AlDhalaan Nouf A, BaQais Asma, Al-Omar Ahmad
Dentistry, King Saud University, Riyadh, SAU.
Surgery, King Saud University, Riyadh, SAU.
Cureus. 2020 Feb 10;12(2):e6944. doi: 10.7759/cureus.6944.
Medication-related osteonecrosis of the jaw (MRONJ) is a rare, severe debilitating condition from unknown causes. It is characterized by nonhealing exposed bone in a patient with a history of antiresorptive or antiangiogenic agents in the absence of radiation exposure to the head and neck region. The first case of MRONJ was reported in the early 2000s. Diagnostic criteria for MRONJ was developed by the American Association of Oral and Maxillofacial Surgeons (AAOMS) based on pharmacological history as well as clinical and radiographic features. Antiresorptive medications such as bisphosphonate and denosumab are currently considered the treatment of choice in patients with osteoclastic bone disease. These reduce bone turnover and improve bone density, thereby improving bone quality. These agents have also been shown to reduce the risk of osteoporotic fractures due to their potent effect in suppressing osteoclastic activity by slowing the remodeling process and increasing bone density, thereby improving quality of life for most of the patients. Despite the great benefits of bisphosphonates and other antiresorptive medications, osteonecrosis of the jaw (ONJ) due to the effects of these medications in the presence of a local risk factor is a significant drawback. Moreover, antiangiogenic drugs play a major role in developing bone necrosis. They are prescribed in cancer cases to prevent metastasis through the blood and lymph nodes. These drugs interfere with the formation of new blood vessels, resulting in ischemia and eventually ONJ. This risk can be managed by evaluating the route and the duration of administration as such a risk can be considered dose-time dependent. As a preventive measure, dental screening before initiating any type of ONJ-related medications can significantly lower the risk of ONJ. Treatment goals can be achieved through pain and infection control, in addition to the management of bone necrosis and resorption. The aim of this review is to identify all causative agents and summarize the preventive measures, diagnostic criteria, and treatment strategies related to MRONJ.
药物相关性颌骨坏死（MRONJ）是一种病因不明的罕见且严重致残性疾病。其特征为在无头颈部放射暴露史的情况下，有抗吸收或抗血管生成药物使用史的患者出现骨暴露不愈合。MRONJ的首例病例于21世纪初被报道。美国口腔颌面外科医师协会（AAOMS）根据用药史以及临床和影像学特征制定了MRONJ的诊断标准。抗吸收药物如双膦酸盐和地诺单抗目前被认为是破骨性骨病患者的首选治疗药物。这些药物可降低骨转换并提高骨密度，从而改善骨质。这些药物还因其通过减缓重塑过程和增加骨密度来抑制破骨细胞活性的强大作用，被证明可降低骨质疏松性骨折的风险，从而改善大多数患者的生活质量。尽管双膦酸盐和其他抗吸收药物有诸多益处，但这些药物在存在局部危险因素时导致的颌骨坏死（ONJ）是一个重大缺点。此外，抗血管生成药物在骨坏死的发生中起主要作用。它们被用于癌症病例中以防止通过血液和淋巴结转移。这些药物干扰新血管的形成，导致局部缺血并最终引发ONJ。这种风险可通过评估给药途径和持续时间来管理，因为这种风险可被认为是剂量 - 时间依赖性的。作为预防措施，在开始任何类型的ONJ相关药物治疗前进行牙科筛查可显著降低ONJ的风险。除了处理骨坏死和骨吸收外，通过控制疼痛和感染也可实现治疗目标。本综述的目的是确定所有致病因素，并总结与MRONJ相关的预防措施、诊断标准和治疗策略。
