- 學位論文
影響骨質疏鬆症患者拔牙後 發生藥物相關性顎骨壞死的危險因子分析
Analysis of Risk Factors Affecting Medication-Related Osteonecrosis of the Jaws After Dental Extraction among Osteoporotic Patients
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摘要
目的：骨質疏鬆症患者常使用抗骨吸收藥物防止骨質流失，而抗骨吸收藥物最令人注意之後遺症為藥物相關顎骨壞死。此研究為一回溯性病例對照研究，旨在研究接受抗骨吸收藥物治療後接受拔牙的骨質疏鬆症患者與藥物相關顎骨壞死產生的相關危險因子。 材料與方法：收集了自 2003 年 1 月至 2022 年 5 月期間的 937 名患者，共計 1,067 次拔牙的數據，其中519名患者接受每週口服一次Alendronate(Fosamax®)治療，276名患者接受每6個月Denosumab(Prolia®)皮下治療，172名患者接受每年Zoledronic acid(Aclasta®)靜脈注射治療。採用單變數及多變數羅吉斯迴歸模型分析來評估潛在的危險因子。 結果：依據羅吉斯多變數迴歸模型顯示年齡較大（AOR=1.09/年；95% CI=1.06-1.12；P value<0.001）和藥物治療超過24個月（AOR=2.07；95% CI =1.29-3.30；P value=0.002）是顯著的危險因子。拔牙前中斷藥物3個月或以上可降低藥物相關顎骨壞死風險（AOR=0.11；95% CI=0.07-0.17；P value< 0.001）。依藥物類型分類，與使用其他藥物的患者相比，Denosumab使用者在拔牙後發生藥物相關顎骨壞死的風險顯著降低（AOR=0.14；95% CI=0.07-0.27；P value<0.001）。協同作用的統計研究下，藥物持續時間≥24個月、拔牙前停藥<3個月、以及拔牙部位在下顎後牙等因素協同作用下導致藥物相關顎骨壞死風險最高（AOR=80.29；95% CI=33.05-195.09）。 結論：為了降低骨質疏鬆症患者拔牙後藥物相關顎骨壞死產生風險，拔牙前建議至少停藥3個月；在藥物種類方面，使用人類單株抗體Denosumab之骨質疏鬆症患者拔牙後產生顎骨壞死發生率較低，使用雙磷酸鹽類之病人需更加提高警覺。除此之外年紀愈大，拔牙後產生藥物相關顎骨壞死風險愈大，故在使用抗骨吸收藥物前的拔牙評估，越高齡的骨質疏鬆症患者應做更謹慎的治療。
並列摘要
Aim: For osteoporotic patient, anti-resorptive medications are one of the choice to prevent bone loss. This retrospective case-control study aimed to identify the risk factors associated with medication-related osteonecrosis of the jaw in osteoporotic patients receiving dental extraction after using anti-resorptive medications. Materials and Methods: Data were collected from 937 patients with 1,067 dental extractions conducted between January 2003 and May 2022, including 519 patients on oral alendronate, 276 on denosumab, and 172 on zoledronic acid. Univariate and multivariate regression analysis was employed to assess potential risk factors. Results: Regression model revealed older age (AOR=1.09 per year; 95% CI=1.06-1.12; p value<0.001) and drug treatment exceeding 24 months (AOR=2.07; 95% CI=1.29-3.30; p value=0.002) as significant risk factors. A drug interruption of 3 or more months prior to tooth extraction lowered risk (AOR 0.11; 95% CI=0.07-0.17; p value<0.001). Stratified by drug type, denosumab users had significantly lower risk of after extraction (AOR 0.14; 95% CI, 0.07-0.27; p value<0.001) compared to those on other medications. Synergistically, factors of drug duration ≥24 months, <3 months interruption, and lower posterior tooth extraction posed the highest risk (AOR 80.29; 95% CI=33.05-195.09; p <0.001). Conclusion: Denosumab reveals less risk of MRONJ for osteoporotic patients after tooth extraction. After anti-resorptive medicine is used, an interruption of 3 months before tooth extraction is recommended. For dental evaluation before anti-resorptive therapy for osteoporotic patients, tooth extraction should be considered more actively.
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