Bisphosphonat-assoziierte Kiefer nekrosen^[1]

Zusammenfassung

Bisphosphonate spielen eine entscheidende Rolle in der Osteologie und Onkologie. Sie vermindern die Häufigkeit unerwünschter skelettaler Ereignisse und verbessern somit die Lebensqualität der Patienten. Bis phosphonate gelten insgesamt als nebenwirkungsarm. Doch seit der Beschreibung Bisphosphonat-assoziierter Kiefernekrosen haben sich diese zu einem ernsthaften klinischen Problem entwickelt. Sie treten hauptsächlich bei Patienten mit langjähriger intravenöser Applikation von stickstoffhaltigen Bisphosphonaten in onkologischer Dosierung auf. Deutlich seltener tritt diese Komplikation jedoch auch im Rahmen der Osteoporosebehandlung auf. Eine wesentliche Ursache für die Entstehung Bisphosphonat-assoziierter Kiefernekrosen wird in lokal entzündlichen Veränderungen sowie häufig daraus resultierenden dentoalveolär chirurgischen Eingriffen gesehen, so dass wesentliche prophylaktische Bemühungen stets auf die Eliminierung von akuten oder chronisch entzündlichen Veränderungen im Bereich der Kiefer vor bzw. unter der Behandlung mit Bisphosphonaten gerichtet sein sollten. Hinsichtlich der Therapie Bisphosphonat-assoziierter Kiefernekrosen setzen sich chirurgische Behandlungskonzepte mehr und mehr durch, wobei insbesondere die innovative fluoreszenzorientierte Knochenabtragung vielversprechend erscheint.

Summary

Bisphosphonates play a key role in the prophylaxis and treatment of osteoporosis and metastatic bone disease. They reduce the frequency of skeletal related events especially fractures and thereby they increase the quality of life of the patients. Bisphosphonates show a favorable risk profile but ever since the description of bisphosphonate-related osteonecrosis of the jaw this side effects has become a major clinical problem which is difficult to treat. The majority of cases occurred in patients suffering from metastatic bone disease who received long term intravenous administrations of nitrogen-containing bisphosphonates. Far less frequently it has also been described in osteoporotic patients receiving oral or intravenous administration of nitrogen-containing bisphosphonates. Bisphosphonate-related osteonecrosis of the jaws is defined by exposed necrotic bone in the maxillofacial region in patients under previous or ongoing bisphosphonate treatment and without history of irradiation of the jaw bones. The clinical hallmark of the disease is exposed necrotic bone in the oral cavity which can be accompanied by signs of infection such as pain, swelling, abscess or fistula formation. The majority of cases were preceded by local inflammations and or dento -alveolar surgeries especially tooth extractions and implant insertions. Therefore care should be taken to eliminate or avoid dental infections prior to or under ongoing bisphosphonate treatment. Once bisphosphonate-related osteonecrosis of the jaw has manifested surgical treatment schemes have shown to be superior when compared to conservative treatment protocols. Especially the fluorescence-guided bone resection seems to be an innovative and promising technique.

Schlüsselwörter

Bisphosphonate - Kiefernekrosen - Bisphosphonat-assoziierte Kiefernekrosen

Keywords

Bisphosphonates - osteonecrosis of the jaw - bisphosphonate-related osteonecrosis of the jaw (ONJ)

¹ Die Arbeit beruht in wesentlichen Teilen auf dem Exposee und den Ergebnissen des Habilitationsprojektes von Dr. med. Dr. med. dent. Sven Otto

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