経口ビスフォスフォネートを処方された患者における抜歯後の薬物関連顎骨壊死の発生率について

The incidence of medication-related osteonecrosis of the jaw following tooth extraction in patients prescribed oral bisphosphonates.

抄録

目的 キングスカレッジ病院口腔外科内の専用クリニックで抜歯後にビスフォスフォネート系薬剤を経口投与された患者さんにおける薬剤関連顎骨壊死の発生率を明らかにすること。また、以前に顎骨壊死の発症リスクに大きく影響すると報告された性別、治療期間、内科的合併症、抜歯部位などの要因の影響についても検討した。材料と方法 8年間に抜歯をした患者の歯科記録からデータを集め、この後ろ向き研究に参加させた。ビスフォスフォネート静注薬、デノスマブ、がん治療で使用される新規標的化学療法、頭頸部への放射線療法に過去または現在曝露されている患者は本研究から除外した。結果 この652人のグループにおける抜歯後の薬剤関連顎骨壊死の発生率は0.8％であった。結論 この研究は、抜歯後、経口ビスフォスフォネートを処方された患者は、薬剤性顎骨壊死を発症するリスクがあり、そのリスクは4年以上ビスフォスフォネートを服用している場合に著しく増加することを示している（p=0.02）。

Aims To determine the incidence of medication-related osteonecrosis of the jaw in patients prescribed oral bisphosphonate medication following dental extraction in a dedicated clinic within the Department of Oral Surgery of King's College Hospital. The effect of factors such as sex, duration of therapy, medical comorbidities and site of extraction, which have previously been reported to significantly affect the risk of developing osteonecrosis of the jaw, was also examined.Materials and methods Data were gathered from the dental records of patients who had extractions over an eight-year period and were included in this retrospective study. Patients with previous or current exposure to intravenous bisphosphonates, denosumab, novel-targeted chemotherapies used in the oncology setting or radiotherapy to the head and neck were excluded from this study.Results The incidence of medication-related osteonecrosis of the jaw following tooth extraction in this group of 652 was 0.8%. A significantly increased risk of developing medication-related osteonecrosis of the jaw was evident in patients prescribed oral bisphosphonates for four years or more (p = 0.02), with an incidence in this group of 1.6%.Conclusion This study demonstrates that, following dental extraction, patients who are prescribed oral bisphosphonates are at risk of developing medication-related osteonecrosis of the jaw and that this risk increases significantly when the patient has been taking the bisphosphonate for four years or more.