İlaca Bağlı Olarak Çene Kemiklerinde Görülen Osteonekroz (Mronj): Derleme

Abstract

Bifosfonatlar, osteoporöz tedavisinde kullanımı günden güne artan ve kemikteki rezorpsiyon sürecini yavaşlatan ve hatta durduran ilaçlardır. Bu ilaçlar, aynı zamanda Paget hastalığı ve metabolik kemik hastalıkları, hiperkalsemi, multiple miyelom ve metastatik durumlar ile ilişkili kemik hastalıklarının tedavisinde de etkin şekilde kullanılmaktadır. Bu ilaçlar için en tehlikeli yan etki olarak da osteonekroza sebebiyet verme riskinden bahsedilebilir. Bifosfonata bağlı olarak oluşan bu osteonekroz, ilk olarak 2002 yılında Marx ve Stern tarafından bifosfonat kullanan hastaların bir kısmında ağız içinde ortaya çıkan, iyileşmeyen, üstü mukoza ile örtülü olmayan ekspoze osteonekrotik kemik alanlarının varlığını farketmeleri ile teşhis edilmiştir.Bifosfonatların kullanımına bağlı olarak çene kemiklerinde görülen bu osteonekroz isimlendirme olarak da ‘’Bisphosphonate-Related Osteonecrosis of the Jaw’’ kelimelerinin baş harflerinin birleştirilmesinden oluşan BRONJ terimi olarak literatüre geçmiştir. Ancak yıllar içinde bu konuda hasta üzerinde yapılan çalışma ve araştırmalar artmış olup bu çeşit bir osteonekroza sadece bifosfonat türevi ilaçların değil; RANKL inhibitörü olan denosumab gibi kemoterapötik ilaçlar ve türevlerinin de sebep olduğu ortaya konmuştur. 2014 AAOMS terimsel olarak değişikliğe gidilmesi gerekliliği nedeniyle ilaca bağlı olarak çene kemiklerinde görülen osteonekroz manasına gelen ‘’Medication-Related Osteonecrosis of the Jaw (MRONJ)’’ olarak terimi güncellemiştir.

Keywords

• Bifosfonatlar,Çenenin bifosfonat ilişkili osteonekrozu,Maksilla,Mandibula

Medication Related Osteonecrosis of The Jaw (Mronj): Review

Abstract

Bisphosphonates are drugs that are increasingly used in osteoporous treatment and that slow down and even stop resorption process in bone. These drugs are also effectively used in treatment of Paget's disease and metabolic bone diseases, hypercalcemia, multiple myeloma and bone diseases associated with metastatic conditions. The most dangerous side effect may be the risk of causing osteonecrosis. This osteonecrosis due to bisphosphonate was first identified in 2002 by Marx and Stern by a group of patients receiving bisphosphonates in the mouth who were aware of the presence of exposed osteonecrotic bone areas that were not healing, not covered with mucosa. This osteonecrosis in the jaw bones due to the use of bisphosphonates has been published in literature as the name of BRONJ, which consists of combining  initials of ‘’Bisphosphonate Related Osteonecrosis of the Jaw’’. However, researches on this subject have increased, and this type of osteonecrosis isn’t only for bisphosphonate-derived drugs; chemotherapeutic drugs and derivatives such as denosumab, which are RANKL inhibitor, have been shown to be the cause. In 2014,  AAOMS updated the term ‘’Medication-Related Osteonecrosis of the Jaw (MRONJ)’’, which means osteonecrosis in jaw bones due to the drug, due to the need for regulation in naming. 

Keywords

• Bisphosphonates,Bisphosphonate-Associated Osteonecrosis of the Jaw,Maxilla,Mandible

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