双膦酸盐相关性颌骨坏死的研究进展

双膦酸盐相关性颌骨坏死（Bisphosphonate-Related Osteonecrosis of the Jaws,BRONJ）是长期使用双膦酸盐类药物出现的一种严重并发症,主要表现为颌面部不愈合的瘘管,暴露的坏死颌骨。BRONJ作为一种新出现的疾病,目前其发病机制尚不明确,诊断和治疗方法也未统一,本文就BRONJ的新近研究进展作一综述。     

双膦酸盐类药物性颌骨坏死:1例病例报告及文献回顾

双膦酸盐类药物通过抑制破骨细胞介导的骨吸收,降低了病理性骨折的发生率,提高了有融骨性疾病患者的生活质量。临床上主要用于治疗妇女绝经后的骨质疏松症、多形性骨髓瘤、恶性肿瘤骨转移(乳腺癌、前列腺癌等)引起的高钙血和骨痛症、成骨不全等代谢性骨病。随着双膦酸盐类药物在临床上的广泛应用,出现了许多该类药物相关性颌骨坏死的报道。现报告我院1例双膦酸盐类药物性左下颌骨坏死的病例,并结合文献讨论双膦酸盐类药物性颌骨坏死(Bisphosphonate-related osteonecrosis of the jaw,BRONJ)的发病机制、预防及治疗方法。     

双膦酸盐相关性颌骨坏死1例报道及文献回顾

随着双膦酸盐类药物在骨质疏松、恶性肿瘤骨转移等方面的广泛应用,有部分患者会发生颌骨坏死的报道,逐渐引起口腔医生的关注。本文报道1例我院双膦酸盐类药物引起颌骨坏死的病例,并结合文献讨论双膦酸盐类药物性颌骨坏死(BRONJ)的发病机制、诊断、预防及治疗方法。     

双膦酸盐及其相关性颌骨坏死的机制和治疗

双膦酸盐相关性颌骨坏死（BRONJ）是长期使用双膦酸盐治疗骨质疏松症,多发性骨髓瘤以及乳腺癌、前列腺癌和肺癌等其他恶性肿瘤骨转移所引起的骨相关性疾病的严重并发症。BRONJ的发生发展与一些因素密切相关,譬如双膦酸盐的效能、用药方式、牙拔除和不良义齿修复等。美国口腔颌面外科协会在2007年对BRONJ进行了定义、分级并颁布其治疗指南,在2009年和2014年进对其行了更新。尽管BRONJ在国际上引起了广泛的重视,但其发病机制仍不完全清楚,治疗措施也存在着较大的争议。本文就双膦酸盐及其相关性颌骨坏死的机制和治疗等研究进展作一综述。     

双膦酸盐相关性颌骨坏死发病机制的研究进展

双膦酸盐相关性颌骨坏死(bisphosphonate related osteonecrosis of the jaw,BRONJ) 是患者长期使用双膦酸盐药物引起的严重不良反应。其主要症状包括软组织破溃、骨面外露、坏死区流脓、局灶牙齿松动等。目前的临床治疗以局部死骨摘除等对症处理为主,由于病因学机制尚不明确,缺乏相应的对因治疗。学者们提出不同的病因学机制,包括颌骨代谢失衡、抑制血管生成、微生物感染、免疫功能紊乱、软组织毒性等。现将近年来对该病的发病机制的研究进展作一综述。     

双膦酸盐类药物相关性颌骨坏死临床研究

目的：了解双膦酸盐类药物相关性颌骨坏死（bisphosphonate?related osteonecrosis of the jaw ,BRONJ）的发病机制,探讨其诊断、临床表现、治疗和预防方法。方法对近两年收治的4例BRONJ患者资料进行回顾分析,结合国内外相关文献报道进行临床总结。结果报告的4例患者均有使用双膦酸盐类药物史,临床主要表现为患区反复疼痛、流脓,骨暴露及死骨形成。3例患者接受手术,同时抗生素对症治疗,其中1例术前病情最重的患者出院后半年内曾有小范围感染灶,口服抗生素控制,其余患者均无明显感染及复发。结论恰当的手术治疗对BRONJ可控制感染,缓解症状,使病情趋于静止。     

小鼠双膦酸盐相关性颌骨坏死建模的研究进展

随着双膦酸盐药物的广泛应用,双膦酸盐相关性颌骨坏死(bisphosphonate related osteonecrosis of the jaw,BRONJ)的病例报道日益增多.动物模型是研究该病发病机制及防治策略的有效途径.小鼠具有饲养周期短、便于进行基因水平的调控等优势,因此利用小鼠构建BRONJ模型的报道逐渐增...     

双膦酸盐相关性颌骨坏死并发腕部舟状骨骨髓炎1例

双膦酸盐类药物可以抑制破骨细胞功能,使颌骨骨密度升高,血流减少,发生骨坏死。双膦酸盐类药物相关性骨坏死多发于颌骨。本文报道1例双膦酸盐相关性颌骨坏死并发腕部舟状骨骨髓炎,并结合文献讨论双膦酸盐药物性颌骨坏死的发病机制、治疗与预防等。     

双膦酸盐性颌骨坏死：病例报告及文献复习

双膦酸盐类药物临床用于治疗骨质疏松症、变形性骨炎和其他代谢性骨病、多发性骨髓瘤以及与肿瘤转移相关的骨骼疾病。该类药物通过抑制破骨细胞介导的骨吸收而产生临床治疗作用。然而,双膦酸盐类药物,尤其是静脉用双膦酸盐类药物有致颌骨骨坏死的危险。目前,国内尚未有该类药物致下颌骨坏死的报道。作者报告1例口服双膦酸盐类药物阿仑膦酸钠（Alendronate,商品名福善美,Fosamax）致下颌骨骨坏死病例,并结合文献对双膦酸盐性颌骨坏死的发病机制、临床表现及其预防和治疗进行讨论。     

二膦酸盐相关颌骨骨坏死临床治疗研究进展

二膦酸盐类药物是临床上治疗骨转移癌最为常用的药物。近年来发现,患者长期应用该类药物可产生二膦酸盐相关颌骨骨坏死（bisphosphonate-related osteonecrosis of the jaw, BRONJ）这一较为严重的并发症。患者一旦出现BRONJ的临床症状（如口腔瘘管、红肿、开口受限及骨折等）,生活质量严重下降,常就诊于口腔科。因此,口腔科医生对于这种疾病治疗方法的了解非常重要。现将近年来针对这种疾病的常用治疗方法做一综述,以期对口腔临床工作起到帮助作用。     

Bisphosphonate-associated osteonecrosis of the jaws: surgical treatment with ErCrYSGG-laser. Case report

Bisphosphonates (BP) play an important role in concomitant therapy of certain types of cancer and multiple myeloma as well as in treatment of osteoporosis. The administration of BP has great therapeutic benefits, but correlates with a specific kind of osteonecrosis of the alveolar bone. The so-called bisphosphonate-related osteonecrosis of the jaws (BRONJ) is a rare, but often severe adverse side effect of high-dosage and long-term BP therapy. Thus far, no consensus for treatment of BRONJ has been achieved. All strategies have to take into account the insecure prognosis and danger of recurrence of clinically apparent necrosis and progression of disease. At the Department of Oral Surgery and Radiology, Medical University of Graz, an ErCrYSGG laser was successfully applied in surgical treatment of BRONJ. Stable mucosal coverage could be achieved in all of 5 cases. Laser surgery can be considered as a promising technique for the effective treatment of BRONJ.     

A brief review: characteristics of bisphosphonate-related osteonecrosis of the jaw (BRONJ) from the viewpoint of pathology

Bisphosphonate (BP) is widely used for the treatment of bone diseases, including osteoporosis. Osteonecrosis of the jaw occurring in patients receiving BP is suggested to indicate an association of osteonecrosis with BP treatment, and hence BP-related osteonecrosis of the jaw (BRONJ) is proposed as a disease condition. The pathogenesis of BRONJ is uncertain, but several predisposing factors have been identified. BRONJ is characterized by bone necrosis, inflammation, and infection, but the sequence of events leading to the bone exposure has not been established. Here, we present a case of BRONJ with radiologic and pathologic correlations, and review its characteristics and putative mechanism for the onset of BRONJ from the viewpoint of pathology.     

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??Bisphosphonates are the most commonly used drugs to treat bone metastases. In recent years?? many authors found that long-term use of bisphosphonate drugs can lead to bisphosphonate-related osteonecrosis of the jaws ??BRONJ??. The life quality of patients with the BRONJ symptoms ??oral fistula?? swelling?? limited opening and fractures??will be seriously affected. These patients often seek help in dentistry??therefore the treatment knowledge of this disease is very important. This article reviews the recent literature about treatment for this disease??hoping to help oral clinical work.     

Auto-fluorescence of the bone and its use for delineation of bone necrosis

Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a challenging complication of long-term bisphosphonate treatment. Currently, the drawback in the surgical management of BRONJ is the difficulty distinguishing between viable and necrotic bone. Intraoperative bone fluorescence induced by tetracyclines has been shown to be a valuable aid to overcome this problem. In this technical note we report the finding that viable bone is auto-fluorescent using the VELscope Vx fluorescence lamp. Necrotic bone shows an altered fluorescence pattern (pale or no fluorescence). Thus it is suggested that auto-fluorescence of bone might be of similar use during the surgical therapy of BRONJ.     

Osteonecrosis and spontaneous exfoliation of dental implants associated with oral bisphosphonate therapy: a case report

Bisphosphonates (BPs) have long been used for the treatment of osteoporosis and diseases like bone malignancies, active Paget's disease of bone, severe osteogenesis imperfecta and fibrous dysplasia among others. They bond highly to the bone surface and inhibit bone resorption. As BPs have a long half-life in bone because of their irreversible binding to bone, patients retain their risk profile even after drug cessation. This property also explains the complications wherein the cessation of bone resorption leads to halt in bone turnover. Usually with alendronate the risk of bisphosphonate-related osteonecrosis of jaw (BRONJ) wears off after 12 months. Reporting of the development of BRONJ is commonly associated with the intravenous BPs. Invasive surgical procedure associated with the placement of implants has been shown to be a major reason for the occurrence or initiation of BRONJ in susceptible patients. The prognosis of implants placed in the jaws of patients under or past BP medication is still uncertain. The present case report describes a patient on long-term oral BP therapy with spontaneous exfoliation of implant supported bone due to osteonecrosis.     

Bisphosphonate-related osteonecrosis of the jaws: a report of three cases demonstrating variability in outcomes and morbidity

BACKGROUND: Bisphosphonates are used widely to manage skeletal disorders resulting from malignancies that destroy bone and from some metabolic bone diseases. A strong association between bisphosphonate treatment and the appearance of painful exposed nonvital bone in the mandible and maxilla after oral surgery has been reported in the last decade. Extensive reviews have appeared in the dental literature regarding bisphosphonate-related osteonecrosis of the jaws (BRONJ), including protocols for diagnosis, management and diagnostic imaging for early detection; feature definition; and determination of extent of the disease. CASE DESCRIPTION: The authors provide three case reports to show the contrast in treatment outcomes and morbidity in patients with BRONJ. The cases involved diagnostic imaging modalities commonly used in the practice of dentistry: panoramic radiography and cone-beam volumetric computed tomography. CLINICAL IMPLICATIONS: These case reports demonstrate the usefulness of dental diagnostic imaging in the detection and management of BRONJ, corroborate the increasing number of reports regarding high levels of morbidity associated with various BRONJ treatments, and underscore the danger of performing invasive dental procedures for patients receiving bisphosphonate therapy.     

Non-exposed bisphosphonate-related osteonecrosis of the jaw: a critical assessment of current definition, staging, and treatment guidelines

Oral Diseases (2012) 18 , 625–632 Non‐exposed bisphosphonate‐related osteonecrosis of the jaw (BRONJ) is a newly reported complication arising from bisphosphonate therapy that presents with atypical symptoms and no apparent mucosal fenestration or exposure of necrotic bone. The clinical observation of the presence of necrotic bone underneath normal epithelial coverage was not conclusive for the diagnosis of BRONJ based on current guidelines established by the American Association of Oral and Maxillofacial Surgeons (AAOMS) and the American Society for Bone and Mineral Research (ASBMR), which specify the presence of clinically exposed necrotic bone for more than 8 weeks. Hence, the purpose of this review is to critically assess the current guidelines for diagnosis and management of BRONJ and propose a modified staging system and treatment guidelines to properly address the non‐exposed variant of BRONJ lesions.     

双膦酸盐相关性颌骨坏死

双膦酸盐类（BPs）药物是一种强有力的骨吸收抑制剂,已广泛应用于临床治疗中。近年来,有关双膦酸盐相关性骨坏死（BRONJ）的报道日渐增多,该病临床上以骨面裸露、死骨形成、疼痛、口臭等为特征。由于目前发病机理不明确,临床上尚无完全有效的治疗方法,因此BRONJ的预防十分重要。本文就BRONJ的发病机制、危险因素、临床特征、治疗预后等方面的研究现状进行阐述,以期为临床提供帮助。