3年以上の経口ビスフォスフォネート製剤服用患者における抜歯後治癒経過に関する後ろ向き調査研究

• Published in: 日本口腔外科学会雑誌 Vol. 60; no. 9; pp. 514 - 521
• Main Authors: 宮腰, 昌明, 鄭, 漢忠, 大賀, 則孝, 秦, 浩信, 山崎, 裕, 北川, 善政, 足利, 雄一, 佐藤, 淳, 浅香, 卓哉
• Format: Journal Article
• Language: Japanese
• Published: 社団法人 日本口腔外科学会 20.09.2014
• Subjects: 休薬; 抜歯; 治癒遅延; 経口ビスフォスフォネート; 骨壊死
• ISSN: 0021-5163; 2186-1579
• DOI: 10.5794/jjoms.60.514

Patients receiving oral bisphosphonates (BP) are at risk for developing bisphosphonate-related osteonecrosis of the jaw (BRONJ), but to a much lesser degree than those treated with intravenous BP. Patients treated with oral BP were reported to have less extensive and / or refractory BRONJ. However, the risk of BRONJ associated with oral BP is reported to increase when the duration of therapy exceeds 3 years. We performed 208 extractions in 99 patients who received oral BP for more than 3 years, and their postoperative course was evaluated retrospectively. These subjects were all female (average age, 72 years). BP was orally administered to 73 patients with osteoporosis, 13 with RA, 3 with SLE, and 10 with other diseases. The mean duration of oral BP exposure was 60 months (median 54 months). Treatment with oral BP was discontinued in 83 patients. There were 24 patients receiving steroids, 13 receiving immunosuppressants, and 14 with diabetes mellitus. Six patients had delayed healing with bone exposure in sockets 4 weeks after tooth extraction ; furthermore, BRONJ developed in 2 other patients (2%). In these 8 patients, we studied the relations between delayed healing and various clinical factors such as age, the type, duration, and holidays of BP, risk factors, steroids, immunosuppressants, steroids plus immunosuppressants, anti-inflammatory treatment before extraction, site and type of extraction, and closure of the extraction socket. Discontinuation of BP, steroids plus immunosuppressants, and type of extraction were significant independent risk factors for delayed healing.