Journal of the Korean Association of Oral and Maxillofacial Surgeons

  • 제44권4호
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  • Pages.174-181
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  • 2018
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  • 2234-7550(pISSN)
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  • 2234-5930(eISSN)
대한구강악안면외과학회 (The Korean Association of Oral and Maxillofacial Surgeons)
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Prognostic factors for outcome of surgical treatment in medication-related osteonecrosis of the jaw

  • Shin, Woo Jin (Department of Oral and Maxillofacial Surgery, College of Dentistry, Dankook University) ;
  • Kim, Chul-Hwan (Department of Oral and Maxillofacial Surgery, College of Dentistry, Dankook University)
  • 투고 : 2018.03.05
  • 심사 : 2018.04.02
  • 발행 : 2018.08.31
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초록

Objectives: The number of patients with medication-related osteonecrosis of the jaw (MRONJ) is increasing, but treatment remains controversial. Published papers and systematic reviews have suggested that surgical treatment is effective in patients with MRONJ. The purpose of this study was to determine whether preoperative University of Connecticut Osteonecrosis Numerical Scale (UCONNS), other serologic biomarkers, and size of necrosis are prognostic factors for outcome of surgical treatment in MRONJ. Materials and Methods: From January 2008 to December 2016, 65 patients diagnosed with MRONJ at the Department of Oral and Maxillofacial Surgery in College of Dentistry, Dankook University who required hospitalization and surgical treatment were investigated. Patient information, systemic factors, and UCONNS were investigated. In addition, several serologic values were examined through blood tests one week before surgery. The size of osteolysis was measured by panoramic view and cone-beam computed tomography in all patients. With this information, multivariate logistic regression analysis with backward elimination was used to examine factors affecting postoperative outcome. Results: In multivariate logistic analysis, higher UCONNS, higher C-reactive protein (CRP), larger size of osteolysis, and lower serum alkaline phosphate were associated with higher incidence of incomplete recovery after operation. This shows that UCONNS, CRP, serum alkaline phosphate, and size of osteolysis were statistically significant as factors for predicting postoperative prognosis. Conclusion: This study demonstrated that CRP, UCONNS, serum alkaline phosphate, and size of osteolysis were statistically significant factors in predicting the prognosis of surgical outcome of MRONJ. Among these factors, UCONNS can predict the prognosis of MRONJ surgery as a scale that includes various influencing factors, and UCONNS should be used first as a predictor. More aggressive surgical treatment and more definite surgical margins are needed when the prognosis is poor.

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참고문헌

  1. Landesberg R, Woo V, Cremers S, Cozin M, Marolt D, Vunjak-Novakovic G, et al. Potential pathophysiological mechanisms in osteonecrosis of the jaw. Ann N Y Acad Sci 2011;1218:62-79. https://doi.org/10.1111/j.1749-6632.2010.05835.x
  2. Francis MD, Valent DJ. Historical perspectives on the clinical development of bisphosphonates in the treatment of bone diseases. J Musculoskelet Neuronal Interact 2007;7:2-8.
  3. Marx RE. Pamidronate (Aredia) and zoledronate (Zometa) induced avascular necrosis of the jaws: a growing epidemic. J Oral Maxillofac Surg 2003;61:1115-7. https://doi.org/10.1016/S0278-2391(03)00720-1
  4. Taylor KH, Middlefell LS, Mizen KD. Osteonecrosis of the jaws induced by anti-RANK ligand therapy. Br J Oral Maxillofac Surg 2010;48:221-3. https://doi.org/10.1016/j.bjoms.2009.08.030
  5. Ruggiero SL, Dodson TB, Fantasia J, Goodday R, Aghaloo T, Mehrotra B, et al. American Association of Oral and Maxillofacial Surgeons position paper on medication-related osteonecrosis of the jaw--2014 update. J Oral Maxillofac Surg 2014;72:1938-56. https://doi.org/10.1016/j.joms.2014.04.031
  6. Badros A, Weikel D, Salama A, Goloubeva O, Schneider A, Rapoport A, et al. Osteonecrosis of the jaw in multiple myeloma patients: clinical features and risk factors. J Clin Oncol 2006;24:945-52. https://doi.org/10.1200/JCO.2005.04.2465
  7. Marx RE, Sawatari Y, Fortin M, Broumand V. Bisphosphonateinduced exposed bone (osteonecrosis/osteopetrosis) of the jaws: risk factors, recognition, prevention, and treatment. J Oral Maxillofac Surg 2005;63:1567-75. https://doi.org/10.1016/j.joms.2005.07.010
  8. Migliorati CA, Schubert MM, Peterson DE, Seneda LM. Bisphosphonate-associated osteonecrosis of mandibular and maxillary bone: an emerging oral complication of supportive cancer therapy. Cancer 2005;104:83-93. https://doi.org/10.1002/cncr.21130
  9. Yoneda T, Hagino H, Sugimoto T, Ohta H, Takahashi S, Soen S, et al. Bisphosphonate-related osteonecrosis of the jaw: position paper from the allied task force committee of Japanese Society for Bone and Mineral Research, Japan Osteoporosis Society, Japanese Society of Periodontology, Japanese Society for Oral and Maxillofacial Radiology, and Japanese Society of Oral and Maxillofacial Surgeons. J Bone Miner Metab 2010;28:365-83. https://doi.org/10.1007/s00774-010-0162-7
  10. Hayashida S, Soutome S, Yanamoto S, Fujita S, Hasegawa T, Komori T, et al. Evaluation of the treatment strategies for medication-related osteonecrosis of the jaws (MRONJ) and the factors affecting treatment outcome: a multicenter retrospective study with propensity score matching analysis. J Bone Miner Res 2017;32:2022-9. https://doi.org/10.1002/jbmr.3191
  11. Allen MR, Ruggiero SL. A review of pharmaceutical agents and oral bone health: how osteonecrosis of the jaw has affected the field. Int J Oral Maxillofac Implants 2014;29:e45-57. https://doi.org/10.11607/jomi.te41
  12. Mucke T, Koschinski J, Deppe H, Wagenpfeil S, Pautke C, Mitchell DA, et al. Outcome of treatment and parameters influencing recurrence in patients with bisphosphonate-related osteonecrosis of the jaws. J Cancer Res Clin Oncol 2011;137:907-13. https://doi.org/10.1007/s00432-010-0953-1
  13. Watters AL, Hansen HJ, Williams T, Chou JF, Riedel E, Halpern J, et al. Intravenous bisphosphonate-related osteonecrosis of the jaw: long-term follow-up of 109 patients. Oral Surg Oral Med Oral Pathol Oral Radiol 2013;115:192-200. https://doi.org/10.1016/j.oooo.2012.05.017
  14. Kim JW, Kong KA, Kim SJ, Choi SK, Cha IH, Kim MR. Prospective biomarker evaluation in patients with osteonecrosis of the jaw who received bisphosphonates. Bone 2013;57:201-5. https://doi.org/10.1016/j.bone.2013.08.005
  15. Molcho S, Peer A, Berg T, Futerman B, Khamaisi M. Diabetes microvascular disease and the risk for bisphosphonate-related osteonecrosis of the jaw: a single center study. J Clin Endocrinol Metab 2013;98:E1807-12. https://doi.org/10.1210/jc.2013-2434
  16. Reich W, Bilkenroth U, Schubert J, Wickenhauser C, Eckert AW. Surgical treatment of bisphosphonate-associated osteonecrosis: prognostic score and long-term results. J Craniomaxillofac Surg 2015;43:1809-22. https://doi.org/10.1016/j.jcms.2015.07.035
  17. Lerman MA, Xie W, Treister NS, Richardson PG, Weller EA, Woo SB. Conservative management of bisphosphonate-related osteonecrosis of the jaws: staging and treatment outcomes. Oral Oncol 2013;49:977-83. https://doi.org/10.1016/j.oraloncology.2013.05.012
  18. Lazarovici TS, Yahalom R, Taicher S, Elad S, Hardan I, Yarom N. Bisphosphonate-related osteonecrosis of the jaws: a single-center study of 101 patients. J Oral Maxillofac Sug 2009;67:850-5. https://doi.org/10.1016/j.joms.2008.11.015
  19. Kim HY, Lee SJ, Kim SM, Myoung H, Hwang SJ, Choi JY, et al. Extensive surgical procedures result in better treatment outcomes for bisphosphonate-related osteonecrosis of the jaw in patients with osteoporosis. J Oral Maxillofac Surg 2017:75:1404-13. https://doi.org/10.1016/j.joms.2016.12.014
  20. Rupel K, Ottaviani G, Gobbo M, Contardo L, Tirelli G, Vescovi P, et al. A systematic review of therapeutical approaches in bisphosphonates- related osteonecrosis of the jaw (BRONJ). Oral Oncol 2014;50:1049-57. https://doi.org/10.1016/j.oraloncology.2014.08.016
  21. Fliefel R, Troltzsch M, Kuhnisch J, Ehrenfeld M, Otto S. Treatment strategies and outcomes of bisphosphonate-related osteonecrosis of the jaw (BRONJ) with characterization of patients: a systematic review. Int J Oral Maxillofac Surg 2015;44:568-85. https://doi.org/10.1016/j.ijom.2015.01.026
  22. Khan AA, Morrison A, Hanley DA, Felsenberg D, McCauley LK, O'Ryan F, et al. Diagnosis and management of osteonecrosis of the jaw: a systematic review and international consensus. J Bone Miner Res 2015;30:3-23. https://doi.org/10.1002/jbmr.2405
  23. Jang HW, Kim JW, Cha IH. Development of animal model for bisphosphonates-related osteonecrosis of the jaw (BRONJ). Maxillofac Plast Reconstr Surg 2015;37:18. https://doi.org/10.1186/s40902-015-0020-6
  24. Wutzl A, Eisenmenger G, Hoffmann M, Czerny C, Moser D, Pietschmann P, et al. Osteonecrosis of the jaws and bisphosphonate treatment in cancer patients. Wien Klin Wochenschr 2006;118:473-8. https://doi.org/10.1007/s00508-006-0644-8
  25. Ruggiero SL, Mehrotra B, Rosenberg TJ, Engroff SL. Osteonecrosis of the jaws associated with the use of bisphosphonates: a review of 63 cases. J Oral Maxillofac Surg 2004;62:527-34. https://doi.org/10.1016/j.joms.2004.02.004
  26. Abu-Id MH, Acil Y, Gottschalk J, Kreusch T. [Bisphosphonateassociated osteonecrosis of the jaw]. Mund Kiefer Gesichtschir 2006;10:73-81. German. https://doi.org/10.1007/s10006-005-0670-0
  27. Vahtsevanos K, Kyrgidis A, Verrou E, Katodritou E, Triaridis S, Andreadis CG, et al. Longitudinal cohort study of risk factors in cancer patients of bisphosphonate-related osteonecrosis of the jaw. J Clin Oncol 2009;27:5356-62. https://doi.org/10.1200/JCO.2009.21.9584
  28. Choi WS, Lee JI, Yoon HJ, Min CK, Lee SH. Medication-related osteonecrosis of the jaw: a preliminary retrospective study of 130 patients with multiple myeloma. Maxillofac Plast Reconstr Surg 2017;39:1. https://doi.org/10.1186/s40902-016-0099-4
  29. Choi SY, An CH, Kim SY, Kwon TG. Bone turnover and inflammatory markers of bisphosphonate-related osteonecrosis of the jaw in female osteoporosis patients. J Oral Maxillofac Surg Med Pathol 2013;25:123-8. https://doi.org/10.1016/j.ajoms.2012.06.007
  30. Lesclous P, Abi Najm S, Carrel JP, Baroukh B, Lombardi T, Willi JP, et al. Bisphosphonate-associated osteonecrosis of the jaw: a key role of inflammation? Bone 2009;45:843-52. https://doi.org/10.1016/j.bone.2009.07.011
  31. Coxon FP, Thompson K, Roelofs AJ, Ebetino FH, Rogers MJ. Visualizing mineral binding and uptake of bisphosphonate by osteoclasts and non-resorbing cells. Bone 2008;42:848-60. https://doi.org/10.1016/j.bone.2007.12.225
  32. Boonyapakorn T, Schirmer I, Reichart PA, Sturm I, Massenkeil G. Bisphosphonate-induced osteonecrosis of the jaws: prospective study of 80 patients with multiple myeloma and other malignancies. Oral Oncol 2008;44:857-69. https://doi.org/10.1016/j.oraloncology.2007.11.012
  33. Pautke C, Bauer F, Otto S, Tischer T, Steiner T, Weitz J, et al. Fluorescence-guided bone resection in bisphosphonate-related osteonecrosis of the jaws: first clinical results of a prospective pilot study. J Oral Maxillofac Surg 2011;69:84-91. https://doi.org/10.1016/j.joms.2010.07.014
  34. Carlson ER, Basile JD. The role of surgical resection in the management of bisphosphonate-related osteonecrosis of the jaws. J Oral Maxillofac Surg 2009;67(5 Suppl):85-95.

피인용 문헌

  1. Bisphosphonate-related osteonecrosis of the jaw (BRONJ) in cancer patients vol.101, pp.2, 2020, https://doi.org/10.17816/kmj2020-226
  2. Epi-Mucosa Fixation and Autologous Platelet-Rich Fibrin Treatment in Medication-Related Osteonecrosis of the Jaw vol.9, pp.5, 2018, https://doi.org/10.3390/dj9050050
  3. Resective Surgery versus Debridement in Stage 2 Medication-Related Osteonecrosis of the Jaw vol.11, pp.18, 2018, https://doi.org/10.3390/app11188553
  4. Prognosis of medication‐related osteonecrosis of the jaws in metastatic prostate cancer patients vol.28, pp.1, 2018, https://doi.org/10.1111/odi.13737