Journal of the Korean Association of Oral and Maxillofacial Surgeons

  • 제37권1호
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  • Pages.1-8
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  • 2011
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  • 2234-7550(pISSN)
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  • 2234-5930(eISSN)
대한구강악안면외과학회 (The Korean Association of Oral and Maxillofacial Surgeons)
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비스포스포네이트 관련 악골괴사환자의 혈청 C-terminal cross linking telopeptide 수치에 따른 위험도 평가와 질환의 심도 및 조기 수술 후 치유 사이의 상관관계

Clinical study of correlation between C-terminal cross-linking telopeptide of type I collagen and risk assessment, severity of disease, healing after early surgical intervention in patients with bisphophonate-related osteonecrosis of the jaws

  • 송진우 (부산대학교 치의학전문대학원 구강악안면외과학교실) ;
  • 김기현 (부산대학교 치의학전문대학원 구강악안면외과학교실) ;
  • 송재민 (부산대학교 치의학전문대학원 구강악안면외과학교실) ;
  • 전병도 (부산대학교 치의학전문대학원 구강악안면외과학교실) ;
  • 김용덕 (부산대학교 치의학전문대학원 구강악안면외과학교실) ;
  • 김욱규 (부산대학교 치의학전문대학원 구강악안면외과학교실) ;
  • 신상훈 (부산대학교 치의학전문대학원 구강악안면외과학교실)
  • Song, Jin-Woo (Department of Oral and Maxillofacial Surgery, School of Dentistry, Pusan National University) ;
  • Kim, Ki-Hyun (Department of Oral and Maxillofacial Surgery, School of Dentistry, Pusan National University) ;
  • Song, Jae-Min (Department of Oral and Maxillofacial Surgery, School of Dentistry, Pusan National University) ;
  • Chun, Byung-Do (Department of Oral and Maxillofacial Surgery, School of Dentistry, Pusan National University) ;
  • Kim, Yong-Deok (Department of Oral and Maxillofacial Surgery, School of Dentistry, Pusan National University) ;
  • Kim, Uk-Kyu (Department of Oral and Maxillofacial Surgery, School of Dentistry, Pusan National University) ;
  • Shin, Sang-Hun (Department of Oral and Maxillofacial Surgery, School of Dentistry, Pusan National University)
  • 투고 : 2010.10.19
  • 심사 : 2011.02.07
  • 발행 : 2011.02.28
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초록

Introduction: The utility of the C-terminal cross-linking telopeptide test (CTX) as a method for staging Bisphosphonate-related osteonecrosis of the jaws (BRONJ) and its healing process was examined. Materials and Methods: A total 19 patients who were diagnosed with BRONJ underwent a fasted morning CTX test, were enrolled in this study. The serum CTX values ranged from 50 to 630 pg/mL (mean 60). The risk assessment was rated according to the CTX values of the individual patient (minimal risk, ${\geq}$ 150 pg/mL, moderate, 100 to 150 pg/mL, high, ${\leq}$100 pg/mL). The BRONJ scores were then calculated according to the number of BRONJ lesions and their stage. The operation was done as soon as possible, regardless of BORNJ stage. Results: The mean duration of bisphosphonate therapy was 4.1 years. Of the 19 patients, 15, 2 ans 2 received alendronate, risedronate and zoledronate, respecively. Of the 19 patients who underwent a sequestrectomy, saucerization and smoothing, 15 healed after the initial surgery, 1 patient healed after one more surgical procedure, 3 patients did not heal completely but showed improvement in symptoms. Therefore, 17 out of the 19 patients healed completely with complete mucosal coverage and the elimination of pain. The risk assessment using the CTX value and disease severity were not correlated (r=-0.264, P=0.275). In addition, the risk assessment using CTX value and healing after surgery were not correlated (r=-0.147, P=0.547). Conclusion: The serum CTX should be considered carefully by clinicians as part of overall management. Early surgical intervention is of benefit in the treatment of stage II BRONJ.

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참고문헌

  1. Marx RE. Pamidronate (Aredia) and zoledronate (Zometa) induced avascular necrosis of the jaws: a growing epidemic. J Oral Maxillofac Surg 2003;61:1115-7. https://doi.org/10.1016/S0278-2391(03)00720-1
  2. Saad F, Lipton A. Clinical benefits and considerations of bisphosphonate treatment in metastatic bone disease. Semin Oncol 2007;34(6 Suppl 4):S17-23.
  3. Diel IJ, Bergner R, Grotz KA. Adverse effects of bisphosphonates: current issues. J Support Oncol 2007;5:475-82.
  4. Khosla S, Burr D, Cauley J, Dempster DW, Ebeling PR, Felsenberg D, et al.; American Society for Bone and Mineral Research. Bisphosphonate-associated osteonecrosis of the jaw: report of a task force of the American Society for Bone and Mineral Research. J Bone Miner Res 2007;22:1479-91. https://doi.org/10.1359/jbmr.0707onj
  5. Mavrokokki T, Cheng A, Stein B, Goss A. Nature and frequency of bisphosphonate-associated osteonecrosis of the jaws in Australia. J Oral Maxillofac Surg 2007;65:415-23. https://doi.org/10.1016/j.joms.2006.10.061
  6. Roelofs AJ, Coxon FP, Ebetino FH, Bala JF, Kashemirov BA, McKenna CE, et al. Use of a fluorescent analogue of risedronate to study localisation and cellular uptake of bisphosphonates in vivo. Bone 2008;42(Suppl 1):S85.
  7. Marx RE, Cillo JE Jr, Ulloa JJ. Oral bisphosphonate-induced osteonecrosis: risk factors, prediction of risk using serum CTX testing, prevention, and treatment. J Oral Maxillofac Surg 2007;65: 2397-410. https://doi.org/10.1016/j.joms.2007.08.003
  8. Advisory Task Force on Bisphosphonate-Related Ostenonecrosis of the Jaws, American Association of Oral and Maxillofacial Surgeons. American Association of Oral and Maxillofacial Surgeons position paper on bisphosphonate-related osteonecrosis of the jaws. J Oral Maxillofac Surg 2007;65:369-76. https://doi.org/10.1016/j.joms.2006.11.003
  9. Marx RE, ed. Oral and intravenous bisphosphonate-induced osteonecrosis of the jaws: history, etiology, prevention, and treatment. 1st ed. Chicago: Quintessence Pub. Co.; 2007.
  10. Hansen T, Kunkel M, Springer E, Walter C, Weber A, Siegel E, et al. Actinomycosis of the jaws--histopathological study of 45 patients shows significant involvement in bisphosphonate-associated osteonecrosis and infected osteoradionecrosis. Virchows Arch 2007;451:1009-17. https://doi.org/10.1007/s00428-007-0516-2
  11. Hansen T, Kirkpatrick CJ, Walter C, Kunkel M. Increased numbers of osteoclasts expressing cysteine proteinase cathepsin K in patients with infected osteoradionecrosis and bisphosphonate-associated osteonecrosis-a paradoxical observation? Virchows Arch 2006;449:448-54. https://doi.org/10.1007/s00428-006-0261-y
  12. Rizzoli R, Burlet N, Cahall D, Delmas PD, Eriksen EF, Felsenberg D, et al. Osteonecrosis of the jaw and bisphosphonate treatment for osteoporosis. Bone 2008;42:841-7. https://doi.org/10.1016/j.bone.2008.01.003
  13. Chiandussi S, Biasotto M, Dore F, Cavalli F, Cova MA, Di Lenarda R. Clinical and diagnostic imaging of bisphosphonate-associated osteonecrosis of the jaws. Dentomaxillofac Radiol 2006;35:236-43. https://doi.org/10.1259/dmfr/27458726
  14. Reid IR, Bolland MJ, Grey AB. Is bisphosphonate-associated osteonecrosis of the jaw caused by soft tissue toxicity? Bone 2007; 41:318-20. https://doi.org/10.1016/j.bone.2007.04.196
  15. McDonald MM, Dulai S, Godfrey C, Amanat N, Sztynda T, Little DG. Bolus or weekly zoledronic acid administration does not delay endochondral fracture repair but weekly dosing enhances delays in hard callus remodeling. Bone 2008;43:653-62. https://doi.org/10.1016/j.bone.2008.05.019
  16. Li C, Mori S, Li J, Kaji Y, Akiyama T, Kawanishi J, et al. Longterm effect of incadronate disodium (YM-175) on fracture healing of femoral shaft in growing rats. J Bone Miner Res 2001;16: 429-36. https://doi.org/10.1359/jbmr.2001.16.3.429
  17. Li J, Mori S, Kaji Y, Kawanishi J, Akiyama T, Norimatsu H. Concentration of bisphosphonate (incadronate) in callus area and its effects on fracture healing in rats. J Bone Miner Res 2000;15: 2042-51. https://doi.org/10.1359/jbmr.2000.15.10.2042
  18. Peter CP, Cook WO, Nunamaker DM, Provost MT, Seedor JG, Rodan GA. Effect of alendronate on fracture healing and bone remodeling in dogs. J Orthop Res 1996;14:74-9. https://doi.org/10.1002/jor.1100140113
  19. Allen MR, Burr DB. The pathogenesis of bisphosphonate-related osteonecrosis of the jaw: so many hypotheses, so few data. J Oral Maxillofac Surg 2009;67(5 Suppl):61-70.
  20. Schwartz S, Joseph C, Iera D, Vu DD. Bisphosphonates, osteonecrosis, osteogenesis imperfecta and dental extractions: a case series. J Can Dent Assoc 2008;74:537-42.
  21. Vignery A, Baron R. Dynamic histomorphometry of alveolar bone remodeling in the adult rat. Anat Rec 1980;196:191-200. https://doi.org/10.1002/ar.1091960210
  22. Enlow DH. Functions of the Haversian system. Am J Anat 1962;110:269-305. https://doi.org/10.1002/aja.1001100305
  23. Marx RE, Sawatari Y, Fortin M, Broumand V. Bisphosphonateinduced exposed bone (osteonecrosis/osteopetrosis) of the jaws: risk factors, recognition, prevention, and treatment. J Oral Maxillofac Surg 2005;63:1567-75. https://doi.org/10.1016/j.joms.2005.07.010
  24. Product information sheet, Aredia. Pamidronatate sodium for injection for intravenous infusion. East Hanover, NJ: Novartis AG; 2001.
  25. Bonewald LF. Osteocytes as dynamic multifunctional cells. Ann N Y Acad Sci 2007;1116:281-90. https://doi.org/10.1196/annals.1402.018
  26. Product information sheet, Zometa. Zoledronic acid injection. East Hanover, NJ: Novartis AG; 2004.
  27. Neff MJ; American College of Obstetricians and Gynecologists. ACOG releases guidelines for clinical management of osteoporosis. Am Fam Physician 2004;69:1558, 1560.
  28. Food and Drug Administration. Boning up on osteoporosis, Pub No. FDA 04-1322C [Internet]. Rockville, MD: FDA Consumer magazine Vol. 30, No. 7, Sep, 1996. Available from: http://webharvest.gov/peth04/20041109083843/http://www.fda.g ov/fdac/features/796_bone.html.
  29. Kwon YD, Kim DY, Ohe JY, Yoo JY, Walter C. Correlation between serum C-terminal cross-linking telopeptide of type I collagen and staging of oral bisphosphonate-related osteonecrosis of the jaws. J Oral Maxillofac Surg 2009;67:2644-8. https://doi.org/10.1016/j.joms.2009.04.067
  30. Stanton DC, Balasanian E. Outcome of surgical management of bisphosphonate-related osteonecrosis of the jaws: review of 33 surgical cases. J Oral Maxillofac Surg 2009;67:943-50. https://doi.org/10.1016/j.joms.2008.12.057

피인용 문헌

  1. 비스포스포네이트 관련 악골괴사(BRONJ)의 병기 2기에서의 외과적, 보존적 치료에 대한 비교 연구 vol.35, pp.5, 2011, https://doi.org/10.14402/jkamprs.2013.35.5.302