Increased incidence of osteonecrosis of the jaw after tooth extraction in patients treated with bisphosphonates: a cohort study
Increased incidence of osteonecrosis of the jaw after tooth extraction in patients treated with bisphosphonates: a cohort study
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DOI：
10.1016/j.ijom.2012.06.020
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发表时间：
2012-11-01
影响因子：
2.4
通讯作者：
Bessho, K.
中科院分区：
文献类型：
--
作者：
Yamazaki, T.;Yamori, M.;Bessho, K.
这项研究评估了使用和不使用双磷酸盐(BP)的患者拔牙后发生颌骨骨坏死(ONJ)的累积发病率和风险比，并确定了双膦酸盐诱导的颌骨骨坏死(BioNJ)的潜在风险因素。2006年4月至2009年6月，在日本一所大学医院对所有拔牙患者进行了一项队列研究。其中5例(3.9%，95%可信区间：1.2~9.2%)发生股骨头坏死，而3090例未服用BP的患者中有1例(0.032%，95%可信区间：0.00081~0.18)发生ONJ。BP治疗与拔牙后ONJ的发生有关，未调整的风险比为122.6(95%可信区间：14.4-1041.8)。当按年龄和给药途径分层时，65岁或以上接受静脉给药的ONJ患者与未接受静脉给药的患者相比，风险比为200.2(95%CI：23.8-1679.4，P<；0.001)。接受BP治疗的患者显示，BioNJ的发生率和牙槽骨丢失评分之间存在显著的相关性。接受BP治疗的患者发生ONJ的风险比未接受BP治疗的患者高，尤其是静脉注射。严重的牙周炎可能是BioNJ的危险因素。
This study estimated the cumulative incidence and risk ratio for osteonecrosis of the jaw (ONJ) after tooth extraction in patients with and without administration of bisphosphonates (BP) and identified potential risk factors for bisphosphonate-induced osteonecrosis of the jaw (BIONJ). A cohort study was conducted in all patients undergoing tooth extraction at a university hospital in Japan from April 2006 to June 2009. Of 3216 patients, 126 had BP administration, of whom 5(3.9%, 95% confidence interval (CI): 1.2-9.2) developed ONJ, versus 1 (0.032%, 95% CI: 0.00081-0.18) among 3090 patients without BP administration. BP administration was associated with the development of ONJ after tooth extraction, with an unadjusted risk ratio of 122.6 (95% CI: 14.4-1041.8). When stratified by age and route of BP administration, the risk ratio for ONJ patients aged 65 years or older with intravenous BP administration compared to those without was 200.2 (95% CI: 23.8-1679.4, P < 0.001). Patients receiving BP showed a significant association between the incidence of BIONJ and alveolar bone loss score. The risk of ONJ is higher in patients with than without BP administration, particularly intravenous administration. Severe periodontitis might be a risk factor for BIONJ.