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

References

• 1. Rogers, M.J., D.J. Watts, and R.G.G. Russell, Overview of bisphosphonates. Cancer: Interdisciplinary International Journal of the American Cancer Society, 1997. 80(S8): p. 1652-1660.
• 2. Kanis, J.A., et al., Rationale for the use of alendronate in osteoporosis. Osteoporosis international, 1995. 5(1): p. 1-13.
• 3. Marx, R.E., et al., Bisphosphonate-induced exposed bone (osteonecrosis/osteopetrosis) of the jaws: risk factors, recognition, prevention, and treatment. Journal of oral and maxillofacial surgery, 2005. 63(11): p. 1567-1575.
• 4. Filleul, O., E. Crompot, and S. Saussez, Bisphosphonate-induced osteonecrosis of the jaw: a review of 2,400 patient cases. Journal of cancer research and clinical oncology, 2010. 136(8): p. 1117-1124.
• 5. Ferlito, S., C. Liardo, and S. Puzzo, Dental extractions in patient treated with intravenous bisphosphonates and risk of osteonecrosis of jaws: presentation of a preventive protocol and case series. Minerva stomatologica, 2010. 59(11-12): p. 593-601.
• 6. Marx, R.E., Oral & intravenous bisphosphonate-induced osteonecrosis of the jaws: History, etiology, prevention, and treatment. 2007: Quintessence Publishing Company.
• 7. Russell, R.G.G., et al., Bisphosphonates: an update on mechanisms of action and how these relate to clinical efficacy. Annals of the New York Academy of Sciences, 2007. 1117(1): p. 209-257.
• 8. Rosella, D., et al., Medication-related osteonecrosis of the jaw: Clinical and practical guidelines. 2016. 6(2): p. 97.
• 9. Dixon, R.J.J.D.R., Bone turnover in elderly canine mandible and tibia. 1997. 76: p. 336.
• 10. Tanna, N., et al., Awareness of medication related osteonecrosis of the jaws (MRONJ) amongst general dental practitioners. British dental journal, 2017. 222(2): p. 121.
• 11. Van den Wyngaert, T., et al., Bisphosphonates in oncology: rising stars or fallen heroes. The oncologist, 2009. 14(2): p. 181-191.
• 12. Baqain, Z.H., et al., Osteonecrosis of jaws related to intravenous bisphosphonates: the experience of a Jordanian teaching hospital. The Annals of The Royal College of Surgeons of England, 2010. 92(6): p. 489-494.
• 13. Ruggiero, S.L., et al., American Association of Oral and Maxillofacial Surgeons position paper on medication-related osteonecrosis of the jaw—2014 update. Journal of oral and maxillofacial surgery, 2014. 72(10): p. 1938-1956.
• 14. Gürbüz-Urvasızoğlu, G., et al., Medication-Related Osteonecrosis of the Jaws (MRONJ) Induced by Incompatible Complete Removable Denture: A Case Report. 2017. 3(2): p. 7.
• 15. Malden, N., C. Beltes, and V. Lopes, Dental extractions and bisphosphonates: the assessment, consent and management, a proposed algorithm. British dental journal, 2009. 206(2): p. 93.
• 16. Saia, G., et al., Occurrence of bisphosphonate-related osteonecrosis of the jaw after surgical tooth extraction. Journal of Oral and Maxillofacial Surgery, 2010. 68(4): p. 797-804.
• 17. Mücke, T., et al. Bisphosphonate and medication-related osteonecrosis of the jaw: a review. in Seminars in musculoskeletal radiology. 2016. Thieme Medical Publishers.
• 18. Ferlito, S., S. Puzzo, and C. Liardo, Preventive protocol for tooth extractions in patients treated with zoledronate: a case series. Journal of Oral and Maxillofacial Surgery, 2011. 69(6): p. e1-e4.
• 19. Sharma, D., et al., Bisphosphonate-related osteonecrosis of jaw (BRONJ): diagnostic criteria and possible pathogenic mechanisms of an unexpected anti-angiogenic side effect. Vascular cell, 2013. 5(1): p. 1.
• 20. Ruggiero, S.L., Guidelines for the diagnosis of bisphosphonate-related osteonecrosis of the jaw (BRONJ). Clinical cases in mineral and bone metabolism, 2007. 4(1): p. 37.
• 21. AHMADOV, R., F. KARACAOĞLU, and M. AKKAYA, Diş Hekimlerinin Bifosfonatlar ve Bifosfonat İlişkili Çene Nekrozu Hakkında Bilgi, Düşünce ve Davranışlarının Değerlendirilmesi. Turkiye Klinikleri. Dishekimligi Bilimleri Dergisi, 2018. 24(2).
• 22. Wooltorton, E., Patients receiving intravenous bisphosphonates should avoid invasive dental procedures. Canadian Medical Association Journal, 2005. 172(13): p. 1684-1684.
• 23. Mozzati, M., et al., Tooth extraction and oral bisphosphonates: comparison of different surgical protocols. Joint, bone, spine: revue du rhumatisme, 2011. 78(6): p. 647-648.
• 24. Ristow, O., et al., Treatment perspectives for medication-related osteonecrosis of the jaw (MRONJ). Journal of Cranio-Maxillofacial Surgery, 2015. 43(2): p. 290-293.
• 25. Carlson, E.R., J.D.J.J.o.O. Basile, and M. Surgery, The role of surgical resection in the management of bisphosphonate-related osteonecrosis of the jaws. 2009. 67(5): p. 85-95.
• 26. Biçer, A.Z.Y., Bifosfonatlar ve çenelerde görülen osteonekroz. Acta Odontologica Turcica, 2013. 30(1): p. 35-8.
• 27. Hillner, B.E., et al., American Society of Clinical Oncology 2003 update on the role of bisphosphonates and bone health issues in women with breast cancer. 2003. 21(21): p. 4042-4057.
• 28. Rupel, K., et al., A systematic review of therapeutical approaches in bisphosphonates-related osteonecrosis of the jaw (BRONJ). Oral oncology, 2014. 50(11): p. 1049-1057.
• 29. ERSAN, N.J.T.K.J.o.O. and M.R.-S. Topics, Bifosfonat Kullanımı ve Cerrahi İşlem Gereken Hastalarda Yaklaşım. 2015. 1(1): p. 63-70.
• 30. Devogelaer, J.-P., et al., Biological and radiological responses to oral etidronate and tiludronate in Paget's disease of bone. 1997. 20(3): p. 259-261.
• 31. Marx, R.E., J.E. Cillo Jr, and J.J. Ulloa, Oral bisphosphonate-induced osteonecrosis: risk factors, prediction of risk using serum CTX testing, prevention, and treatment. Journal of Oral and Maxillofacial Surgery, 2007. 65(12): p. 2397-2410.
• 32. Rosen, H., et al., Serum CTX: a new marker of bone resorption that shows treatment effect more often than other markers because of low coefficient of variability and large changes with bisphosphonate therapy. Calcified tissue international, 2000. 66(2): p. 100-103.
• 33. Bagan, J.V., et al., Collagen telopeptide (serum CTX) and its relationship with the size and number of lesions in osteonecrosis of the jaws in cancer patients on intravenous bisphosphonates. Oral oncology, 2008. 44(11): p. 1088-1089.
• 34. Baim, S. and P.D. Miller, Perspective: assessing the clinical utility of serum CTX in postmenopausal osteoporosis and its use in predicting risk of osteonecrosis of the jaw. Journal of bone and mineral research, 2009. 24(4): p. 561-574.
• 35. Kwon, Y.-D., et al., Correlation between serum C-terminal cross-linking telopeptide of type I collagen and staging of oral bisphosphonate-related osteonecrosis of the jaws. Journal of Oral and Maxillofacial Surgery, 2009. 67(12): p. 2644-2648.
• 36. Kwon, Y.-D., et al., Oral bisphosphonate-related osteonecrosis of the jaws: Favorable outcome after bisphosphonate holiday. Quintessence International, 2009. 40(4).