비스포스포네이트와 연관된 악골 괴사의 임상 양상
Bisphosphonate-Related Osteonecrosis of the Jaw: Clinical Characteristics of Patients in Korea
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목적: 본 연구는 국내에서 발생한 비스포스포네이트 관련 악골 괴사 20례의 임상 양상 및 위험 인자를 분석하고자 하였다. 방법: 아주대학교병원 및 경희대학교병원에서 20명의 비스포스포네이트 관련 악골 괴사 환자들이 모집되었으며, 이들의 의무기록 검토를 통한 후향적 연구로 진행되었다결과: 15명의 환자는 골다공증의 치료를 위해, 5명의 환자는 악성 종양의 골 전이의 치료를 위하여 비스포스포네이트를 사용하였다. 남자가 6명, 여자가 14명이었고, 진단 당시 평균 연령은 69.4세(48～84)였다. 병변 부위는 상악골이 11명(55%)이었고, 하악골이 9명(45%)이었다. 6명(30%)이 당뇨병에 이환되어 있었으며, 류마티스 관절염 환자가 4명(20%)이었고, 당질코르티코이드 복용력이 명확히 있었던 환자는 6명(30%)이었다. 진단 당시 평균 비스포스포네이트의 사용기간은 3.3년이었고, 15명(75%)의 환자들이 악골 괴사 발병 이전에 발치를 한 과거력이 있었다. 결론: 고령, 여성 그리고 발치를 시행한 환자들에게서 비스포스포네이트 관련 악골 괴사가 잘 발생하며, 당뇨병의 병력이나 스테로이드의 사용 등도 영향을 미친다.
Abstract
Objectives: The purpose of this study is to describe the clinical characteristics of patients diagnosed with bisphosphonate-related osteonecrosis of the jaw (BRONJ) and to identify potential risk factors. Methods: Twenty cases were identified who were diagnosed as BRONJ at the Ajou University Hospital and Kyung Hee University Hospital. We performed a retrospective review of charts. Results: Fifteen cases of BRONJ were developed in patients with osteoporosis treated with oral bisphosphonates while 5 cases were developed in patients with malignancy treated with IV bisphosphonates. Mean age of BRONJ group was 69.4 (48~84) years-old and 14 of 20 (70%) were women. Eleven cases (55%) occurred in the maxilla and 9 cases (45%) occurred in the mandible. Six out of 20 (30%) had history of diabetes mellitus, 4 out of 20 (20%) had history of rheumatoid arthritis, 6 out of 20 (30%) took glucocorticoid, and 15 of 20 (75%) had dental extractions before diagnosis of BRONJ. The mean duration of bisphosphonates administration was 3.3 (SD=0.5) years. The management of BRONJ was surgical in 17 patients, nonsurgical in two patients and one patient was lost to follow up. Conclusion: Old age, female sex, and previous invasive dental procedure were the most common characteristics of those who developed BRONJ. Concomitant disease including diabetes mellitus, glucocorticoid use might influence the development of BRONJ.
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