Wan Jason T, Sheeley Douglas M, Somerman Martha J, Lee Janice S
1National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD USA.
2Laboratory for Oral Connective Tissue Biology, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD USA.
Bone Res. 2020 Mar 11;8:14. doi: 10.1038/s41413-020-0088-1. eCollection 2020.
It is well established that alterations in phosphate metabolism have a profound effect on hard and soft tissues of the oral cavity. The present-day clinical form of osteonecrosis of the jaw (ONJ) was preceded by phosphorus necrosis of the jaw, ca. 1860. The subsequent removal of yellow phosphorus from matches in the early 20th century saw a parallel decline in "phossy jaw" until the early 2000s, when similar reports of unusual jaw bone necrosis began to appear in the literature describing jaw necrosis in patients undergoing chemotherapy and concomitant steroid and bisphosphonate treatment. Today, the potential side effect of ONJ associated with medications that block osteoclast activity (antiresorptive) is well known, though the mechanism remains unclear and the management and outcomes are often unsatisfactory. Much of the existing literature has focused on the continuing concerns of appropriate use of bisphosphonates and other antiresorptive medications, the incomplete or underdeveloped research on ONJ, and the use of drugs with anabolic potential for treatment of osteoporosis. While recognizing that ONJ is a rare occurrence and ONJ-associated medications play an important role in fracture risk reduction in osteoporotic patients, evidence to date suggests that health care providers can lower the risk further by dental evaluations and care prior to initiating antiresorptive therapies and by monitoring dental health during and after treatment. This review describes the current clinical management guidelines for ONJ, the critical role of dental-medical management in mitigating risks, and the current understanding of the effects of predominantly osteoclast-modulating drugs on bone homeostasis.
众所周知，磷酸盐代谢的改变对口腔的硬组织和软组织有着深远影响。颌骨坏死（ONJ）目前的临床形式之前是颌骨磷中毒坏死，大约在1860年。20世纪初火柴中黄磷的去除导致“磷毒性颌骨坏死”相应减少，直到21世纪初，文献中开始出现类似的关于异常颌骨坏死的报告，描述了接受化疗以及同时使用类固醇和双膦酸盐治疗的患者中的颌骨坏死情况。如今，与阻断破骨细胞活性的药物（抗吸收药物）相关的ONJ潜在副作用已为人所知，但其机制仍不清楚，管理和治疗效果往往不尽人意。现有许多文献聚焦于对双膦酸盐和其他抗吸收药物合理使用的持续关注、对ONJ不完整或未充分开展的研究，以及使用具有合成代谢潜力的药物治疗骨质疏松症。虽然认识到ONJ是一种罕见情况，且与ONJ相关的药物在降低骨质疏松症患者骨折风险方面发挥着重要作用，但迄今为止的证据表明，医疗保健提供者可以通过在开始抗吸收治疗前进行牙科评估和护理，以及在治疗期间和治疗后监测牙齿健康来进一步降低风险。本综述描述了ONJ目前的临床管理指南、牙科 - 医疗管理在降低风险方面的关键作用，以及目前对主要调节破骨细胞的药物对骨稳态影响的理解。
