Dental and Medical Problems

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Dental and Medical Problems

2012, vol. 49, nr 4, October-December, p. 576–582

Publication type: review

Language: English

License: Creative Commons Attribution 3.0 Unported (CC BY 3.0)

Bisphosphonates – Risk Assessment of Osteonecrosis of the Jaw and Potential Benefits for Periodontal Therapy

Bisfosfoniany – ocena ryzyka martwicy kości szczęk i potencjalnych korzyści w leczeniu periodontologicznym

Bartłomiej Górski1,A,B,E,F, Magdalena Bryłka1,B,E,F

1 Department of Periodontology, Medical University of Warsaw, Poland

Abstract

Bisphosphonates (BPs) are a class of drugs commonly used for the treatment and prevention of increased bone resorption associated with diseases such as osteoporosis, osteopenia, hypercalcemia of malignancy, multiple myeloma, Paget’s disease. BPs are known to inhibit osteoclastic bone resorption and stimulate the formation of osteoblast precursors to promote osteoblastogenesis. Since 2003 cases of bisphosphonate-related osteonecrosis of the jaws (BRONJ) have been reported. On the basis of the available data, a significantly increased risk of this complication is observed in patients receiving intravenous BPs compared to those receiving oral BPs. Other risk factors for the development of BRONJ include: duration of therapy, dentoalveolar surgery, age, concomitant oral disease, demographic and systemic factors. Preventive dental interventions before initiating bisphosphonate therapy can reduce the risk of BRONJ. Antiresorptive and anti-inflammatory properties of BPs can play a potentially important role in treatment of periodontitis. The results of the recent studies showed that the local delivery of alendronate in treatment of chronic and aggressive periodontitis was more effective in improving clinical and radiographic parameters compared to placebo.

Streszczenie

Bisfosfoniany to grupa leków powszechnie stosowanych w leczeniu i zapobieganiu nasilonej resorpcji kości związanej z takimi chorobami, jak: osteoporoza, osteopenia, hiperkalcemia nowotworowa, szpiczak mnogi, choroba Pageta. Bisfosfoniany hamują zależną od osteoklastów resorpcję kości i przyspieszają formowanie prekursorów osteoblastów, pobudzając tym samym osteoblastogenezę. W 2003 r. pojawiły się doniesienia o przypadkach martwicy kości szczęk związanej z terapią bisfosfonianami. Na podstawie dostępnych danych stwierdza się znacząco większe ryzyko tego powikłania u pacjentów otrzymujących bisfosfoniany drogą dożylną niż doustną. Inne czynniki ryzyka rozwoju martwicy kości związanej z bisfosfonianami to: długość trwania terapii, zabiegi chirurgii stomatologicznej, wiek, współistniejące choroby w jamie ustnej, czynniki demograficzne i ogólnoustrojowe. Profilaktyczne zabiegi stomatologiczne przed rozpoczęciem terapii bisfosfonianami mogą przyczynić się do minimalizacji ryzyka martwicy kości. Antyresorpcyjne i przeciwzapalne właściwości bisfosfonianów mogą mieć potencjalnie ważną rolę w leczeniu zapaleń przyzębia. Wyniki najnowszych badań wykazały, że miejscowe zastosowanie alendronatu w leczeniu przewlekłego i agresywnego zapalenia przyzębia było bardziej skuteczne w porównaniu z placebo.

Key words

bisphosphonates, osteonecrosis of the jaws, periodontitis

Słowa kluczowe

bisfosfoniany, martwica kości szczęk, zapalenie przyzębia

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