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

Year 2019, Volume: 3 Issue: 1, 8 - 20, 30.04.2019

Ergin Öztürk Nesrin Saruhan

https://doi.org/10.34084/bshr.535974

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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