Journal of Dental Rehabilitation and Applied Science (구강회복응용과학지)

Korean Academy of Stomatognathic Function and Occlusion (대한턱관절교합학회)
권호 표지

Bisphophonate-Related Osteonecrosis of the Jaw (BRONJ)

비스포스포네이트 연관 악골괴사증(BRONJ)

  • Kim, Hyeon-Mook (Sunplus Dental Clinic) ;
  • Park, Chan-Jin (Department of Prosthodontics and Institute of Oral Science, College of Dentistry, Gangneung-Wonju National University)
  • 김현묵 (선플러스 치과) ;
  • 박찬진 (강릉원주대학교 치과대학 치과보철학교실)
  • Received : 2011.11.10
  • Accepted : 2011.12.25
  • Published : 2011.12.31
Download PDF
⟨ Previous Next ⟩

Abstract

Recently, jawbone osteonecrosis has been largely reported as a potential adverse effect of bisphosphonate (BP)administration. Currently available published incidence data for BRONJ are based on retrospective studies and estimates of cumulative incidence range from 0.8 to 12%. The mandible is more commonly affected than the maxilla (2:1 ratio), and 60-70% of cases are preceded by a dental surgical procedure. The signs and symptoms that may occur before the appearance of clinical evident osteonecrosis include changes in the health of periodontal tissues, non-healing mucosal ulcers, loose teeth and unexplained soft-tissue infection. Tooth extraction as a precipitating event is a common observation. The significant benefits that bisphosphonates offer to patients clearly surpass the risk of potential side effects; however, any patient for whom prolonged bisphosphonate therapy is indicated, should be provided with preventive dental care in order to minimize the risk of developing this severe condition.

근래에 비스포스포테이트(bisphosphonate) 투약의 부작용으로 악골괴사에 관한 보고들이 점차적으로 증가하고 있다. 최근에 보고된 유병율은 대략 0.8% - 12 % 정도이다. 하악은 상악보다 2배 정도 호발하는 것으로 보고되었고 이의 60 - 70 %는 치과진료와 연관성이 거론되었다. 임상적으로 골괴사 현상이 일어나기 전에 건강한 치주조직에 변화가 일어나는데 치유지연 점막궤양, 치아동요와 원인을 알 수 없는 연조직 감염등이 관찰되었다. 치아발거가 치과영역에서 가장 흔한 사전 처치행위로 알려져 있다. 장기적인 비스포스포네이트 투약시 세심한 예방적 치과진료가 이러한 심각한 괴사로 이어지지 않도록 하는데 절대적이다.

Keywords

References

  1. Wu S, Dahut WL, Gulley JL. The use of bisphosphonates in cancer patients. Acta Oncol 2007;46:581- 91 https://doi.org/10.1080/02841860701233435
  2. Wang J, Goodger NM, Pogrel MA. Osteonecrosis of the jaws associated with cancer chemotherapy. J Oral Maxillofac Surg 2003;61:1104-7 https://doi.org/10.1016/S0278-2391(03)00328-8
  3. Rosenberg TJ, Ruggiero S. Osteonecrosis of the jaws associated with the use of bisphosphonates. J Oral Maxillofac Surg 2003;61:60 (letter) https://doi.org/10.1016/S0278-2391(03)00566-4
  4. 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
  5. Migliorati CA. Bisphosphonates and oral cavity avascular bone necrosis. New Engl J Med 2003;21: 4253-4 (letter)
  6. Ruggiero SL, Mehrotra B, Rosenberg TJ, et al. Osteonecrosis of the jaws associated with the use of bisphosphonates: a review of 63 cases. J Oral Maxillofac Surg 2004;62:527-34 https://doi.org/10.1016/j.joms.2004.02.004
  7. Lugassy G, Shaham R, Nemets A, et al. Severe osteomyelitis of the jaw in long-term survivors of multiple myeloma: a new clinical entity. Am J Med 2004;117:440-1 https://doi.org/10.1016/j.amjmed.2004.04.015
  8. Bagan JV, Murillo J, Poveda R, et al. Avascular jaw osteonecrosis in association with cancer chemotherapy: series of 10 cases. J Oral Pathol Med 2005;34:120-3 https://doi.org/10.1111/j.1600-0714.2004.00269.x
  9. Vannucchi AM, Ficarra G, Antonioli E, et al. Osteonecrosis of the jaw associated with zoledronate therapy in a patient with multiple myeloma. Br J Haematol 2005;128:738 https://doi.org/10.1111/j.1365-2141.2005.05382.x
  10. Yarom N, Yahalom Y, Shoshani, et al. Osteonecrosis of the jaw induced by orally administered bisphosphonates: incidence, clinical features, predisposing factors and treatment outcome. Osteoporos Int 2007;18(10):1363-70 https://doi.org/10.1007/s00198-007-0384-2
  11. Lehrer S, Montazem A, Ramanathan L, Pessin- Minsley M, Pfail J, Stock RG, et al. Normal serum bone markers in bisphosphonate-induced osteonecrosis of the jaws. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008; 106 : 389-91. https://doi.org/10.1016/j.tripleo.2008.01.033
  12. Ficarra G, Beninati F. Bisphosphonate-related osteonecrosis of the jaws: an update on clinical, pathological and management aspects. Head Neck Pathol 2007; 1 : 132-40. https://doi.org/10.1007/s12105-007-0033-2
  13. Kos M, Kuebler JF, Luczak K, Engelke W. Bisphosphonate related osteonecrosis of the jaws: a review of 34 cases and evaluation of risk. J Craniomaxillofac Surg 2010; 38 : 255-9. https://doi.org/10.1016/j.jcms.2009.06.005
  14. Reid IR, Bolland MJ. Is bisphosphonates-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. Migliorati CA, Schubert MM, Peterson DE, et al. Bisphosphonate-associated osteonecrosis of mandibular and maxillary bone: an emerging oral complication of supportive cancer therapy. Cancer 2005;104:83-93 https://doi.org/10.1002/cncr.21130
  16. Merigo E, Manfredi M, Meleti M, et al. Jaw bone necrosis without previous dental extractions associated with the use of bisphosphonates (pamidronate and zoledronate): a four- case report. J Oral Pathol Med 2005;34:613-7 https://doi.org/10.1111/j.1600-0714.2005.00351.x
  17. Olson KB, Hellie CM, Pienta KJ. Osteonecrosis of jaw in patient with hormone-refractory prostate cancer treated with zoledronic acid. Urology 2005;66:658
  18. Zervas K, Verrou E, Teleioudis Z, et al. Incidence, risk factors and management of osteonecrosis of the jaw in patients with multiple myeloma: a single- centre experience in 303 patients. Br J Haematol 2006;134:620-3 https://doi.org/10.1111/j.1365-2141.2006.06230.x
  19. Sanna G, Preda L, Bruschini R, et al. Bisphosphonates and jaw osteonecrosis in patients with advanced breast cancer. Ann Oncol 2006;17:1512-6 https://doi.org/10.1093/annonc/mdl163
  20. Badros A, Weikel D, Salama A, et al. Osteonecrosis of the jaw in multiple myeloma patients: clinical features and risk factors. J Clin Oncol 2006;24:945- 52 https://doi.org/10.1200/JCO.2005.04.2465
  21. American Association of Oral and Maxillofacial Surgeons position paper on bisphosphonates-related osteonecrosis of the jaws. J Oral Maxillofac Surg 2007;65:369-76 https://doi.org/10.1016/j.joms.2006.11.003