Department of Surgical Sciences/Periodontology, Marquette University School of Dentistry, Milwaukee, Wisconsin, USA.
Private Practice Odessa, Odessa, Texas, USA.
Aust Dent J. 2020 Mar;65(1):100-103. doi: 10.1111/adj.12738. Epub 2019 Dec 10.
Bisphosphonates (BPs) have long been used for the treatment of osteoporosis and diseases like bone malignancies, active Paget's disease of bone, severe osteogenesis imperfecta and fibrous dysplasia among others. They bond highly to the bone surface and inhibit bone resorption. As BPs have a long half-life in bone because of their irreversible binding to bone, patients retain their risk profile even after drug cessation. This property also explains the complications wherein the cessation of bone resorption leads to halt in bone turnover. Usually with alendronate the risk of bisphosphonate-related osteonecrosis of jaw (BRONJ) wears off after 12 months. Reporting of the development of BRONJ is commonly associated with the intravenous BPs. Invasive surgical procedure associated with the placement of implants has been shown to be a major reason for the occurrence or initiation of BRONJ in susceptible patients. The prognosis of implants placed in the jaws of patients under or past BP medication is still uncertain. The present case report describes a patient on long-term oral BP therapy with spontaneous exfoliation of implant supported bone due to osteonecrosis.
双膦酸盐（BPs）长期以来一直被用于治疗骨质疏松症和其他疾病，如骨恶性肿瘤、活动期 Pagets 骨病、严重成骨不全症和纤维结构不良等。它们与骨表面高度结合，抑制骨吸收。由于 BPs 在骨骼中的半衰期长，因为它们与骨骼的不可逆结合，即使在停药后，患者仍然保留其风险特征。这种特性也解释了停止骨吸收导致骨转换停止的并发症。通常，使用阿伦膦酸盐，颌骨相关的双膦酸盐性骨坏死（BRONJ）的风险在 12 个月后消失。BRONJ 的发生通常与静脉注射 BPs 有关。研究表明，与植入物相关的侵入性手术是易感患者发生或引发 BRONJ 的主要原因。在接受或停止 BP 药物治疗的患者的颌骨中植入物的预后仍然不确定。本病例报告描述了一名长期接受口服 BP 治疗的患者，由于骨坏死导致植入物支持的骨自发脱落。
