Bisphosphonate Associated Osteonecrosis of the Jaw

作者：Khan Aliya A^*; Sandor George K B; Dore Edward; Morrison Archibald D; Alsahli Mazen; Amin Faizan; Peters Edmund; Hanley David A; Chaudry Sultan R; Lentle Brian; Dempster David W; Glorieux Francis H; Neville Alan J; Talwar Reena M; Clokie Cameron M; Al Mardini Majd; Paul Terri; Khosla Sundeep; Josse Robert G; Sutherland Susan; Lam David K; Carmichael Robert P; Blanas Nick; Kendler David; Petak Steven; Ste Marie Louis Georges; Brown Jacques; Evans A Wayne

来源：Journal of Rheumatology, 2009, 36(3): 478-490.

DOI：10.3899/jrheum.080759

• OSTEONECROSIS OF THE JAW
• BISPHOSPHONATES
• SIDE EFFECTS
• GUIDELINES
• EPIDEMIOLOGY

In 2003, the first reports describing osteonecrosis of the jaw (ONJ) in patients receiving bisphosphonates (BP) were published. These cases occurred in patients with cancer receiving high-dose intravenous BP, however, 5% of the cases were in patients with osteoporosis receiving low-dose bisphosphonate therapy. We present the results of a systematic review of the incidence, risk factors, diagnosis, prevention, and treatment of BP associated ONJ. We conducted a comprehensive literature search for relevant studies on BP associated ONJ in oncology and osteoporosis patients published before February 2008. All selected relevant articles were sorted by area of focus. Data for each area were abstracted by 2 independent reviewers. The results showed that the diagnosis is made clinically. Prospective data evaluating the incidence and etiologic factors are very limited. in oncology patients receiving high-dose intravenous BP, ONJ appears to be dependent on the dose and duration of therapy, with an estimated incidence of 1%-12% at 36 months of exposure. In osteoporosis patients, it is rare, with an estimated incidence <1case per 100,000 person-years of exposure. The incidence of ONJ in the general Population is not known. Currently, there is insufficient evidence to confirm a causal link between low-dose BP use in the osteoporosis patient Population and ONJ. We concluded BP associated ONJ is associated with high-dose BP therapy primarily in the oncology patient population. Prevention and treatment strategies are currently based on expert opinion and focus on maintaining good oral hygiene and conservative surgical intervention. (J Rheumatol 2009;36:478-90; doi: 10.3899/jrheum.080759)

• 出版日期2009-3