長期口服Bisphosphonates(Fosamax(上標 ®))藥物引起齒槽骨壞死－病例報告

Oral Bisphosphonate Drug Induced Osteonecrosis of the Maxilla Alveolar Bone-A Case Report

許月閔(Yueh-Min Hsu) ； 張陽明(Yang-Ming Chang) ； 侯俊羽(Chun-Yu Ho) ； 張淑俐(Shu-Li Chang)

《臺灣口腔顎面外科學會雜誌》 19卷2期 (2008/06) Pp. 91-99

https://doi.org/10.7104/TJOMS.200806.0091

摘要

Bisphosphonates被廣泛的使用在治療骨質疏鬆、多發性骨髓瘤、骨骼轉移的乳癌與前列腺癌及惡性腫瘤轉移到骨骼造成高鈣血症的病患。Bisphosphonates的作用機制是抑制蝕骨細胞產生溶骨效應，減少骨頭被吸收，但這個藥理作用也會造成骨基質過度礦物化、進一步的骨壞死、黏膜破裂和骨頭暴露。
本篇報告是一位72歲女性，在後上頷區域有個數個月尚未癒合的拔牙傷口，他過去因爲有骨質疏鬆所以口服了三年的bisphosphonate(Forsamax(上標 ®)),這個區域經過了兩次清創和高壓氧的治療都沒有任何症狀緩解的現象，但是在病人接受膝關節的置換手術之後，他即停止服用Forsamax(上標 ®)，在停藥的六個月之後，我們在同一區域又做了一次清創的手術，此處的傷口才痊癒。
本篇報告用以提醒牙科醫師，對於長期使用Bisphosphonates的病患進行拔牙及手術治療時必須要提高警覺。並藉由此病例報告討論此藥物之作用機制，臨床症狀與發生位置並簡介其治療方式與原理。

關鍵字

顎骨壞死 ； 骨骼轉換率

並列摘要

Bisphosphonate was widely used in postmentopausal women for osteoporosis, bone resorption in multiple myeloma, breast and prostate cancer with bone metastasis, and severe hypercalcemia. The mechanism of action is to inhibit bone resorption and bone renewal via osteoclast apoptosis. This action leads to the accumulation of hypermineralized bone matrix, future bone necrosis, mucosal dehiscence and bone exposure.
A 72 year-old woman presented with a non-healing extraction wound over the posterior right maxilla for several months. Past medical history revealed 3 years oral bisphosphonate (Fosamax) taking for osteoporosis. Two times of surgical debridement and HBO (hyperbaric oxygen) therapy, the symptom and sign had no improvement. For the total hip joint replacement surgery, she stopped taking Fosamax. Six months later, the debridement procedure was performed over the same oral area. The wound healed completely.
Every dentists should be careful while performing oral surgery for patients with long- term history of oral bisphosphonate taking. Here, we proposed a guideline for diagnosis staging and treatment principles.

並列關鍵字

Bisphosphonate ； ONJ Osteonecrosis of the Jaws ； Bone turn-over rate