Bisphosphonat-assoziierte Osteonekrosen des Kieferknochens

摘要

Summary. Intravenous application of bisphosphonates n(BP) represents an established therapeutic strategy of ntumor-associated bone metastasis and severe hypercal-ncemia. Patients can develop osteonecrosis of the jaw n(ONJ) as a side effect of this therapy. The diagnosis of nONJ is based on three criteria: a) patients have been or nare currently treated with BP; b) a defciency in wound nhealing, which is in 70–80% associated with necrotic nalveolar bone, characteristically exposed, is present for nat least 8 weeks and c) no radiotherapy of the head and nneck was performed. The suppression of bone turnover, nconcomitant with high functional load of the alveolar nbone, and the subsequent accumulation of microfrac-ntures are considered the main pathologic factors of this ndisease. The cumulative incidence of ONJ lies approxi-nmately between 1 and 10% in oncologic patients, being nassociated with the antiresorptive potency and the re-nspective molecular structure of the BPs. Patients with nmultiple myeloma develop ONJ more frequently than npatients with other oncological diseases such as metas-ntasizing breast- and prostate cancer, a fact that may nalso be due to the higher transfusion/injection fre-nquency of BP in these patients. Dental treatment strate-ngies are responsible for the occurrence of ONJ in ap-nproximately 80% of cases. Based on a clinical staging, npatients can be grouped into three categories and nshould receive the corresponding treatment regime. nProspective clinical studies are required for a better nunderstanding of etiology and pathogenesis of ONJ to nmake treatment, risk estimation and prognosis of ONJ nmore accurate.