薬物関連顎骨壊死症のイメージングモダリティ（2）、薬物関連顎骨壊死症に関するポジションペーパーの概要と日本のMRONJの現状

Imaging modalities for drug-related osteonecrosis of the jaw (2), Overview of the position paper on medication-related osteonecrosis of the jaw and the current status of the MRONJ in Japan.

• Takahiko Shibahara

抄録

ビスフォスフォネート（BP）の注射剤であるパミドロネートやゾレドロネートによる顎骨壊死についてMarxが報告して以来、骨の露出を伴う顎の放射線性骨壊死・骨髄炎に類似した病態として、欧米のみならず日本でもビスフォスフォネート関連顎骨壊死症（BRONJ）の報告が多くなっている。また、BPsとは作用機序が異なる骨吸収阻害剤である抗受容体活性化核因子κ-Βリガンド（RANKL）抗体デノスマブでもBPsと同様の顎骨壊死が生じており、血管新生阻害剤ベバシズマブに関連した顎骨壊死の報告もあります。このため、AAOMSは最新のポジションペーパー（2014年）で、BRONJから「Medication-related osteonecrosis of the jaw」（MRONJ）に名称を変更した。本稿では、投薬関連顎骨壊死症に関するポジションペーパーの概要と、日本におけるMRONJの現状を紹介する。

Since Marx reported on osteonecrosis of the jaw caused by the injectable bisphosphonates (BPs) pamidronate and zoledronate, there have been numerous reports not only in Western countries, but in Japan as well, of bisphosphonate-related osteonecrosis of the jaw (BRONJ) as a pathology similar to radiation-related osteonecrosis/osteomyelitis of the jaw, which is accompanied by exposure of the bone. Osteonecrosis of the jaw similar to that occurring with BPs is also produced with the anti-receptor activator of nuclear factor kappa-Β ligand (RANKL) antibody denosumab, a bone resorption inhibitor that has a different mode of action from BPs, and there is also a report of osteonecrosis of the jaw related to bevacizumab, an angiogenic inhibitor. Because of this, in its newest position paper (2014), the AAOMS changed the nomenclature from BRONJ to "medication-related osteonecrosis of the jaw" (MRONJ). This article presents an overview of the position paper on medication-related osteonecrosis of the jaw and the current status of the MRONJ in Japan.