Hekimlerin ilaç kullanımına bağlı çene osteonekrozu ile ilgili farkındalık ve bilgi düzeyleri

Bifosfonat, denosumab ve benzer yan etkilere sahip ilaçların osteoporoz, kanser ile ilişkili kemik metastazları ve Paget hastalığı gibi kemik ile ilişkili hastalıklarda kullanımının artması hekimlerin çenelerde ortaya çıkan osteonekroz [İlaç kullanımına bağlı çene osteonekrozu (Medication-Related Osteonecrosis of the Jaws, MRONJ)] tablosu ile sıkça karşılaşmalarına neden olmaktadır. Bu durum özellikle söz konusu ilaçları reçete eden tıp hekimlerinin ve diş hekimlerinin ilaçların kullanım alanları, etki mekanizmaları, ortaya çıkabilecek komplikasyonları konusunda gerekli bilgi ve donanımına sahip olmalarını gerektirmektedir. Hekimlerin MRONJ ile ilgili farkındalığını değerlendiren az sayıda çalışma mevcuttur. Osteonekrozun, bifosfonat, denosumab ve benzer ilaçların etki mekanizmalarının ve yan etkilerinin anlatıldığı bu derlemede, bu ilaçları reçete eden hekimlerin farkındalıkları ile ilgili tüm dünyada yapılmış çalışmalar gözden geçirilmiş ve Ankara şehrinde yapılmış bir çalışmanın sonuçları sunulmuştur.

Anahtar Kelimeler:

bifosfonat, denosumab, osteonekroz, farkındalık

Physicians’ awareness and knowledge of medication-related osteonecrosis of the jaw

Increasing usage of bisphosphonates, denosumab, and other drugs with similar side effects, which are prescribed for osteoporosis, cancer-related metastases, and bone-related diseases such as Paget’s disease, cause medication-related osteonecrosis of the jaw (MRONJ) cases to be encountered more frequently. Medical doctors and dentists who prescribe or employ these drugs must have comprehensive knowledge about the usage indications, mechanisms of action, and complications which may be caused by these drugs. However, there are few studies evaluating physicians’ awareness of MRONJ. In this review, osteonecrosis, mechanisms of action, and complications which may be caused by bisphosphonates, denosumab, and other drugs with similar side effects are examined. Studies from various countries of the world related to the awareness of physicians who prescribe these drugs were reviewed for the purpose of this study. Also, the results of a study from the city of Ankara are presented.

Keywords:

bisphosphonate, denosumab, osteonecrosis, awareness,

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Ruggiero SL, Dodson TB, Assael LA, Landesberg R, Marx RE, Mehrotra B. American Association of Oral and Maxillofacial Surgeons Position Paper on Bisphosphonate‐Related Osteonecrosis of the Jaw–2009 Update. Aust Endod J. 2009; 35(3): 119–30.
McLeod NMH, Brennan PA, Ruggiero SL. Bisphosphonate osteonecrosis of the jaw: a historical and contemporary review. Surg. 2012; 10(1): 36–42.
Marx RE. Oral and intravenous bisphosphonate-induced osteonecrosis of the jaws. Chicago, Ill, USA Quintessence. 2007; 12.
Farrier AJ, Franco LCS, Shoaib A, Gulati V, Johnson N, Uzoigwe CE, et al. New anti-resorptives and antibody mediated anti-resorptive therapy. Bone Jt J. 2016; 98(2): 160–5.
Wang Z, Qiao D, Lu Y, Curtis D, Wen X, Yao Y, et al. Systematic literature review and network meta-analysis comparing bone-targeted agents for the prevention of skeletal-related events in cancer patients with bone metastasis. Oncologist. 2015; 20: 440–449.
Shah AD, Shoback D, Lewiecki EM. Sclerostin inhibition: a novel therapeutic approach in the treatment of osteoporosis. Int J Womens Health. 2015; 7: 565.
Rachner TD, Khosla S, Hofbauer LC. Osteoporosis: now and the future. Lancet. 2011; 377(9773): 1276–87.
Marx RE. Pamidronate (Aredia) and zoledronate (Zometa) induced avascular necrosis of the jaws: a growing epidemic. J Oral Maxillofac Surg. 2003; 61(9): 1115–7.
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.
Noury Rad Davaji H. How dentists in Ankara approach patients who use drugs that have side effects similar to biphosphonates, denosumab and etc. [Ankara]: Gazi University Faculty of Dentistry, Speciality Thesis. 2017.
Keskinkılıç B, Gültekin M, Karaca AS, Öztürk C, Boztaş G, Zayıfoğlu Karaca M, et al. editors. Turkey Cancer Control Programme. first ed. ANKARA: Republic of Turkey, Ministry of Health. 2016; p.18.
Cancer Fact Sheets : All Cancers Excluding Non-Melanoma Skin Cancer [Internet]. International Agency for Research on Cancer, World Health Organization. 2016 [cited 2017 October 21]. Available at: http://gco.iarc.fr/today/data/pdf/fact-sheets/cancers/cancer-fact-sheets-29.pdf
Raj D V, Abuzar M, Borromeo GL. Bisphosphonates, healthcare professionals and oral health. Gerodontology. 2016; 33(1): 135–43.
Alhussain A, Peel S, Dempster L, Clokie C, Azarpazhooh A. Knowledge, practices, and opinions of ontario dentists when treating patients receiving bisphosphonates. J Oral Maxillofac Surg. 2015; 73(6): 1095–105.
López‐Jornet P, Camacho‐Alonso F, Molina‐Miñano F, Gomez‐Garcia F. Bisphosphonate‐associated osteonecrosis of the jaw. Knowledge and attitudes of dentists and dental students: a preliminary study. J Eval Clin Pract. 2010; 16(5): 878–82.
Yoo J, Park Y, Kwon Y, Kim D, Ohe J. Survey of Korean dentists on the awareness on bisphosphonate‐related osteonecrosis of the jaws. J Investig Clin Dent. 2010; 1(2): 90–5.
El Osta L, El Osta B, Lakiss S, Hennequin M, El Osta N. Bisphosphonate-related osteonecrosis of the jaw: awareness and level of knowledge of Lebanese physicians. Support Care Cancer. 2015; 23(9): 2825–31.
Al-Mohaya MA, Al-Khashan HI, Mishriky AM, Al-Otaibi LM. Physicians’ awareness of bisphosphonates-related osteonecrosis of the jaw. Saudi Med J. 2011; 32(8): 830–5.
McLeod NMH, Davies BJB, Brennan PA. Management of patients at risk of bisphosphonate osteonecrosis in maxillofacial surgery units in the UK. Surg. 2009; 7(1): 18–23.