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
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
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DOI：
10.14219/jada.archive.2011.0108
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发表时间：
2011-11-01
影响因子：
3.9
通讯作者：
Ristic, Helen
中科院分区：
文献类型：
--
作者：
Hellstein, John W.;Adler, Robert A.;Ristic, Helen
背景。这篇对接受抗骨吸收药物治疗的低骨量患者下颌骨坏死的叙述性回顾是基于美国牙科协会科学事务委员会咨询委员会对文献的评估。它更新了委员会 2008 年咨询声明的方法。作者在 MEDLINE 上检索了 2008 年 5 月（上次检索的结束日期）至 2011 年 2 月之间发表的文献。结果。本报告包含基于文献检索结果和与普通牙科相关的专家意见的建议；牙周病管理；种植体植入和维护；口腔颌面外科；牙髓病学；修复牙科和口腔修复学；正畸；和C-末端端肽测试和药物假期。结论。抗骨吸收剂引起的颌骨坏死 (ARONJ) 患病率的最高可靠估计约为 0.10%。骨质疏松症造成相当大的发病率和死亡率。因此，抗骨吸收治疗的益处超过了发生颌骨坏死的低风险。临床意义。包括良好卫生习惯和定期牙科护理在内的口腔健康计划可能是降低 ARONJ 风险的最佳方法。目前还没有经过验证的诊断技术可以确定哪些患者患 ARONJ 的风险增加。停止双磷酸盐治疗可能不会降低风险，但可能对低骨量治疗结果产生负面影响。
Background. This narrative review of osteonecrosis of the jaw in patients with low bone mass receiving treatment with antiresorptive agents is based on an appraisal of the literature by an advisory committee of the American Dental Association Council on Scientific Affairs. It updates the committee's 2008 advisory statement.Methods. The authors searched MEDLINE for literature published between May 2008 (the end date of the last search) and February 2011.Results. This report contains recommendations based on the findings of the literature search and on expert opinion that relate to general dentistry; periodontal disease management; implant placement and maintenance; oral and maxillofacial surgery; endodontics; restorative dentistry and prosthodontics; orthodontics; and C-terminal telopeptide testing and drug holidays.Conclusions. The highest reliable estimate of antiresorptive agent-induced osteonecrosis of the jaw (ARONJ) prevalence is approximately 0.10 percent. Osteoporosis is responsible for considerable morbidity and mortality. Therefore, the benefit provided by antiresorptive therapy outweighs the low risk of developing osteonecrosis of the jaw.Clinical Implications. An oral health program consisting of sound hygiene practices and regular dental care may be the optimal approach for lowering ARONJ risk. No validated diagnostic technique exists to determine which patients are at increased risk of developing ARONJ. Discontinuing bisphosphonate therapy may not lower the risk but may have a negative effect on low-bone-mass treatment outcomes.