurs, the large majority of patients can be managed conservatively. In conclusion, ONJ is a rare condition associated with antiresorptive drugs. Both osteoporotic and oncologic patients should be well informed about its low absolute risk and regarding the fact that the benefits of antiresorptive therapy far outweigh this potential risk of ONJ.
颌骨坏死（ONJ）是双膦酸盐（BP）和地诺单抗（DMAb）等抗吸收药物罕见的不良事件。对于先前接受抗吸收药物治疗的患者，若颌面部区域暴露的骨组织在8周内未愈合，则考虑诊断为ONJ。在骨质疏松症患者中，ONJ被报道为非常罕见的不良事件，而在患有骨转移或恶性高钙血症的肿瘤患者中，其发生率显著更高（高达患者的1%-10%）。ONJ的病理生理学仍未完全了解，但它是多因素的。ONJ是一种与口腔健康不良、口腔手术和抗吸收药物使用相关的病症。预防至关重要，尤其是在癌症患者中，其中绝大多数ONJ病例（>90%）被报道，但在骨质疏松症患者中也应予以考虑，特别是在牙科手术过程中。一些简单的预防措施可有效降低其出现的风险。当不幸发生ONJ时，绝大多数患者可采用保守治疗。总之，ONJ是一种与抗吸收药物相关的罕见病症。骨质疏松症患者和肿瘤患者均应充分了解其绝对风险较低，以及抗吸收治疗的益处远大于ONJ这种潜在风险这一事实。
