Medication-Related Osteonecrosis of the Jaws: Two Center Retrospective Cohort Studies
Medication-Related Osteonecrosis of the Jaws: Two Center Retrospective Cohort Studies
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DOI：
10.1155/2019/8345309
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发表时间：
2019-01-01
影响因子：
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通讯作者：
Konstantinovic, Vitomir
中科院分区：
文献类型：
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作者：
Petrovic, Milan;Jelovac, Drago B.;Konstantinovic, Vitomir
这项回顾性队列研究旨在描述MRONJ患者的特征，确定与MRONJ发展相关的因素，并检查与有利结局相关的变量。在2009年至2018年期间，共对32名患者进行了随访和观察：21名女性和11名男性，年龄范围为35-84岁。进行临床、放射学检查（Orthopantomography和CBCT）和活检以达到诊断。考虑人口统计学和临床变量：性别、年龄、原发疾病、药物类型、分娩方式、解剖位置、药物治疗持续时间、拔牙时间、化疗、骨转移的存在、MRONJ的病因、疾病分期和治疗方式。分别有11例和21例患者在骨质疏松和恶性疾病下发生MRONJ。32例中有30例是由拔牙或外伤引起的，而2例患者是自发发生的。分别在5例（16%）、18例（58%）和9例（28%）患者中证实了I、II和III期。23例（72%）患者的下颌骨受到影响。MRONJ在我科通过保守和手术方式治疗。在这项研究中，我们发现65%的患者被归类为治愈/改善组，35%的患者被归类为稳定/进展组。女性、原发性骨质疏松症、口服方案摄入、BP治疗时间较短、疾病早期和特定解剖定位（额和前磨牙上颌骨）是与治疗反应更好和临床结局良好相关的因素。进一步改善的治疗方案和进一步的随机研究是必要的。
This retrospective cohort study aims to describe characteristics of patients with MRONJ, to identify factors associated with MRONJ development, and to examine variables associated with favourable outcome. Totally 32 patients were followed and observed: 21 females and 11 males, in the age range 35-84 in the period from 2009 to 2018. Clinical, radiological examination (Orthopantomograph and CBCT) and biopsy were performed in order to achieve diagnosis. Demographic and clinical variables were taken into consideration: sex, age, primary disease, medication type, mode of delivery, anatomic location, drug treatment duration, timing of tooth extraction, chemotherapy, presence of bone metastasis, aetiology of MRONJ, disease stage, and treatment modality. MRONJ developed under osteoporosis and malignant disease in 11 and 21 patients, respectively. MRONJ development was triggered by tooth extraction or trauma in 30 out of 32 cases, whereas the two patients developed MRONJ spontaneously. Stages I, II, and III were confirmed in 5 (16%), 18 (58%), and 9 (28%) patients, respectively. Mandible was affected in 23 (72%) patients. MRONJ was treated in our department by conservative and surgical modality. In this study we found that 65% of all patients were classified in the cured/improvement group and 35% in the stable/progression group. The female gender, osteoporosis as primary disease, oral regime intake, shorter period on BPs, earlier stage of disease, and specific anatomic localisation (frontal and premolar maxilla) were factors associated with better response to therapy and favourable clinical outcome. Comprehensive treatment protocol and further randomized studies are necessary for further improvements.