双膦酸盐相关性颌骨坏死1例  

Bisphosphonates-related osteonecrosis of the jaw:A case report

作　　者：杨菊 刘玥 曲春娜 孙健斌 李天英 石连杰[2,7] YANG Ju;LIU Yue;QU Chunna;SUN Jianbin;LI Tianying;SHI Lianjie(Department of Rheumatology and Immunology,Suining Central Hospital,Suining 629099,Sichuan,China;Department of Rheumatology and Immunology,Peking University International Hospital,Beijing 102206,China;Department of Maxillofacial Surgery,Peking University International Hospital,Beijing 102206,China;Department of Stomatology,Peking University International Hospital,Beijing 102206,China;Department of Endocrinology,Peking University International Hospital,Beijing 102206,China;Department of Pathology,Peking University International Hospital,Beijing 102206,China;Department of Rheumatology and Immunology,Peking University Shougang Hospital,Beijing 100144,China)

机构地区：[1]遂宁市中心医院风湿免疫科,四川遂宁629099 [2]北京大学国际医院风湿免疫科,北京102206 [3]北京大学国际医院口腔颌面外科,北京102206 [4]北京大学国际医院口腔科,北京102206 [5]北京大学国际医院内分泌科,北京102206 [6]北京大学国际医院病理科,北京102206 [7]北京大学首钢医院风湿免疫科,北京100144

出　　处：《北京大学学报(医学版)》2025年第2期388-392,共5页Journal of Peking University:Health Sciences

基　　金：北京大学国际医院院内基金重点项目(YN2020ZD01)。

摘　　要：双膦酸盐(bisphosphonates,BPs)类药物诞生于上世纪80年代,可以缓解恶性肿瘤骨转移引起的疼痛,同时可通过抑制破骨细胞功能抑制骨吸收从而增加骨密度,目前已被广泛应用于治疗恶性肿瘤骨转移及骨质疏松等以骨吸收为特点的疾病[1]。骨质疏松在临床中被认为是以骨质丧失为主的病理过程,目前研究认为骨质疏松是由于成骨和破骨活动失衡所致[2]。2003年Marx[3]报道使用BPs后出现颌骨坏死,这一严重并发症在医学界引起了广泛重视,此后,国内外相继报道了多起BPs相关性颌骨坏死(BPs-related osteonecrosis of the jaw,BRONJ)。Osteonecrosis of the mandible is also called avascular necrosis of the jaw,and it is a rare complication of bisphosphonates.It is characterized with pain,swelling,exposure of bone,local infection and pathologic fractures of the jaw.With the widespread usage of bisphosphonates in bone metastasis of malignant tumors and osteoporosis,this rare complication has received more attention in recent years.Here,we reported a case of bisphosphonates-related osteonecrosis of the jaw(BRONJ)caused by intravenous zoledronic acid for osteoporosis.A 62-year-old female patient with 7-year history of Sjogren’s syndrome and 3-year history of osteoporosis developed BRONJ after 3-year treatment of zoledronic acid.Two months before she went to the Peking University International Hospital,she visited the dentist for periodontal purulent secretion and extracted one tooth from the right mandible.However,the condition was not improved and she felt persistent pain and swelling in the right mandible.Hence,she received repeated root curettage,but there was no improvement.Finally,she was diagnosed with osteonecrosis of the mandible based on the digital volume tomography scan,which showed right mandibular osteonecrosis bone destruction.She underwent surgical debridement of the necrotic bone and administered intravenous antibio-tics at the Peking University International Hospital.Histopathological analysis of the bone biopsy further confirmed the diagnosis of BRONJ.Her condition was improved successfully during a 3-year follow-up.Osteonecrosis of the mandible become more common with the increased use of bisphosphonates.Recent study has reported that osteonecrosis of the mandible is more likely to occur in patients with Sjogren’s syndrome.In addition,age,long-term and irregular administration of glucocorticoids,irregular oral examination and treatment also might be the risk factors in the pathogenesis of osteonecrosis of the mandible.For the elder osteoporosis patients who would receive or had received bisphosphonate-related drugs,oral health

关 键 词：双膦酸盐相关性颌骨坏死 骨质疏松 唑来膦酸 

分 类 号：R782.32[医药卫生—口腔医学]