ビスフォスフォネート治療による顎骨壊死発症の現状

• Published in: 日本口腔外科学会雑誌 Vol. 56; no. 5; pp. 292 - 297
• Main Author: 浦出, 雅裕
• Format: Journal Article
• Language: Japanese
• Published: 社団法人 日本口腔外科学会 20.05.2010
• Subjects: ビスフォスフォネート治療; 発症の現状; 顎骨壊死
• ISSN: 0021-5163; 2186-1579
• DOI: 10.5794/jjoms.56.292

Bisphosphonates (BPs) have clinically been used as a highly effective drug in the treatment of hypercalcemia of malignancy, skeletal events associated with multiple myeloma, metastatic breast cancer and prostate cancer, and osteoporosis. Despite these benefits, however, the emergence of BP-related osteonecrosis of the jaws (BRONJ) becomes a growing and significant problem in a subset of patients receiving these drugs, especially intravenous preparations. It has also been reported in the patients receiving oral BPs, although the incidence is extremely low. Most of BRONJ cases occur after dental treatments such as tooth extraction, periodontal surgery, and dental implants, and are refractory to conventional treatment modalities such as debridement, antibiotics and hyperbaric oxygen therapy. As compared to USA and EU, the number of BRONJ cases is still small in Japan, but it is exactly increasing year by year. The ratio of the number of BRONJ in patients receiving oral BPs to that in patients receiving intravenous BPs is higher in Japan than in USA and EU, speculating due to the difference of time of approval and oral hygienic condition of the Japanese elderly. In this issue, the present condition of occurrence of BRONJ in USA, EU and Japan and the practical guidelines for diagnosis and treatment proposed in USA and EU are described. Although no effective therapy for BRONJ is established yet, the importance of oral hygiene, patient education and treatments suitable for clinical stage is emphasized. In addition, it is considered that the survey of incidence of BRONJ in Japan and the preparation of Japanese guideline are urgent need.