Hatunen Suzanna L, Anderson Jamie G, Bell Cynthia M, Campos Hugo C, Finkelman Matthew D, Shope Bonnie H
Veterinary Dental Services LLC., Boxborough, MA, United States.
School of Dental Medicine, University of Pennsylvania, Philadelphia, PA, United States.
Front Vet Sci. 2024 Aug 23;11:1436988. doi: 10.3389/fvets.2024.1436988. eCollection 2024.
This retrospective study highlights the salient aspects of a series of feline patients affected with bisphosphonate related osteonecrosis of the jaw. Though more commonly published in human literature, this presentation is rare in cats. The authors hope that this study will assist in making this a more globally known entity with subsequent improved prognosis.
Data was retrospectively obtained from the medical records between 2015 and 2021 of 20 cats with Medication Related Osteonecrosis of the Jaw. Data included patient information, clinical history, presenting complaint, systemic diseases, details referable to hypercalcemia and treatment thereof, bisphosphonate specifics (dose and duration), clinical presentation of the lesion, diagnostic testing including radiographic and histopathologic descriptions, treatment, and outcome.
Pertinent results include that all 20 cats who developed Medication Related Osteonecrosis of the Jaw had been treated for idiopathic hypercalcemia with the bisphosphonate medication alendronate. Eighty-five percent of the cases had prior dental extractions at the site of MRONJ lesion. Ninety-five percent of the affected cats required a surgical procedure to control the disease. Thirty-five percent of cases required at least one revision surgery after the initial procedure was performed. Diagnosis of MRONJ was made by a correlation of diagnostic findings and patient history. No single diagnostic, or combination was pathognomonic for lesion diagnosis. As well, there were no statistically significant associations between patient variables assessed and the overall patient outcome.
The case series reveals that cats with feline idiopathic hypercalcemia treated with alendronate may be at a risk for development of MRONJ, a serious oral condition with significant morbidity. Prior dental extraction sites in patients concurrently treated with bisphosphonate medications were often associated with MRONJ lesions. Therefore, any needed dental surgery should be performed prior to the use of bisphosphonates where possible. The authors have also included a relevant comparative literature review.
这项回顾性研究突出了一系列患有双膦酸盐相关颌骨坏死的猫科动物患者的显著特征。尽管该病症在人类文献中更为常见，但在猫中这种情况很少见。作者希望这项研究将有助于使这一病症在全球范围内更广为人知，从而改善预后。
回顾性收集了2015年至2021年间20只患有药物相关性颌骨坏死的猫的病历资料。数据包括患者信息、临床病史、就诊主诉、全身疾病、高钙血症及其治疗细节、双膦酸盐具体情况（剂量和疗程）、病变的临床表现、诊断检查（包括影像学和组织病理学描述）、治疗及结果。
相关结果包括，所有20只发生药物相关性颌骨坏死的猫均因特发性高钙血症接受了双膦酸盐药物阿仑膦酸钠治疗。85%的病例在药物相关性颌骨坏死病变部位之前进行过拔牙。95%的患病猫需要进行手术来控制病情。35%的病例在首次手术后需要至少一次翻修手术。药物相关性颌骨坏死的诊断是通过诊断结果与患者病史的关联得出的。没有单一的诊断方法或联合诊断方法对病变诊断具有特异性。此外，所评估的患者变量与患者总体结局之间没有统计学上的显著关联。
该病例系列表明，用阿仑膦酸钠治疗的猫特发性高钙血症猫可能有发生药物相关性颌骨坏死的风险，这是一种具有显著发病率的严重口腔疾病。同时接受双膦酸盐药物治疗的患者，之前的拔牙部位通常与药物相关性颌骨坏死病变有关。因此，任何必要的牙科手术应尽可能在使用双膦酸盐之前进行。作者还纳入了相关的比较文献综述。
