骨吸収抑制薬関連顎骨壊死の発生と治癒に関する前向き多施設共同研究 −北海道東部 十勝, 釧路・根室, オホーツク医療圏における顎骨壊死発生率−

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  • A multicenter prospective study on the incidence and cure of anti-resorptive agents-related osteonecrosis of the jaw: an epidemiological study in Eastern Hokkaido
  • 骨吸収抑制薬関連顎骨壊死の発生と治癒に関する前向き多施設共同研究 : 北海道東部 十勝,釧路・根室,オホーツク医療圈における顎骨壊死発生率
  • コツ キュウシュウ ヨクセイヤク カンレン ガッコツ エシ ノ ハッセイ ト チユ ニ カンスル マエムキ タシセツ キョウドウ ケンキュウ : ホッカイドウ トウブ トカチ,クシロ ・ ネムロ,オホーツク イリョウケン ニ オケル ガッコツ エシ ハッセイリツ

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<p>　Objectives: The present study aimed to determine the incidence and cure rates of anti-resorptive agentsrelated osteonecrosis of the jaw (ARONJ) and anti-resorptive agents-unrelated osteonecrosis of the jaw (AUONJ).</p><p>　Materials and methods: Patients at eight eastern Hokkaido advanced dental care facilities during the period 1 October 2013 to 30 September 2016 were included in this study. We used the results of a partial analysis performed in a multicenter prospective study on ARONJ by the Hokkaido Association of Hospital Dentistry. We also conducted an additional survey on the number and type of bone modifying agent (BMA) prescriptions dispensed during the above 3-year study period at all 574 medical facilities in eastern Hokkaido. These results were used to calculate the incidence and cure rates of ARONJ and AUONJ.</p><p>　Results: Eighty-five cases of osteonecrosis of the jaw (ONJ) had been diagnosed during the study period. Low-dose bisphosphonate-related osteonecrosis of the jaw (BRONJ) was observed in 39 patients, high-dose BRONJ in 29 patients, low-dose denosumab-related osteonecrosis of the jaw (DRONJ) in five patients, high-dose DRONJ in three patients, and AUONJ in nine patients. An additional survey regarding BMA prescriptions conducted at all medical facilities in the eastern Hokkaido area yielded a response rate of 96.3% (553/574). High-dose bisphosphonates accounted for 5,778 prescriptions in 1,781 patients; low-dose denosumab (Dmab) for 9,787 prescriptions in 3,756 patients; and high-dose Dmab for 3,268 prescriptions in 986 patients. During the 3-year study period, the estimated incidences of ARONJ due to low-dose BRONJ, high-dose BRONJ, low-dose DRONJ, high-dose DRONJ, and AUONJ were 0.104%, 1.623%, 0.133%, 0.304% and 0.0004%, respectively. The 12-month cumulative cure rate for AUONJ was 100%. The cumulative cure rates for low-dose ARONJ were 46.5% at 12 months, 71.2% at 24 months, and 85.6% at 36 months, and those for high-dose ARONJ were 0% at 12 months and 30.0% at 24 and 36 months. The three groups showed a significant difference (P<0.001).</p><p>　Conclusions: The results suggest that the incidence of ARONJ is higher than that of AUONJ in the general population. The cumulative cure rates for AUONJ, low-dose ARONJ, and high-dose ARONJ differ significantly.</p>

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