Bisphosphonate therapy for cancer and prevalence of inflammatory jaw conditions.
Bisphosphonate therapy for cancer and prevalence of inflammatory jaw conditions.
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DOI：
10.1093/jnci/djm029
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发表时间：
2007-07
期刊：
影响因子：
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通讯作者：
S. Woo;D. Solomon
中科院分区：
文献类型：
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作者：
S. Woo;D. Solomon
请参阅“参考文献”后面的“资金”。患有多发性骨髓瘤和骨转移癌的患者在接受静脉内双磷酸盐（例如帕米膦酸或唑来膦酸）治疗时，骨骼相关事件的发生率降低 (1, 2)。多年来，此类患者连续（通常每月一次）使用双膦酸盐并没有受到质疑。然而，2003 年，该患者群体报告了一种不良反应，称为双磷酸盐相关颌骨坏死 (3 , 4)。迄今为止，已报告了 600 多例病例，但很可能还存在更多病例。在小型单中心回顾性研究 (5 – 7) 中，肿瘤人群颌骨骨坏死的患病率为 6% – 11%，在一项网络调查中为 4% (8)。发生颌骨坏死的风险取决于药物的累积剂量和效力 (6 , 9)。癌症患者比骨质疏松症患者更容易发生颌骨骨坏死，因为他们接受更有效的药物和更频繁的给药。梅奥诊所最近的建议警告不要无限期使用此类药物，因为可能会发生颌骨坏死 (10)。颌骨坏死的发病机制尚不清楚，但骨转换的严重抑制可能起着重要作用。威尔金森等人的研究。 (11) 在本期杂志中很好地展示了药物流行病学分析的优势。通过使用之前通过监测、流行病学和最终结果登记处收集的数据，汇集了一大群未经选择的癌症患者，无论是否有双膦酸盐治疗史。由于这些数据包括来自转诊中心和更广泛社区的患者，因此它们减少了严重依赖于癌症中心治疗的转诊人群的研究中出现的普遍性问题。此外，研究数据库还包含有关合并症的重要信息，这些信息可能会混淆双磷酸盐和颌病理之间的关系。最后，使用来自数千名患者的数据转化为一项统计上强大的研究，该研究在没有庞大预算的情况下相对较快地进行。作者发现，与不治疗相比，静脉注射双磷酸盐治疗会增加颌骨或面骨手术的风险，并增加被诊断为颌骨炎症或骨髓炎的风险（6 年时分别为 5.48% 和 0.30%）。风险随着累积剂量的增加而增加。在另一项流行病学研究中……
See " Funding " following " References. " Patients with multiple myeloma and metastatic cancer to the bones show reduced incidence of skeletal-related events when they are treated with intravenous bisphosphonates such as pamidronate or zoledronic acid (1 , 2). For many years, the continuous, often monthly, use of bisphosphonates in such patients was not questioned. However, in 2003, an adverse reaction, termed bisphosphonate-associated osteonecrosis of the jaws, was reported in this patient population (3 , 4). To date, more than 600 cases have been reported, but it is likely that many more exist. The prevalence of osteonecro-sis of the jaws in the oncologic population was 6% – 11% in small single-center retrospective studies (5 – 7) and 4% in one web-based survey (8). The risk of development of osteonecrosis of the jaws is dependent on cumulative dose and potency of the agent (6 , 9). Patients with cancer are more likely than those with osteoporosis to develop osteonecrosis of the jaws because they receive more potent agents and more frequent dosing. Recent recommendations from the Mayo Clinic caution against indefinite use of such agents because of the occurrence of osteonecrosis of the jaws (10). The etiopathogenesis of osteonecrosis of the jaws is unknown, but severe suppression of bone turnover probably plays an important role. The study by Wilkinson et al. (11) in this issue of the Journal nicely demonstrates the strengths of pharmacoepidemiologic analyses. A large unselected group of patients with cancer, with and without a history of bisphosphonate treatment, was assembled by use of previously collected data through the Surveillance, Epidemiology, and End Results registry. Because these data include patients from referral centers and the wider community, they reduce problems of generalizability that occur in studies that rely heavily on referral populations treated at cancer centers. As well, the study database includes important information regarding comorbid conditions that may confound the relationship between bisphosphonates and jaw pathology. Finally, the use of data from thousands of patients translates into a statistically powerful study conducted relatively quickly without an enormous budget. The authors found that treatment with intravenous bisphospho-nates was associated with an increased risk of jaw or facial bone surgery and an increased risk of being diagnosed with an infl amma-tory condition or osteomyelitis of the jaw, compared with nontreat-ment (5.48% versus 0.30%, respectively, at 6 years). The risk rose with increasing cumulative dose. In another epidemiologic study that …