Department of Oral and Maxillofacial Radiology, School of Dentistry, Matsumoto Dental University, 1780 Hirooka Gobara, Shiojiri, Nagano, 399-0781, Japan.
Department of Hard Tissue Research, Graduate School of Oral Medicine, Matsumoto Dental University, 1780 Gobara, Hirooka, Shiojiri, Nagano, 399-0781, Japan.
J Bone Miner Metab. 2023 Nov;41(6):854-864. doi: 10.1007/s00774-023-01466-3. Epub 2023 Oct 28.
To investigate the differences in the incidence rates of suspected stage 0/1 osteonecrosis of the jaw (ONJ) and incidence risk of relevant clinical findings of suspected stage 0 ONJ between patients treated with sequential therapy comprising weekly teriparatide for 72 weeks followed by alendronate for 48 weeks vs. those who received monotherapy with alendronate for 120 weeks.
Suspected stage 0/1 ONJ was defined by non-specific symptoms. Tooth mobility and periodontal symptoms (gingival bleeding, swelling, and/or pain) were selected as clinical findings of suspected stage 0 ONJ. Poisson regression models were applied to calculate the incidence rate ratios of suspected stage 0/1 between the teriparatide group (TG) and alendronate group (AG). Generalized linear models were used to calculate the risk ratios of clinical findings between groups.
Two hundred and sixty-one participants in the TG and 344 in the AG answered a structured questionnaire on oral health and were included in this study. There were no significant differences between the groups in the incidence rate of suspected stage 0/1 ONJ at both 72 and 120 weeks. The risk ratio of the TG to AG for tooth mobility was 0.34 (95% confidence interval [CI] 0.13-0.88, p = 0.02) at 72 weeks and 0.90 (95% CI 0.40-2.03, p = 0.83) at 120 weeks. The incidence rate of tooth mobility related to periodontal symptoms decreased in the TG and increased in the AG during the study.
Tooth mobility accompanied by clinical periodontal symptoms may be a useful early sign of stage 0 ONJ.
研究每周特立帕肽治疗 72 周序贯治疗与 120 周阿仑膦酸钠单药治疗相比，0/1 期疑似颌骨骨坏死（ONJ）发生率及疑似 0 期 ONJ 相关临床发现的发生率差异。
疑似 0/1 期 ONJ 通过非特异性症状定义。牙齿松动和牙周症状（牙龈出血、肿胀和/或疼痛）被选为疑似 0 期 ONJ 的临床发现。应用泊松回归模型计算特立帕肽组（TG）和阿仑膦酸钠组（AG）疑似 0/1 期的发病率比值。采用广义线性模型计算组间临床发现的风险比。
261 名 TG 患者和 344 名 AG 患者回答了一份关于口腔健康的结构化问卷，并纳入本研究。在 72 周和 120 周时，两组疑似 0/1 期 ONJ 的发生率均无显著差异。72 周时，TG 组至 AG 组牙齿松动的风险比为 0.34（95%置信区间[CI] 0.13-0.88，p=0.02），120 周时为 0.90（95% CI 0.40-2.03，p=0.83）。在研究期间，TG 组牙齿松动与牙周症状相关的发生率下降，AG 组增加。
伴有临床牙周症状的牙齿松动可能是 0 期 ONJ 的一个有用的早期征象。
