双膦酸盐治疗患者拔牙后发生双膦酸盐相关性颌骨骨坏死的多中心前瞻性研究（完整翻译）

IF 0.4 Q4 DENTISTRY, ORAL SURGERY & MEDICINE

Journal of Oral and Maxillofacial Surgery Medicine and Pathology Pub Date : 2025-06-13 DOI:10.1016/j.ajoms.2025.06.006

Masaki Fujimori , Yoshiyuki Toriyabe , Nobuhiro Kaku , Kosuke Shimazaki , Masayoshi Miyasawa , Hiroki Mityate , Hideaki Kitada , Yuji Satoh , Hajime Misawa , Tetsuro Yamashita , Yoritoshi Nakajima , Yasushi Hariya , Ichizo Kobayashi , Satoshi Nishikata , Taishi Yoshihito , Sugiura Chihiro , Kazue Kasahiara , Yuichiro Asaka , Noriyuki Sakakibara , Masuhiko Okada , Shujiroh Makino

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引用次数: 0

摘要

目的本研究旨在确定双膦酸盐（bp）治疗患者拔牙后发生双膦酸盐相关性颌骨骨坏死（BRONJ）的频率，并评估预防性停用bp对降低BRONJ风险的效果。方法采用26个中心的前瞻性研究，对1323例2013-2016年正在或曾经接受过bp治疗的患者进行研究。患者在标准化方案下进行拔牙，并评估BRONJ和不良事件的发生率。结果1323例（2371例）拔牙中，预防性停用bp组808例，延续bp组515例。BRONJ总发病率为1.74 %，停药组和继续治疗组分别为1.73 %和1.75 % （P = 1.000）。BRONJ在骨质疏松组和恶性肿瘤组的发病率分别为1.23 %和28.00 % （P <； 0.001）。BRONJ发生的相关因素包括性别、bp适应症、口腔卫生、拔牙部位和denosumab的使用。采用逆概率加权法进行倾向评分分析，BRONJ的发生与预防性停用bp无显著相关性（P = 0.834；优势比：1.131,95 %置信区间：0.36-3.57）。停药组无脆性骨折发生。结论bp治疗组拔牙后BRONJ发生率为1.74 %，骨质疏松组停用bp治疗无预防效果。显著的危险因素包括性别、denosumab使用、bp适应症、口腔卫生和拔牙部位。

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Multicenter prospective study on the development of bisphosphonate-related osteonecrosis of the jaw after tooth extraction in patients treated with bisphosphonates (complete translation)

Objective

This study aimed to determine the frequency of bisphosphonate-related osteonecrosis of the jaw (BRONJ) after tooth extraction in patients treated with bisphosphonates (BPs) and to assess the efficacy of preventive BPs discontinuation in reducing BRONJ risk.

Methods

A 26-center prospective study was conducted on 1323 patients with current or past BPs treatment (2013–2016). Patients underwent tooth extraction under a standardized protocol, and the incidence of BRONJ and adverse events were evaluated.

Results

Among 1323 cases (2371 teeth extracted), 808 were in the preventive BPs discontinuation group, and 515 were in the BPs continuation group. The overall BRONJ incidence was 1.74 %, with rates of 1.73 % and 1.75 % in the discontinuation and continuation groups, respectively (P = 1.000). The incidence rates of BRONJ in the osteoporosis and malignancy groups were 1.23 % and 28.00 %, respectively (P < 0.001). Factors associated with BRONJ development included sex, BPs indications, oral hygiene, tooth extraction site, and denosumab use. Propensity score analysis using the inverse probability weighting method showed no significant association between BRONJ development and preventive BPs discontinuation (P = 0.834; odds ratio: 1.131, 95 % confidence interval: 0.36–3.57). No fragility fractures occurred in the discontinuation group.

Conclusions

The incidence of BRONJ after tooth extraction in patients receiving BPs was 1.74 %, with no preventive effect of BPs discontinuation in the osteoporosis group. Significant risk factors included sex, denosumab use, BPs indication, oral hygiene, and extraction site.

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