- 期刊
Denosumab-related Osteonecrosis of Jaws in Osteoporotic Patients-Report of 3 Cases
骨質疏鬆患者使用denosumab引起的顎骨壞死－三例報告
摘要
Osteonecrosis of the jaw (ONJ) associated with the use of antiresorptive drugs such as bisphosphonates or denosumab is referred to as ＂medication-related ONJ＂ or MRONJ. Denosurnab is a monoclonal antibody against RANKL, a ligand required for osteoclastic precursors to differentiate into mature osteoclasts. There are two indications for this drug including prevention of bone loss in metastasis disease and bone loss in osteoporosis. The incidence of ONJ caused by denosurnab in treatment of osteoporosis is relatively rare. The reported incidence is between 0.001% and 0.01 %. Therefore, we report 3 new cases of MRONJ in patients receiving denosurnab (Prolia) for osteoporosis in our hospital. All the 3 patients were all above 80 years old. The ONJ occurred after 3 to 4 doses of Denosurnab (Prolia, q6M) use and all located at posterior mandible. Only one case had tooth extraction prior ONJ occurrence. After withholding the drug use, debridement of necrotic tissue with sequestrectomy, all the lesions healed within 53 to 146 days.
並列摘要
使用雙磷酸鹽類或denosumab類等抗吸收藥物引起的顎骨壞死統稱之為“藥物引起之顎骨壞死”。Denosumab是一種拮抗RANKL的單株抗體，妨礙RANKL與蝕骨前驅細胞上的RANK結合，抑制蝕骨細胞的分化成熟，進而達到抑制骨質再吸收的效果。兩種主要的適應症是防止骨轉移疾病和骨質疏鬆症造成的骨吸收。對於骨質疏鬆症的患者，使用densumab引起之骨壞死的發生率是相對罕見的。過往的文獻指出約在萬分之一以下。因此，我們提出了三例使用denosumab來治療骨質疏鬆而引發顎骨壞死之病例，皆為超過八十歲之長者。顎骨壞死發生在經過三至四次Denosumab注射劑使用後，位置皆在下顎後牙區，只有一例是因為拔牙觸發引起的。患者們在停藥並接受清創治療後，病灶最長在五個月內皆癒合良好。