Mathai Paul C, Andrade Neelam N, Aggarwal Neha, Nerurkar Shibani, Kapoor Prathmesh
Department of Oral and Maxillofacial Surgery, Nair Hospital Dental College, Mumbai Central, Mumbai, 400008, India.
Oral Maxillofac Surg. 2018 Jun;22(2):235-240. doi: 10.1007/s10006-018-0688-8. Epub 2018 Mar 5.
Bisphosphonate-induced osteonecrosis of the jaw [BIONJ] is a relatively new pathological condition which was first described in the year 2003. The prevalence of BIONJ in patients on oral formulations is around 0.05% within the first 3 years and increases up to 0.2% after 4 years of consumption. Proven systemic risk factors like anemia, uncontrolled diabetes, corticosteroid therapy, and chemotherapy in neoplastic diseases [e.g., high doses of methotrexate up to 30 mg daily] significantly increase the chances of acquiring BIONJ. We present three patients with osteoporosis and rheumatoid arthritis [RA] who consumed oral bisphosphonates [alendronate] for less than 1 year and developed BIONJ within 2 to 5 months of undergoing a traumatic dental procedure. The patients also gave a history of consuming low doses of methotrexate [disease-modifying anti-rheumatic drugs] up to 20 mg weekly for 4 to 10 years. No history of steroid consumption was given by any of the patients. This case series highlights the possibility of rheumatoid arthritis and low-dose methotrexate being potential risk factors for BIONJ. This may be on account of the synergistic effect of methotrexate and bisphosphonates and the pro-inflammatory state created by RA which increased the risk of acquiring BIONJ.
双膦酸盐类药物所致颌骨坏死[BIONJ]是一种相对较新的病理状况，于2003年首次被描述。服用口服制剂的患者中，BIONJ在前3年的患病率约为0.05%，用药4年后患病率增至0.2%。已证实的全身性风险因素，如贫血、未控制的糖尿病、皮质类固醇治疗以及肿瘤性疾病中的化疗[如每日高达30毫克的高剂量甲氨蝶呤]，会显著增加发生BIONJ的几率。我们报告3例患有骨质疏松症和类风湿关节炎[RA]的患者，他们服用口服双膦酸盐类药物[阿仑膦酸钠]不足1年，并在接受创伤性牙科手术后2至5个月内发生了BIONJ。这些患者还曾有每周服用低剂量甲氨蝶呤[改善病情抗风湿药]达20毫克、持续4至10年的病史。所有患者均无使用类固醇的病史。该病例系列突出了类风湿关节炎和低剂量甲氨蝶呤可能是BIONJ的潜在风险因素。这可能是由于甲氨蝶呤和双膦酸盐类药物的协同作用以及RA所产生的促炎状态增加了发生BIONJ的风险。
