Discontinuing oral bisphosphonate therapy during dental extraction does not prevent osteonecrosis of the jaw: A multicenter retrospective study of 341 patients with propensity score matching analysis
Discontinuing oral bisphosphonate therapy during dental extraction does not prevent osteonecrosis of the jaw: A multicenter retrospective study of 341 patients with propensity score matching analysis
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DOI：
10.1016/j.ajoms.2017.07.008
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发表时间：
2017-11-01
影响因子：
0.4
通讯作者：
Umeda, Masahiro
中科院分区：
文献类型：
--
作者：
Kawakita, Akiko;Yanamoto, Souichi;Umeda, Masahiro
目的：口服双膦酸盐（BPs）广泛应用于骨质疏松症的治疗。当拔牙时，如果患者有糖尿病、类固醇治疗、恶性肿瘤、类风湿性关节炎和肾衰竭等风险因素，或长期接受这些药物治疗，则建议停止口服BP治疗。然而，几乎没有证据支持这一建议。本多中心回顾性研究的目的是评估预防效果中断口服BP对发展的双膦酸盐相关的颌骨骨坏死（BRONJ）。方法：共341例接受口服BP进行了提取850颗牙齿从402颌骨。评估了各种因素，包括年龄、性别、糖尿病、类固醇使用、恶性肿瘤、类风湿性关节炎、肾衰竭、口服BP给药类型、治疗持续时间、拔牙数量、拔牙原因、部位（上颌或下颌）、伤口状态（开放或完全闭合）以及是否停止BP治疗。采用Fisher精确检验和单因素方差分析分析这些因素与BRONJ发生的关系。此外，倾向评分匹配分析进行，以减少选择偏差与中断和继续groups.Results之间的回顾性数据：BRONJ开发7（2.1%）的341例患者。单变量分析显示，BRONJ在接受第二代药物的患者中更常见。停用BP与BRONJ风险降低无关。倾向评分匹配后，没有因素，包括停止BP与BRONJ的发展。结论：本研究的结果不支持停止口服BP拔牙前，以防止BRONJ。(c)2017年亚洲AOMS、ASOMP、JSOP、JSOMS、JSOM和JAMI。由爱思唯尔有限公司出版。保留所有权利。
Objective: Oral bisphosphonates (BPs) are widely used in the treatment of osteoporosis. When tooth extraction is performed, the recommendation is to discontinue oral BP therapy in patients if they have risk factors such as diabetes, treatment with steroids, malignancy, rheumatoid arthritis and renal failure, or have received these agents for a long period. However, there is little evidence to support this recommendation. The aim of this multicenter retrospective study was to assess the preventive effect of discontinuing oral BPs on development of bisphosphonate-related osteonecrosis of the jaw (BRONJ).Methods: A total of 341 patients receiving oral BPs underwent extraction of 850 teeth from 402 jaws. Various factors were evaluated, including age, gender, diabetes, steroid use, malignancy, rheumatoid arthritis, renal failure, type of oral BP administered, duration of treatment, number of teeth extracted, reason for extraction, site (upper or lower jaw), wound status (open or complete closure), and whether BP therapy was discontinued. The relationship between these factors and development of BRONJ was analyzed by Fisher's Exact test and one-way analysis of variance. Further, propensity score matching analysis was performed to reduce selection biases associated with retrospective data between discontinuing and continuing groups.Results: BRONJ developed in 7 (2.1%) of 341 patients. Univariate analysis showed that BRONJ developed significantly more often in patients receiving second-generation agents. Discontinuation of BPs was not associated with a reduced risk of BRONJ. After propensity score matching, no factors including discontinuing BPs were correlated with development of BRONJ.Conclusion: The results of this study do not support discontinuation of oral BPs before tooth extraction to prevent BRONJ. (c) 2017 Asian AOMS, ASOMP, JSOP, JSOMS, JSOM, and JAMI. Published by Elsevier Ltd. All rights reserved.