Schwaneck E C, Streit A, Krone M, Hartmann S, Müller-Richter U, Kübler A C, Gadeholt O, Schmalzing M, Tony H-P, Brands R C
Department of Rheumatology and Immunology (Head: H.-P. Tony), University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany.
Institute for Hygiene and Microbiology, University of Wuerzburg, Josef-Schneider-Straße 2, 97080, Würzburg, Germany.
Z Rheumatol. 2020 Mar;79(2):203-209. doi: 10.1007/s00393-019-0606-y.
The aim of the present study was to assess the prevalence of medication-related osteonecrosis of the jaw (MRONJ) in osteoporosis patients suffering from inflammatory rheumatic diseases, as well as to assess the prevalence of relevant dental, behavioral, and medical risk factors for MRONJ.
A total of 198 patients with inflammatory rheumatic diseases and osteoporosis therapy were recruited from a tertiary rheumatological/immunological referral center between June 2015 and September 2016. They were assessed using a structured interview. A maxillofacial surgeon later examined patients complaining of possible symptoms of osteonecrosis. In cases of osteonecrosis, dental records were obtained and evaluated. Preventive measures taken and dental as well as other clinical risk factors were evaluated.
Of the 198 patients, three suffered from osteonecrosis of the jaw, none of whom had any history of malignant disease or radiation therapy, resulting in a prevalence of 1.5%. Of these three patients, only one was given bisphosphonates intravenously (i.v.), whereas all three had been treated orally. All three diagnoses of MRONJ had been previously known to the patients and their maxillofacial surgeons. Two of the patients had rheumatoid arthritis, and one patient suffered from large vessel vasculitis. Long anti-osteoporotic treatment duration, low functional status, and low bone density of the femur were significantly associated with MRONJ development.
Inflammatory rheumatic diseases constitute a risk factor for MRONJ in patients treated with bisphosphonates for osteoporosis. Patients should be counseled accordingly and should be offered dental screening and regular dental check-ups.
本研究旨在评估患有炎性风湿性疾病的骨质疏松症患者中与药物相关的颌骨坏死（MRONJ）的患病率，以及评估MRONJ相关的牙科、行为和医学风险因素的患病率。
2015年6月至2016年9月期间，从一家三级风湿病/免疫学转诊中心招募了总共198例患有炎性风湿性疾病并接受骨质疏松症治疗的患者。通过结构化访谈对他们进行评估。颌面外科医生随后对主诉可能存在骨坏死症状的患者进行检查。对于骨坏死病例，获取并评估牙科记录。评估所采取的预防措施以及牙科和其他临床风险因素。
在198例患者中，有3例患有颌骨坏死，其中无一例有恶性疾病或放射治疗史，患病率为1.5%。在这3例患者中，只有1例接受了静脉注射双膦酸盐治疗，而3例均接受过口服治疗。所有3例MRONJ诊断此前患者及其颌面外科医生均已知晓。其中2例患者患有类风湿关节炎，1例患者患有大血管血管炎。抗骨质疏松治疗时间长、功能状态差和股骨骨密度低与MRONJ的发生显著相关。
炎性风湿性疾病是接受双膦酸盐治疗骨质疏松症患者发生MRONJ的一个危险因素。应相应地为患者提供咨询，并为其提供牙科筛查和定期牙科检查。
