Osteonecrosis of the Jaw and the Role of Bisphosphonates: A Critical Review

被引:115
|
作者
Silverman, Stuart L. [1 ,2 ]
Landesberg, Regina [3 ]
机构
[1] Univ Calif Los Angeles, Cedars Sinai Med Ctr, Los Angeles, CA 90048 USA
[2] Univ Calif Los Angeles, David Geffen Sch Med, Los Angeles, CA 90095 USA
[3] Columbia Univ, Div Oral & Maxillofacial Surg, New York, NY USA
来源
AMERICAN JOURNAL OF MEDICINE | 2009年 / 122卷 / 02期
关键词
Bisphosphonate treatment; Intravenous bisphosphonate; Osteonecrosis of the jaw; Osteoporosis; Paget disease; NITROGEN-CONTAINING BISPHOSPHONATES; LONG-TERM RISEDRONATE; POSTMENOPAUSAL OSTEOPOROSIS; ZOLEDRONIC ACID; RISK-FACTORS; IN-VITRO; INFECTED OSTEORADIONECROSIS; ALENDRONATE TREATMENT; AVASCULAR NECROSIS; FEMORAL-HEAD;
D O I
10.1016/j.amjmed.2008.12.005
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Osteonecrosis of the jaw (ONJ), a condition characterized by necrotic exposed bone in the maxillofacial region, has been reported in patients with cancer receiving bisphosphonate therapy, and rarely in patients with postmenopausal osteoporosis or Paget disease of bone receiving such therapy. In the absence of a uniform definition, the American Academy of Oral and Maxillofacial Surgeons (AAOMS), the American Society for Bone and Mineral Research (ASBMR), and other groups have established similar diagnostic criteria for bisphosphonate-related ONJ, which is more commonly reported in patients with advanced malignancies with skeletal metastases who receive higher doses, and is more rarely reported in patients with osteoporosis and Paget disease who receive lower doses. However, a critical review of the literature reveals that the etiology of ONJ remains unknown, and to date no direct causal link to bisphosphonates has been established. Despite an increased awareness of ONJ and recent improvements in preventive strategies, patients and physicians alike continue to express concern about the potential risks of bisphosphonate treatment in both oncologic and nononcologic settings. Although much remains to be learned about this condition, including its true incidence in various patient populations, its pathophysiology, and optimal clinical management, evidence to date suggests that the positive benefits of bisphosphonates in patients with malignant bone disease, osteoporosis, or Paget disease outweigh the relatively small risk of ONJ. (C) 2009 Published by Elsevier Inc. The American Journal of Medicine (2009) 122, S33-S45
引用
收藏
页码:33 / 45
页数:13
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