본문 바로가기
KERD
논문KCI 등재

Clinical characteristics and recurrence-related factors of medication-related osteonecrosis of the jaw

2

조회

0

다운로드

1

인용

0

참고문헌

키워드

주제분류치의학

초록

Objectives: The purpose of this study was to investigate the demographic and clinical characteristics of patients with medication-related osteonecrosis of the jaw (MRONJ) and to elucidate factors affecting recurrence in surgical treatment. Materials and Methods: A total of 51 patients who were diagnosed with MRONJ were analyzed according to demographic and clinical features and treatment results through a retrospective chart review from 2013 to 2017 in the Department of Oral and Maxillofacial Surgery, Korea University Anam Hospital, Seoul in Korea. Results: Alendronate composed the majority of medication doses (55.6%), followed by ibandronate (20.0%), risedronate (15.6%), and zoledronate (6.7%). Forty patients (88.9%) were given oral medication, and five patients (11.1%) were intravenously treated, and the mean duration of medication use was 61.1±42.9 months. A total of 10 patients (22.2%) had a drug holiday before MRONJ-induced dental treatment lasting an average of 6.8±7.0 months. MRONJ occurred 2.7 times more in the mandible, with 41 cases (73.2%) occurring in the mandible and 15 cases (26.8%) occurring in the maxilla, and the prevalence of affected posterior parts (premolar-molar) was six times greater than that of the anterior parts (incisor-canine) (48 cases vs 8 cases, 85.7% vs 14.3%). The most common dental cause of MRONJ was tooth extraction (69.6%). Regarding recurrence, there was no statistical difference in recurrence rate according to either site or stage. However, recurrence occurred in 4 out of 34 cases (11.8%) in the primary closure group and 9 out of 20 cases (45.0%) in the secondary healing group, and there was a statistical difference with respect to closure technique. Conclusion: The identified risk factors in patients taking bone resorption inhibitors can aid dental clinicians in ensuring prevention and proper treatment of MRONJ.

Abstract

Objectives: The purpose of this study was to investigate the demographic and clinical characteristics of patients with medication-related osteonecrosis of the jaw (MRONJ) and to elucidate factors affecting recurrence in surgical treatment. Materials and Methods: A total of 51 patients who were diagnosed with MRONJ were analyzed according to demographic and clinical features and treatment results through a retrospective chart review from 2013 to 2017 in the Department of Oral and Maxillofacial Surgery, Korea University Anam Hospital, Seoul in Korea. Results: Alendronate composed the majority of medication doses (55.6%), followed by ibandronate (20.0%), risedronate (15.6%), and zoledronate (6.7%). Forty patients (88.9%) were given oral medication, and five patients (11.1%) were intravenously treated, and the mean duration of medication use was 61.1±42.9 months. A total of 10 patients (22.2%) had a drug holiday before MRONJ-induced dental treatment lasting an average of 6.8±7.0 months. MRONJ occurred 2.7 times more in the mandible, with 41 cases (73.2%) occurring in the mandible and 15 cases (26.8%) occurring in the maxilla, and the prevalence of affected posterior parts (premolar-molar) was six times greater than that of the anterior parts (incisor-canine) (48 cases vs 8 cases, 85.7% vs 14.3%). The most common dental cause of MRONJ was tooth extraction (69.6%). Regarding recurrence, there was no statistical difference in recurrence rate according to either site or stage. However, recurrence occurred in 4 out of 34 cases (11.8%) in the primary closure group and 9 out of 20 cases (45.0%) in the secondary healing group, and there was a statistical difference with respect to closure technique. Conclusion: The identified risk factors in patients taking bone resorption inhibitors can aid dental clinicians in ensuring prevention and proper treatment of MRONJ.

참고문헌 (49)

  1. Ruggiero SL, "American Association of Oral and Maxillofacial Surgeons position paper on medication-related osteonecrosis of the jaw--2014 update", J Oral Maxillofac Surg, 72, pp.1938~1956 (2014)[DOI]
  2. Watts NB, "Bisphosphonate treatment of osteoporosis", Clin Geriatr Med, 19, pp.395~414 (2003)[DOI]
  3. Nussbaum SR, "Single-dose intravenous therapy with pamidronate for the treatment of hypercalcemia of malignancy: comparison of 30-, 60-, and 90-mg dosages", Am J Med, 95, pp.297~304 (1993)[DOI]
  4. Berenson JR, "Zoledronic acid reduces skeletal-related events in patients with osteolytic metastases", Cancer, 91, pp.1191~1200 (2001)[DOI]
  5. Black DM, "Once-yearly zoledronic acid for treatment of postmenopausal osteoporosis", N Engl J Med, 356, pp.1809~1822 (2007)[DOI]
  6. Lipton A, "Effect of denosumab versus zoledronic acid in preventing skeletal-related events in patients with bone metastases by baseline characteristics", Eur J Cancer, 53, pp.75~83 (2016)[DOI]
  7. Cummings SR, "Denosumab for prevention of fractures in postmeno- pausal women with osteoporosis", N Engl J Med, 361, pp.756~765 (2009)[DOI]
  8. Baron R, "Denosumab and bisphosphonates: different mechanisms of action and effects", Bone, 48, pp.677~692 (2011)[DOI]
  9. Ripamonti CI, "Decreased occurrence of osteonecrosis of the jaw after implementation of dental preventive measures in solid tumour patients with bone metastases treated with bisphosphonates. The experience of the National Cancer Institute of Milan", Ann Oncol, 20, pp.137~145 (2009)[DOI]
  10. Landesberg R, "Potential pathophysiological mechanisms in osteonecrosis of the jaw", Ann N Y Acad Sci, 1218, pp.62~79 (2011)[DOI]
  11. Reid IR, "Is bisphosphonate-associated osteonecrosis of the jaw caused by soft tissue toxicity?", Bone, 41, pp.318~320 (2007)[DOI]
  12. Lopez-Jornet P, "Perioperative antibiotic regimen in rats treated with pamidronate plus dexamethasone and subjected to dental extraction: a study of the changes in the jaws", J Oral Maxillofac Surg, 69, pp.2488~2493 (2011)[DOI]
  13. Hoefert S, "Importance of mi- crocracks in etiology of bisphosphonate-related osteonecrosis of the jaw: a possible pathogenetic model of symptomatic and nonsymptomatic osteonecrosis of the jaw based on scanning electron microscopy findings", Clin Oral Investig, 14, pp.271~284 (2010)[DOI]
  14. 김경민, "Medication Related Osteonecrosis of the Jaw: 2015 Position Statement of the Korean Society for Bone and Mineral Research and the Korean Association of Oral and Maxillofacial Surgeons", 대한골대사학회지, 22(4), pp.151~165 (2015), 대한골대사학회
  15. Tsao C, "Oral health risk factors for bisphosphonate-associated jaw osteonecrosis", J Oral Maxillofac Surg, 71, pp.1360~1366 (2013)[DOI]
  16. Peer A, "Diabetes as a risk factor for medication-related osteonecrosis of the jaw", J Dent Res, 94, pp.252~260 (2015)[DOI]
  17. McGowan K, "Risk factors for medication-related osteonecrosis of the jaws: a systematic review", Oral Dis, 24, pp.527~536 (2018)[DOI]
  18. Stanton DC, "Outcome of surgical management of bisphosphonate-related osteonecrosis of the jaws: review of 33 surgical cases", J Oral Maxillofac Surg, 67, pp.943~950 (2009)[DOI]
  19. Scoletta M, "Treatment outcomes in patients with bisphosphonate-related osteonecrosis of the jaws: a prospective study", Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 110, pp.46~53 (2010)[DOI]
  20. Mucke T, "Outcome of treatment and parameters influencing recurrence in patients with bisphosphonate-related osteonecrosis of the jaws", J Cancer Res Clin Oncol, 137, pp.907~913 (2011)[DOI]
  21. Klingelhoffer C, "Evaluation of surgical outcome and influencing risk factors in patients with medication-related osteonecrosis of the jaws", J Craniomaxillofac Surg, 44, pp.1694~1699 (2016)[DOI]
  22. Yamazaki T, "Increased incidence of osteonecrosis of the jaw after tooth extraction in patients treated with bisphosphonates: a cohort study", Int J Oral Maxillofac Surg, 41, pp.1397~1403 (2012)[DOI]
  23. Etminan M, "Use of oral bisphosphonates and the risk of aseptic osteonecrosis: a nested case-control study", J Rheumatol, 35, pp.691~695 (2008)
  24. Khan AA, "Bisphosphonate-associated osteonecrosis of the jaw in Ontario: a survey of oral and maxillofacial surgeons", J Rheumatol, 38, pp.1396~1402 (2011)[DOI]
  25. Ulmner M, "Osteonecrosis of the jaw in Sweden associated with the oral use of bisphosphonate", J Oral Maxillofac Surg, 72, pp.76~82 (2014)[DOI]
  26. Grbic JT, "The incidence of osteonecrosis of the jaw in patients receiving 5 milligrams of zoledronic acid: data from the health outcomes and reduced incidence with zoledronic acid once yearly clinical trials program", J Am Dent Assoc, 141, pp.1365~1370 (2010)[DOI]
  27. Papapoulos S, "Five years of denosumab exposure in women with postmenopausal osteoporosis: results from the first two years of the FREEDOM extension", J Bone Miner Res, 27, pp.694~701 (2012)[DOI]
  28. Saad F, "Incidence, risk factors, and outcomes of osteonecrosis of the jaw: integrated analysis from three blinded active-controlled phase III trials in cancer patients with bone metastases", Ann Oncol, 23, pp.1341~1347 (2012)[DOI]
  29. Hyo Won Jang, "Development of animal model for Bisphosphonates-related osteonecrosis of the jaw (BRONJ)", Maxillofacial Plastic Reconstructive Surgery, 37(7), pp.1~7 (2015), 대한악안면성형재건외과학회[DOI]
  30. Hong-Joon Kim, "Bisphosphonate-related osteonecrosis of the jaw in metastatic breast cancer patients: a review of 25 cases", Maxillofacial Plastic Reconstructive Surgery, 38(2), pp.1~8 (2016), 대한악안면성형재건외과학회[DOI]
  31. 최우성, "Medication-related osteonecrosis of the jaw: a preliminary retrospective study of 130 patients with multiple myeloma", Maxillofacial Plastic Reconstructive Surgery, 39(1), pp.1~7 (2017), 대한악안면성형재건외과학회[DOI]
  32. Vahtsevanos K, "Longitudinal cohort study of risk factors in cancer patients of bisphosphonate-related osteonecrosis of the jaw", J Clin Oncol, 27, pp.5356~5362 (2009)[DOI]
  33. Fehm T, "Bisphosphonate-induced osteonecrosis of the jaw (ONJ): incidence and risk factors in patients with breast cancer and gynecological malignancies", Gynecol Oncol, 112, pp.605~609 (2009)[DOI]
  34. Phal PM, "Imaging findings of bisphosphonate-associated osteonecrosis of the jaws", AJNR Am J Neuroradiol, 28, pp.1139~1145 (2007)[DOI]
  35. Ida M, "CT findings as a significant predictive factor for the curability of mandibular osteomyelitis: multivariate analysis", Dentomaxillofac Radiol, 34, pp.86~90 (2005)[DOI]
  36. Hellstein JW, "Managing the care of patients receiving antiresorptive therapy for prevention and treatment of osteoporosis: executive summary of recommendations from the American Dental Association Council on Scientific Affairs", J Am Dent Assoc, 142, pp.1243~1251 (2011)[DOI]
  37. Khan AA, "Diagnosis and management of osteonecrosis of the jaw: a systematic review and international consensus", J Bone Miner Res, 30, pp.3~23 (2015)[DOI]
  38. Damm DD, "Bisphosphonate-related osteonecrosis of the jaws: a potential alternative to drug holidays", Gen Dent, 61, pp.33~38 (2013)
  39. Ruggiero SL, "Bisphosphonate-related osteonecrosis of the jaw: background and guidelines for diagnosis, staging and management", Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 102, pp.433~441 (2006)[DOI]
  40. Ruggiero SL, "Bisphosphonate-related osteonecrosis of the jaw: an overview", Ann N Y Acad Sci, 1218, pp.38~46 (2011)[DOI]
  41. 이호경, "비스포스포네이트 관련 악골괴사(BRONJ)의 병기 2기에서의 외과적, 보존적 치료에 대한 비교 연구", Maxillofacial Plastic Reconstructive Surgery, 35(5), pp.302~309 (2013), 대한악안면성형재건외과학회
  42. Lopes RN, "Surgical therapy for bisphosphonate-related osteonecrosis of the jaw: six-year experience of a single institution", J Oral Maxillofac Surg, 73, pp.1288~1295 (2015)[DOI]
  43. Stockmann P, "The outcome after surgical therapy of bisphosphonate-associated osteonecrosis of the jaw--results of a clinical case series with an average follow-up of 20 months", Clin Oral Investig, 18, pp.1299~1304 (2014)
  44. Stockmann P, "Osteotomy and primary wound closure in bisphosphonate-associated osteonecrosis of the jaw: a prospective clinical study with 12 months follow-up", Support Care Cancer, 18, pp.449~460 (2010)[DOI]
  45. 신상훈, "Effect of low-level laser therapy on bisphosphonate-treated osteoblasts", Maxillofacial Plastic Reconstructive Surgery, 38(11), pp.1~8 (2016), 대한악안면성형재건외과학회[DOI]
  46. Ho-Chul Kim, "Combined effect of bisphosphonate and recombinant human bone morphogenetic protein 2 on bone healing of rat calvarial defects", Maxillofacial Plastic Reconstructive Surgery, 37(6), pp.1~7 (2015), 대한악안면성형재건외과학회[DOI]
  47. Kim HY, "Extensive surgical procedures result in better treatment outcomes for bisphosphonate-related osteonecrosis of the jaw in patients with osteoporosis", J Oral Maxillofac Surg, 75, pp.1404~1413 (2017)[DOI]
  48. Wilde F, "The role of surgical therapy in the management of intrave- nous bisphosphonates-related osteonecrosis of the jaw", Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 111, pp.153~163 (2011)[DOI]
  49. Gallego L, "The use of pedicled buccal fat pad combined with sequestrectomy in bisphosphonate-related osteonecrosis of the maxilla", Med Oral Patol Oral Cir Bucal, 17, pp.236~241 (2012)

관련 논문AI추천

Recurrence - Related Factors of Medication Related Osteonecrosis of the Jaw (MRONJ) ; a Retrospective study국민석, 김지현, 김혜진, 류재영, 박철영, 박홍주, 오희균, 정승곤, 최경석대한치과의사협회 · 대한치과의사협회지2023 · 제61권 제12호Drug holiday as a prognostic factor of medication-related osteonecrosis of the jaw김윤호, 송승일, 이정근, 이호경대한구강악안면외과학회 · 대한구강악안면외과학회지2014 · 제40권 제5호The effect of bisphosphonate discontinuation on the incidence of postoperative medication-related osteonecrosis of the jaw after tooth extraction강상훈, 김문기, 박세진대한구강악안면외과학회 · 대한구강악안면외과학회지2020 · 제46권 제1호Clinical significance of drug cessation on medication-related osteonecrosis of the jaw in patients with osteoporosis서미현, Ju Young Lee, Kezia Rachellea Mustakim, Mi Young Eo, Soung Min Kim대한구강악안면외과학회 · 대한구강악안면외과학회지2023 · 제49권 제2호약물 관련 악골괴사와 연관된 위험인자와 골밀도에 관한 연구김훈민, 백유정, 성일용, 손나리, 손장호, 이진호, 조영철대한통합치과학회 · 대한통합치과학회지2023 · 제12권 제1호Bisphosphonates-related osteonecrosis of the jaw in Korea: a preliminary report국민석, 권대근, 권용대, 김경욱, 김수관, 김용덕, 김철환, 김현민, 문성용, 민승기, 박영욱, 박인숙, 박준우, 박홍주, 백진아, 이동근, 이정근, 최진영대한구강악안면외과학회 · 대한구강악안면외과학회지2013 · 제39권 제1호

이 간행물의 다른 논문 (7건)