Graduate Program in Pharmaceutical Sciences, University of Sorocaba, Sorocaba, Brazil.
Division of Pharmacology, Anesthesiology and Therapeutics, Faculdade São Leopoldo Mandic, Instituto de Pesquisas São Leopoldo Mandic, Campinas, Brazil.
Oral Dis. 2023 Jan;29(1):75-99. doi: 10.1111/odi.14003. Epub 2021 Sep 22.
To determine the frequency of osteonecrosis of the jaw in bisphosphonate users submitted to dental procedures.
This systematic review searched the sources: MEDLINE, EMBASE, Web of Science, Scopus, and Virtual Health Library, with no restriction on language or publication date. Reviewers, in pairs and independently, selected the studies, extracted their data, and assessed the risk of bias. Meta-analyses were pooled using the DerSimonian and Laird random effects model.
A total of 27 studies (5391 participants) were included. The most reported bisphosphonates were zoledronate (n = 17 studies) and alendronate (n = 19) for treating cancers (n = 11) and osteoporosis (n = 16), respectively. Twelve studies were of low methodological quality. The frequency of osteonecrosis was 2.7% (95% CI: 0.9-5.2%) and proved higher for intravenous [6.9% (0.7-17.3%)] than oral [0.2% (0.9-5.2%)] bisphosphonate use. No association between longer treatment duration and greater frequency of osteonecrosis was observed.
Higher frequency of osteonecrosis was observed in intravenous bisphosphonate users submitted to dental extraction. Further studies collecting more detailed information on the bisphosphonates used and of greater methodological rigor are warranted to confirm these findings and better inform prescribers, dental surgeons, and other professionals on risks of bisphosphonate use in this patient group.
确定接受牙科手术的双膦酸盐使用者发生下颌骨坏死的频率。
本系统评价检索了 MEDLINE、EMBASE、Web of Science、Scopus 和 Virtual Health Library 等来源，对语言和出版日期没有限制。审查员成对且独立地选择研究、提取数据并评估偏倚风险。使用 DerSimonian 和 Laird 随机效应模型对荟萃分析进行汇总。
共纳入 27 项研究（5391 名参与者）。报告最多的双膦酸盐分别为唑来膦酸（n=17 项研究）和阿仑膦酸钠（n=19 项研究），分别用于治疗癌症（n=11 项研究）和骨质疏松症（n=16 项研究）。12 项研究的方法学质量较低。下颌骨坏死的发生率为 2.7%（95%CI：0.9-5.2%），静脉内[6.9%（0.7-17.3%）]使用双膦酸盐的发生率高于口服[0.2%（0.9-5.2%）]。未观察到治疗持续时间较长与下颌骨坏死发生率较高之间存在关联。
接受牙科拔牙的静脉内双膦酸盐使用者中，下颌骨坏死的发生率较高。需要进一步收集关于使用的双膦酸盐的更详细信息且具有更高方法学严谨性的研究，以证实这些发现，并更好地为处方医生、牙科外科医生和其他专业人员提供关于此类患者群体使用双膦酸盐的风险信息。
