長期使用雙磷酸鹽藥物與下顎骨壞死－病例報告

Long-Term Usage of Bisphosphonate and Osteonecrosis of Jaw: Case Report

吳至行(Chih-Hsing Wu) ； 王東堯(Tung-Yiu Wong)

《台灣老年醫學雜誌》 2卷3期 (2007/02) Pp. 201-208

https://doi.org/10.29462/TGG.200702.0003

摘要

隨著人口的老化，骨質疏鬆症已是老年人常見的臨床疾病。長效型雙磷酸鹽類藥物具有強力的抑制破骨細胞活性，減緩骨再吸收速率而顯著降低骨折機率，是目前治療骨質疏鬆症最主要的藥物。一般認爲此類藥物的副作用極低，然而近年來，有愈來愈多證據顯示一種罕見的相關徵候－下顎骨壞死，可能與該藥物的長期使用有關。本文報導一位長期服用雙磷酸鹽類藥物的82歲骨質疏鬆症女性，在接受拔牙術後引發牙齦癒合不良與上顎骨外露現象。經排除其他疾病的可能性後，依據服用雙磷酸鹽藥物的病史下診斷爲雙磷酸鹽藥物相關下顎骨壞死。在停止雙磷酸鹽藥物並給予抗生素後，病情逐漸改善。發生此類副作用個案極少，但令人印象深刻，國內目前未有正式的文獻報告，本文整理相關文獻並彙整目前的防治策略以提醒臨床醫師及早預防。

關鍵字

骨質疏鬆症 ； 雙磷酸鹽 ； 下顎骨壞死

並列摘要

With the increasing aging population, osteoporosis is now a very common disease in clinical practice. Long-acting bisphosphonates, the mainstay of osteoporosis treatment, work by inhibiting osteoclast activity and suppressing bone resorption to significantly decrease osteoporotic fracture rates. While bisphosphonate has been thought to generate minimal adverse side effects, increasing evidence has suggested that long-term bisphosphonate use may be associated with an uncommon problem-jaw osteonecrosis. An 82-year-old osteoporotic female taking long term bisphosphonate was found to suffer from poor healing of extraction socket and exposed maxillary bone after removal of painful teeth. Bisphosphonate-related osteonecrosis of the jaw (BRONJ) was diagnosed based on her long-term use of bisphosphonate and absence of any other significant chronic conditions. Her symptom was much improved by discontinuing bisphosphonate and administrating antibiotics. The case of BRONJ is rare but impressive. We briefly review the clinical manifestations of BRONJ and summarize the current strategies of treatment and prevention to remind general practitioners of the early prevention of BRONJ.

並列關鍵字

osteoporosis ； bisphosphonate ； osteonecrosis BMD