ビスフォスフォネート投与と関連性があると考えられた顎骨骨髄炎ならびに顎骨壊死 30 症例に関する追跡調査〜2年後の現状について

• Published in: 日本口腔外科学会雑誌 Vol. 55; no. 11; pp. 553 - 561
• Main Authors: 浦出, 雅裕, 田中, 徳昭, 嶋田, 淳, 柴田, 考典, 古澤, 清文, 桐田, 忠昭, 山本, 哲也, 池邊, 哲郎, 北川, 善政, 倉科, 憲治, 瀬戸, かん一, 福田, 仁一
• Format: Journal Article
• Language: Japanese
• Published: 社団法人 日本口腔外科学会 20.11.2009
• Subjects: ビスフォスフォネート; 追跡調査; 顎骨; 骨壊死; 骨髄炎
• ISSN: 0021-5163; 2186-1579
• DOI: 10.5794/jjoms.55.553

Bisphosphonates（BPs）were first reported to inhibit bone resorption by Fleisch et al. in 1969. BPs are frequently used to treat bone metastatic carcinoma, hypercalcemia, multiple myeloma, and osteoporosis. However, many cases of BP-related osteonecrosis of the jaws（BRONJ）have been reported in the United States since 2003, and similar cases have also been documented in Japan since 2006. The results of the first nationwide survey of BRONJ in Japan were reported in 2007. The present report is the follow-up survey of the previous one in 2007 and describes the present status of the patients after 2 years. Twenty-eight patients were studied because 2 were ineligible. Because 9 patients were completely cured during this follow-up survey, 17 patients（60.8 ％）of all patients were completely cured. Nine（52.9 ％）of the 17 patients given intravenous BPs and 7（77.8 ％）of the 9 patients given oral BPs were completely cured. Surgical treatments, such as sequestrectomy, curettage, and resection of the jaw bone, were performed in 15（88.2 ％）of the 17 cured patients and 7（63.6 ％）of the 11 non-cured patients. Antibiotic therapy was given to 14（82.4 ％）of the cured patients and all of the non-cured patients. Drug holidays of BPs were taken in 9（52.9 ％）of the cured patients and 10（90.9 ％）of the non-cured patients. Surgical treatments appeared to be performed at a higher rate in the cured patients than in the non-cured patients. In contrast, conservative treatments were given to more non-cured patients than cured patients. These results suggest that surgical treatments may be useful for BRONJ when given at the appropriate time. In addition, BRONJ was shown to be refractory because only 9 of 17 cases were cured in these 2 years.