Osteonecrosis of the jaw in cancer after treatment with bisphosphonates: Incidence and risk factors
Osteonecrosis of the jaw in cancer after treatment with bisphosphonates: Incidence and risk factors
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DOI：
10.1200/jco.2005.02.8670
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发表时间：
2005-12-01
影响因子：
45.3
通讯作者：
Dimopoulos, MA
中科院分区：
文献类型：
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作者：
Bamias, A;Kastritis, E;Dimopoulos, MA
目的颌骨骨坏死（ONJ）最近与帕米膦酸盐和唑来膦酸的使用有关。我们研究了双膦酸盐治疗骨转移患者发生ONJ的发生率、特征和危险因素。患者和方法自2003年7月起对ONJ进行前瞻性评估。1997年，ONJ患者首次接受双膦酸盐治疗。自1997年1月以来接受双膦酸盐治疗的252例患者被纳入本分析。结果17例（6.7%）发生ONJ: 111例多发性骨髓瘤11例（9.9%），70例乳腺癌2例（2.9%），46例前列腺癌3例（6.5%），25例其他肿瘤1例（4%）（P = 0.289）。ONJ患者的中位治疗周期和暴露时间分别为35次和39.3个月，而无ONJ患者的中位治疗周期和暴露时间分别为15次（P < 0.001）和19个月（P = 0.001）。ONJ的发病率随着暴露时间的增加而增加，从治疗4 - 12个月的1.5%增加到治疗37 - 48个月的7.7%。唑来膦酸与帕米膦酸单用或帕米膦酸与唑来膦酸联用的累积危害显著高于帕米膦酸（P < 0.001）。除两名患者外，所有ONJ患者在过去一年内都有牙科手术史或使用假牙。结论双膦酸盐的使用可能与ONJ的发生有关。暴露时间的长短似乎是该并发症最重要的危险因素。双膦酸盐的类型可能起作用，以前的牙科手术可能是一个沉淀因素。
Purpose Osteonecrosis of the jaw (ONJ) has been associated recently with the use of pamidronate and zoledronic acid. We studied the incidence, characteristics, and risk factors for the development of ONJ among patients treated with bisphosphonates for bone metastases.Patients and Methods ONJ was assessed prospectively since July 2003. The first bisphosphonate treatment among patients with ONJ was administered in 1997. Two hundred fifty-two patients who received bisphosphonates since January 1997 were included in this analysis.Results Seventeen patients (6.7%) developed ONJ: 11 of 111 (9.9%) with multiple myeloma, two of 70 (2.9%) with breast cancer, three of 46 (6.5%) with prostate cancer, and one of 25 (4%) with other neoplasms (P = .289). The median number of treatment cycles and time of exposure to bisphosphonates were 35 infusions and 39.3 months for patients with ONJ compared with 15 infusions (P < .001) and 19 months (P = .001), respectively, for patients with no ONJ. The incidence of ONJ increased with time to exposure from 1.5% among patients treated for 4 to 12 months to 7.7% for treatment of 37 to 48 months. The cumulative hazard was significantly higher with zoledronic acid compared with pamildronate alone or pamidronate and zoledronic acid sequentially (P < .001). All but two patients with ONJ had a history of dental procedures within the last year or use of dentures.Conclusion The use of bisphosphonates seems to be associated with the development of ONJ. Length of exposure seems to be the most important risk factor for this complication. The type of bisphosphonate may play a role and previous dental procedures may be a precipitating factor.