Bisphosphonate-associated osteonecrosis of the jaw: A key role of inflammation?
Bisphosphonate-associated osteonecrosis of the jaw: A key role of inflammation?
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DOI：
10.1016/j.bone.2009.07.011
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发表时间：
2009-11-01
期刊：
影响因子：
4.1
通讯作者：
Samson, Jacky
中科院分区：
文献类型：
--
作者：
Lesclous, Philippe;Najm, Semaan Abi;Samson, Jacky
颌骨骨坏死（ONJ）可能与含氮双膦酸盐（NBP）治疗有关。已经提出了各种NBP-associated ONJ的机制，目前还没有达成共识的潜在发病机制。分析了30例接受NBP治疗恶性疾病（24例）或骨质疏松症（6例）的ONJ患者的详细病史和牙科病史。切除坏死骨，脱矿后进行组织学分析。在10例患者中，周围坏死骨也被切除和处理，而不脱矿。5例健康人的牙槽骨标本作为对照。在14例ONJ患者中，也可获得99 mTc-亚甲基二膦酸盐的连续CT扫描，并与其他数据进行对照。在临床诊断ONJ前几个月，一些患者检测到强放射性核素摄取。坏死骨的髓腔充满了细菌聚集体。在坏死周围骨中，无菌骨髓表现出典型的炎症反应。作为炎症指标的髓炎性细胞的数量允许我们区分ONJ样品中的两个炎症等级。轻度炎症，表现为骨髓纤维化和少量炎性细胞浸润，TRAP（+）单核细胞和多核细胞数量在骨暴露患者中增加
Osteonecrosis of the jaw (ONJ) can be associated with nitrogen-containing bisphosphonates (NBPs) therapy. Various mechanisms of NBP-associated ONJ have been proposed and there is currently no consensus of the underlying pathogenesis. The detailed medical and dental histories of 30 ONJ patients treated with NBPs for malignant diseases (24) or osteoporosis (6) were analyzed. The necrotic bone was resected and analyzed histologically after demineralization. In 10 patients the perinecrotic bone was also resected and processed without demineralization. Alveolar bone samples from 5 healthy patients were used as controls. In 14 ONJ patients, serial technetium-99m-methylene diphosphonate scintigraphic scans were also available and confronted to the other data. Strong radionuclide uptake was detected in some patients several months before clinical diagnosis of ONJ. The medullary spaces of the necrotic bone were filled with bacterial aggregates. In the perinecrotic bone, the bacteria-free bone Marrow characteristically showed an inflammatory reaction. The number of medullary inflammatory cells taken as an index of inflammation allowed us to discriminate two inflammation grades in the ONJ samples. Low-grade inflammation, characterized by marrow fibrosis and low inflammatory cells infiltration, increased numbers of TRAP(+) mono- and multineacleated cells was seen in patients with bone exposure