Bisphosphonat-associeret osteonekrose: et nyt fænomen
Der har i de seneste år på internationalt plan været et stigende antal af indrapporteringer af kæbebens nekroser hos patienter som er i bisphosphonatbe handling. Selv om dette antal stadig er lavt i forhold til antallet af patienter som modtager bisphosphonat, er der alligevel grund til bekymring, ikke mindst fordi der ikke findes nogen effektiv behandling af en bis phosphonatinduceret osteonekrose. Bisphosphonat er et relativt nyt medikament, som anvendes i behandlingen af stadig flere patientgrup per. Især patienter med cancer og knoglemetastaser synes at have god gavn af dette præparat. Der er endnu ikke faste retningslinjer for hvad man kan gøre for disse patienter i privat praksis, og hvilke der skal henvises til specialafdelinger. Da disse patienter sjældent selv er klar over risikoen for disse bivirkninger, er der behov for at øge tandlægers opmærksomhed over for de mulige pro blemer. Denne artikel er således skrevet for at belyse disse problemstillinger og give den alment praktise rende tandlæge viden om hvordan man bør forholde sig til denne patientgruppe.
Bisphosphonate-induced osteonecrosis: a new phenomenon: In recent years there has been an increase in the prevalece of osteonecrosis of the jaws. This has been connected to the use of Bisphosphonate (BP). BP is used to treat breast cancer-related bone metastases, multiple myeloma, hypercalcaemia and osteoporosis. The therapeutic use of BP to treat metastatic bone disease expands continuously. BP is an artificial derivate of pyrophosphate which has shown high bone affinity. BP has an inhibitory effect on the osteoclastic remodelling of bone and the angiogenesis. The effect of BP is multifactorial, and its effect is not yet fully understood. In our patients with bisphosphonate-associated osteonecrosis (BON) all but one had a history of dental extra ctions. A review of the literature confirms a connection between tooth extractions and BON.Due to this apparent connection we suggest that until an evidence-based treatment of BON exists, pre-emptive me asures are employed. We recommend that prior to treatment with BP, an exhaustive oral examination, diagnosis and treatment of infectious foci must be undertaken. Furthermore, patients in BP-treatment should receive regular oral follow-up examinations throughout their treatment. Surgical treatment involving bone healing should be avoided, and if necessary non-surgical treatment (e.g. endodontics) should be preferred. Physicians, general dentists and patients need to be aware of the side effects of BP- treatments.
