Bifosfonatlar ve Çenelerde Görülen Osteonekroz

Abstract

Bifosfonatlar, stabil kemik mineralizasyonu düzenlerler.Endojen inorganik pirofosfatların analoglarıdır. Bifosfonatların osteoklastları inaktive ederek osteoklastik kemik rezorbsiyonunu azalttığı bilinmektedir. Bu sebeple kemik rezorbsiyonunu azaltması ve kontrol altına alınması gereken çoğu hastalıkta tercih edilmektedir. Kullanıma girdikleri 1969 yılından bu yana pek çok çalışma ile etkin, güvenilir ve iyi tolere edilebilir oldukları ortaya konmuştur. Oral bifosfonatlar genellikle osteopeni ve osteoporozda kullanılırken, inravenöz bifosfonatlar ilk olarak iskeletle ilişkili durumların düzeltilmesinde (kırıklar, kemik ağrısı, aşırı kemik rezorbsiyonu ile sonuçlanan hiperkalsemi durumlarında), multiple myelom, meme, prostat, akciğer ve kemik metaztazlı renal kanserler gibi malignitelerde kullanılmaktadır. Bifosfonatların yan etkileri minimal olarak bilinmektedir. Ancak ilacın uzun süreli kullanımına bağlı olarak bifosfonatın kemikte yüksek konsantrasyona ulaşması sonucunda, çenelerde osteonekrozlar ve oral mukoza epiteli üzerinde toksik etkiler gelişebilmektedir. Bu derlemede bifosfonatların kimyasal yapıları, etki mekanizmaları, endikasyonları, yan etkileri ve osteonekrozun tanı ve tedavisi hakkında önem arz eden bilgilerin verilmesi amaçlanmaktadır.

Keywords

• Bifosfonat
• çene
• kemik metabolizması
• osteonekroz

Bisphosphonates and Osteonecrosis Seen in Jaws

Abstract

Bisphosphonates are analogues of endogenous inorganic pyrophosphates that regulate stabilized bone mineralization. It is known that bisphosphonates reduce osteoclastic bone resorption by inactivating osteoclasts. For this reason, it is preferred in most diseases where bone resorption is to be reduced and controlled. Their use has been proven effective, reliable and well tolerated by many studies since 1969. Oral bisphosphonates are commonly used in osteopenia and osteoporosis, while intravenous bisphosphonates are first used in malignancies such as multiple myeloma, breast, prostate, lung, and bone metastases renal cancers, in the correction of skeletal related conditions (fractures, bone pain, hypercalcemia resulting in excessive bone resorption). Side effects of bisphosphonates are known to be minimal. However, due to the long-term use of the drug, the bisphosphonate can reach high concentrations in the bone, resulting in toxic effects on osteonecrosis and oral mucosal epidermis in the jaws. In this review, it is aimed to give important information about chemical structures, effect mechanisms, indications, side effects and diagnosis and treatment of osteonecrosis of bisphosphonates.

Keywords

• Bisphosphonate
• jaw
• bone metabolism
• osteonecrosis

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