Managing the care of patients with bisphosponate-associated osteonecrosis - An American Academy of Oral Medicine position paper
Managing the care of patients with bisphosponate-associated osteonecrosis - An American Academy of Oral Medicine position paper
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DOI：
10.14219/jada.archive.2005.0108
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发表时间：
2005-12-01
影响因子：
3.9
通讯作者：
Woo, SB
中科院分区：
文献类型：
--
作者：
Migliorati, CA;Casiglia, J;Woo, SB
背景本立场文件涉及预防双膦酸盐相关性骨坏死（BON）和管理的护理癌症和/或骨质疏松症患者谁是接受双膦酸盐和谁有BON或在rsk的发展。作者回顾了有关这种新描述的口腔并发症的现有文献。感兴趣的信息包括二膦酸盐，与这种口腔并发症相关的药物;有发生BON风险的患者人群和用这类药物治疗的疾病;口腔课程的临床表现;发生BON患者的护理管理指南;根据现有知识预防这种并发症;并对接受双膦酸盐治疗的患者的常规牙科治疗提出了建议。有强有力的证据表明，双膦酸盐治疗是骨坏死患者的常见环节。导致骨坏死的病理生物学机制可能与双膦酸盐抑制骨重建和减少骨内血流量有关。有风险的人包括多发性骨髓瘤患者和接受静脉注射双膦酸盐的骨转移癌患者，以及因骨质疏松症服用双膦酸盐的患者。发生并发症的风险似乎随着药物使用时间的增加而增加。目前尚无基于证据的指南，口腔并发症的临床处理基于专家意见。预防BON是治疗这种并发症的最佳方法。在制定BON的具体指南之前，可以使用现有的方案来管理将接受放疗或化疗的患者的护理。
Background. This position paper addresses the prevention of bisphosphonate-associated osteonecrosis (BON) and the management of care of patients with cancer and/or osteoporosis who are receiving bisphosphonates and who have BON or are at the rsk of developing it.Methods. The authors reviewed the literature available on this newly described oral complication. Information of interest included bisphosphonates, the medications associated with this oral complication; the patient population at risk of developing BON and the diseases being treated with this class of medications; the clinical presentation of the oral lessons; guidelines for managing the care of patients who develop BON; the prevention of this complication based on current knowledge; and recommendations for routine dental treatment of patients receiving bisphosphonates.Results. There is strong evidence that bisphosphonate therapy is the common link in patients with BON. The pathobiological mechanism leading to BON may have to do with the inhibition of bone remodeling and decreased intraosseous blood flow caused by bisphosphonates. People at risk include patients with multiple myeloma and patients with cancer metastatic to bone who are receiving intravenous bisphosphonates, as well as patients taking bisphosphonates for osteoporosis. The risk of developing complications appears to increase with time of use of the medication. There are no guidelines based on evidence, and the clinical management of the oral complication is based on expert opinion.Conclusions. Prevention of BON is the best approach to management of this complication. Existing protocols to manage the care of patients who will receive radiation therapy or chemotherapy may be used until specific guidelines for BON are developed.