IV Zolendronik Asit Kullanımına Bağlı Patolojik Mandibular Fraktür : Olgu Sunumu

Bifosfonatlar malignitelerde kemik metastazlarının engellenmesinde ve kemik metabolizmasının bozulduğu hastalıkların tedavisinde sık kullanılan ilaçlardır. Bifosfonat grubu ilaçlar osteoklast aktivitesini baskılayarak kemik remodellingini azaltırlar. Uzun dönem veya yüksek doz kullanımlarında çenelerde osteonekroz gibi geç yan etkilere sebep olurlar. Özellikle IV kullanımlarında oral kullanımlarına göre kemikteki tutulum oranları daha fazladır. Bifosfonat kullanımına bağlı çene osteonekrozu spontan veya başta diş çekimleri olmak üzere, mukoza bütünlüğünün bozulduğu, kemiğin dış ortama açıldığı durumlarda gelişebilir. İlerleyen dönemde MRONJ bölgesinde patolojik fraktür meydana gelebilir. Hastaların sistemik durumlarıyla beraber tedavi süreci karmaşık bir hal alabilir. Bu makalede multiple myeloma nedeniyle IV zolendronik asit kullanan hastada diş çekimi sonrası mandibulada oluşan osteonekroz tedavisi ve daha sonra meydana gelen patolojik fraktür oluşumu sunulmuştur.

Anahtar Kelimeler:

ıv zolendronik asit, mronj, osteonekroz, patolojik fraktür

IV Zolendronic Acid-Induced Pathologic Mandibular Fracture: A Case Report

Bisphosphonates are drug group frequently used in the treatment of the diseases which is characterized by osteoporosis and metastatic bone resorption. Bisphosphonate originated drugs decrease bone remodeling by suppressing osteoclast activity. They cause late side effects such as osteonecrosis in the jaws in long term or high dose use. Particularly in IV use, bone involvement rates are relatively higher than oral use. Bisphosphonate related osteonecrosis of the jaws can be occurred spontaneously or after cases such as tooth extraction which makes the bone open to external environment and causes mucosa integrity lost. In the following period, pathological fractures might be occurred in the BRONJ region. The treatment process can become complicated with the systemic conditions of the patients. In this article, the treatment of osteonecrosis in the mandible after tooth extraction and subsequent pathological fracture formation of the patient who uses IV zolendronic acid because of multiple myeloma are presented

Keywords:

ıv zolendronic acid, mronj, osteonecrosis, pathologic fracture,

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Referans1. Soares MQS, Van Dessel J, Jacobs R, da Dilva Santos PS, Cestari TM, Garlet GP. et al. Zolendronic acit induces site-specific structural changes and decreases vascular area in the alveolar bone. J Oral Maxillofac Surg. 2018;76(9):1893-1901.
Referans2. Ilyas Z, Camacho PM. Rare adverse effects of bisphosphonate therapy. Curr Opin Endocrinol Diabetes Obes. 2019;26(6):335-38.
Referans3. Awad ME, Sun C, Jernigan J, Elsalanty M. Serum C-terminal cross-linking telopeptide level as a predictive biomarker of osteonecrosis after dentoalveolar surgery in patients receiving bisphosphonate therapy: Systematic review and meta-analysis. J Am Dent Assoc. 2019;150(8):664-75.e8.
Referans4. Coletti D, Ord RA. Treatment rationale for pathological fractures of the mandible: a series of 44 fractures. Int J Oral Maxillofac Surg. 2008;37(3):215-22.
Referans5. Erdil A, Soylu E, Altan A, Akbulut N. Çenelerin ilaca bağlı osteonekrozu ve güncel tedavi yaklaşımları. Arşiv Kaynak Tarama Dergisi. 2019;28(4):285-99.
Referans6. Erdem NF, Gümüşer Z. Bifosfonat kullanımına bağlı çene kemiklerinde görülen osteonekroz vakalarının medikal ve cerrahi tedavileri sonrası uzun dönem takipleri. Atatürk Üniv. Diş Hek. Fak. Derg. 2019;29(1):89-97.
Referans7. Japanese Allied Committee on Osteonecrosis of the Jaw, Yoneda T, Hagino H, Sugimoto T, Ohta H, Takahashi S, Soen S. et al. Antiresorptive agent-related osteonecrosis of the jaw: Position Paper 2017 of the Japanese Allied Committee on Osteonecrosis of the Jaw. J Bone Miner Metab. 2017;35(1):6-19.
Referans8. Perazella MA, Markowitz GS. Bisphosphonate nephrotoxicity. Kidney Int. 2008 Dec;74(11):1385-93.
Referans9. Aslan A, Gülcü A, Özmeriç A. Yaşlı postmenapozal osteoporozlu hastalarda tedavi sonuçlarımız: oral ve parenteral bifosfonatların karşılaştırılması. Turk J Osteoporos. 2018;24:53-8.
Referans10. Ruggiero SL, Dodson TB, Fantasia J, Goodday R, Aghaloo T, Mehrotra B. et al. American Association of Oral and Maxillofacial Surgeons position paper on medication-related osteonecrosis of the jaw--2014 update. J Oral Maxillofac Surg. 2014;72(10):1938-56.
Referans11. Yurtseven Günay A, Ak G. İlaca bağlı olarak çene kemiklerinde görülen osteonekrozda dental yönetim ve güncel tedavi yaklaşımları: derleme. Sağlık Bilimlerinde İleri Araştırmalar Dergisi. 2020; 3(2): 81-92.
Referans12. Çalış Sipahi A, Efeoğlu C, Sezer B, Koca H. Kanser hastalarında bifosfonata bağlı osteonekroz (BRONJ): retrospektif çalışma. EÜ Dişhek Fak Derg. 2018;39(1):32-38
Referans13. Imai T, Michizawa M. "Phoenix jaw"-bone regeneration of the necrotic mandible between pathological fractures: an unusual but evocative course of bisphosphonate-related osteonecrosis. J Craniofac Surg. 2014;25(4):e333-36.
Referans14. Van Camp P, Gemels B, Heijsters G, Schepers S. Case report of maxillofacial fracture in a patient under bisphosphonates in the absence of ONJ disease: Guidelines. Int J Surg Case Rep. 2018;51:318-22.
Referans15. Abu-Id MH, Warnke PH, Gottschalk J, et al. "Bis-phossy jaws" - high and low risk factors for bisphosphonate-induced osteonecrosis of the jaw. J Craniomaxillofac Surg. 2008;36(2):95-103.
Referans16. Shibahara T. Imaging modalities for drug-related osteonecrosis of the jaw (2), Overview of the position paper on medication-related osteonecrosis of the jaw and the current status of the MRONJ in Japan. Jpn Dent Sci Rev. 2019;55(1):71-75.
Referans17. Caldroney S, Ghazali N, Dyalram D, Lubek JE. Surgical resection and vascularized bone reconstruction in advanced stage medication-related osteonecrosis of the jaw. Int J Oral Maxillofac Surg. 2017;46(7):871-76.
Referans18. Pichardo SEC, Ten Broek FW, Richard van Merkesteyn JP. Treatment of pathologic fractures of the mandible in stage III medication-related osteonecrosis of the jaw-an observational study. J Craniomaxillofac Surg. 2018;46(8):1241-46.
Referans19. Wongchuensoontorn C, Liebehenschel N, Wagner K, Fakler O , Gutwald O , Schmelzeisen R. et al. Pathological fractures in patients caused by bisphosphonate-related osteonecrosis of the jaws: report of 3 cases. J Oral Maxillofac Surg. 2009;67(6):1311-16.
Referans20. Kim MS, Kim KJ, Kim BJ, Kim CH, Kim JH. Immediate reconstruction of mandibular defect after treatment of medication-related osteonecrosis of the jaw (MRONJ) with rhBMP-2/ACS and miniplate: Review of 3 cases. Int J Surg Case Rep. 2020;66:25-29.