약물관련 골괴사(MRONJ) 치료권고안, 무엇이 달라졌나?
Position Papers on MRONJ(Medication related osteonecrosis of the jaw), What has changed?
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Antiresorptives, such as bisphosphonate, denosumab, are widely prescribed drugs for the treatment of osteoporosis, osteopenia, malignant bone metastases, multiple myeloma and Paget`s disease. They have therapeutic efficacy for controlling bone pain and reducing skeletal related events including the pathologic fractures. However, it was reported that the development of osteonecrosis of the jaw(ONJ) could be related to antiresorptive treatments. It was first defined as Bisphosphonaterelated osteonecrosis of the jaw in 2007 American Association of Oral and Maxillofacial Surgeons(AAOMS) position paper. This was changed to Medication-related osteonecrosis of the jaw(MRONJ) in the AAOMS position paper 2014. This position paper was updated recently in May 2022 and contains revisions to disease definition and management strategies at “AAOMS position paper on MRONJ-2022 update”. The important changes in clinical implications are as follows; 1) In the definition, immune modulators (such as Romosozumab) were included with potential medications related with osteonecrosis of the jaw (ONJ), 2) Operative therapy was included for all stages (1, 2 and 3) in treatment strategies, 3) Formerly mentioned drug holiday before surgical procedure to prevent MRONJ was not identified in 2022 AAOMS position paper. Most of the statements in AAOMS 2022 position paper were based on strict literature reviews and changes were made if there is little evidence to suggest the specific diagnosis or therapeutic options. Understanding the changes compared to the previous position papers is important in selecting adequate treatment strategies for MRONJ.
Abstract
Antiresorptives, such as bisphosphonate, denosumab, are widely prescribed drugs for the treatment of osteoporosis, osteopenia, malignant bone metastases, multiple myeloma and Paget`s disease. They have therapeutic efficacy for controlling bone pain and reducing skeletal related events including the pathologic fractures. However, it was reported that the development of osteonecrosis of the jaw(ONJ) could be related to antiresorptive treatments. It was first defined as Bisphosphonaterelated osteonecrosis of the jaw in 2007 American Association of Oral and Maxillofacial Surgeons(AAOMS) position paper. This was changed to Medication-related osteonecrosis of the jaw(MRONJ) in the AAOMS position paper 2014. This position paper was updated recently in May 2022 and contains revisions to disease definition and management strategies at “AAOMS position paper on MRONJ-2022 update”. The important changes in clinical implications are as follows; 1) In the definition, immune modulators (such as Romosozumab) were included with potential medications related with osteonecrosis of the jaw (ONJ), 2) Operative therapy was included for all stages (1, 2 and 3) in treatment strategies, 3) Formerly mentioned drug holiday before surgical procedure to prevent MRONJ was not identified in 2022 AAOMS position paper. Most of the statements in AAOMS 2022 position paper were based on strict literature reviews and changes were made if there is little evidence to suggest the specific diagnosis or therapeutic options. Understanding the changes compared to the previous position papers is important in selecting adequate treatment strategies for MRONJ.
참고문헌 (34)
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