Ohga Noritaka, Sato Jun, Asaka Takuya, Morimoto Masahiro, Yamazaki Yutaka, Kitagawa Yoshimasa
Oral Diagnosis and Medicine, Department of Oral Pathobiological, Faculty of Dental Medicine, Hokkaido University.
Gerodontology, Department of Oral Health Science, Faculty of Dental Medicine, Hokkaido University.
J Oral Sci. 2018;60(1):159-162. doi: 10.2334/josnusd.17-0027.
We report a case of osteonecrosis of the jaw (ONJ) associated with denosumab therapy in a 62-year-old female patient being treated for bone metastases from breast cancer. Upon initial presentation at the Department of Oral Medicine, Hokkaido University Hospital, the patient's mandibular molar teeth were extracted because of severe periodontal disease. Two months later, epithelialization of the sockets was observed and treatment with anti-resorptive drugs was started for bone metastases. One year after tooth extraction, bone exposure in the right lower first molar region was observed, and stage 2 medication-related ONJ (MRONJ) was diagnosed. Up to this time, the patient had received zoledronic acid twice and denosumab 22 times. Denosumab was discontinued by the oncologist, and oral antibiotics with rinsing of the exposed bone area were prescribed. By 36 weeks after discontinuation of denosumab, a sequestrum in the posterior part of the mandible was naturally shed, and the site was healed. Bisphosphonate is deposited in bones, whereas denosumab functions extracellularly and circulates in the blood. The effect of denosumab on bone remodeling is reversed shortly after the drug has been discontinued.
我们报告了一例62岁女性患者，因乳腺癌骨转移接受治疗，在使用地诺单抗治疗过程中发生颌骨骨坏死（ONJ）。该患者最初在北海道大学医院口腔内科就诊时，因严重牙周病拔除了下颌磨牙。两个月后，观察到拔牙窝上皮化，并开始使用抗吸收药物治疗骨转移。拔牙一年后，观察到右下第一磨牙区域骨暴露，诊断为2期药物相关性颌骨骨坏死（MRONJ）。截至此时，患者已接受两次唑来膦酸和22次地诺单抗治疗。肿瘤内科医生停用了地诺单抗，并开具了口服抗生素，同时对暴露的骨区域进行冲洗。地诺单抗停用36周后，下颌骨后部的死骨自然脱落，创口愈合。双膦酸盐沉积在骨骼中，而地诺单抗在细胞外起作用并在血液中循环。地诺单抗停药后不久，其对骨重塑的作用就会逆转。
