Turkiye Klinikleri Journal of Dental Sciences

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Antirezorptif İlaç Reçete Eden Tıp Hekimlerinin MRONJ Yaklaşımı
MRONJ Approach of Medical Doctors Who Prescribing Antiresorptive Drug
Gamze ŞENOLa , İpek Necla GÜLDİKEN b , Muazzez SUZEN a , Hayrunisa KOÇYİĞİTc, Çağrı DELİLBAŞI c
aMedipol Mega Üniversite Hastanesi, Ağız, Diş ve Çene Cerrahisi ABD, İstanbul, TÜRKİYE
bMedipol Esenler Üniversite Hastanesi, Ağız, Diş ve Çene Cerrahisi ABD, İstanbul, TÜRKİYE
cMedipol Unkapanı Üniversite Hastanesi, Ağız, Diş ve Çene Cerrahisi ABD, İstanbul, TÜRKİYE
Turkiye Klinikleri J Dental Sci. 2021;27(2):168-77
doi: 10.5336/dentalsci.2020-75321
Article Language: TR
Full Text
ÖZET
 Amaç: Diş çekimi gibi çene üzerinde cerrahi işlem uygulandığında, kemik iyileşmesinin bozulmasıyla çenenin bifosfonat ilişkili nekrozu meydana gelebilir. Bifosfonat kullanan hasta sayısının her geçen gün artması ve çenelerin ilaçlara bağlı gelişen osteonekrozu (MRONJ) olgularındaki yükseliş, hekimlerin bu komplikasyonla karşılaşma ihtimalîni artırmaktadır. Hekimler, diş hekimleri ve hastalar tarafından MRONJ farkındalığı; erken teşhis, tedavi ve önlenmesi açısından önemlidir. Bu çalışmada, antirezorptif ve antianjiyojenik ilaçları reçete eden tıp doktorlarının, ciddi bir komplikasyon olan MRONJ ile ilgili farkındalıklarını ve yaklaşımlarını değerlendirmek amaçlanmıştır. Gereç ve Yöntemler: Araştırmaya bazı üniversite hastaneleri, eğitim ve araştırma hastaneleri ve özel sağlık kurumlarında çalışan; ortopedi, dahiliye, romatoloji, fizik tedavi ve rehabilitasyon ve onkoloji uzmanları dâhil edilmiştir. Katılan hekimlere, bifosfonatlar ve MRONJ hakkındaki bilgileri, tedavi sürecindeki yaklaşımları ile ilgili 15 sorudan oluşan bir anket formunu yanıtlamaları istenmiştir. Bulgular: Çalışmaya katılan hekimlerin %46'sı asistan, %54'ü uzman doktordur. Hekimlerin %74'ü bu ilaçları osteoporoz tedavisi için reçete ederken, %47'si alendronatı tercih ettiklerini belirtmişlerdir. Hekimlerin %21'i tedavi öncesi dental muayeneyi önerirken, %51'i dental tedaviyi hastanın şikâyeti olduğunda önerdiğini bildirmiştir. Hekimlerin %22'si bifosfonat grubu MRONJ ile karşılaştığını bildirmiştir. Ayrıca hekimlerin uzmanlık alanları arasında, bifosfonata bağlı çene nekrozu hakkında bilgi durumu dağılım oranları açısından istatistiksel olarak anlamlı farklılık bulunmaktadır. Bununla beraber hekimlerin %16'sı bifosfonat grubu ilaç kullanımına bağlı çene nekrozu hakkında bilgisinin olmadığını bildirmiştir. Sonuç: Bifosfonat grubu ilaçları reçete eden tıp hekimlerinin, çenelerde gelişen MRONJ hakkındaki farkındalıklarının artması için bifosfonatlar ve MRONJ ile ilgili eğitim stratejileri oluşturulmalıdır.

Anahtar Kelimeler: MRONJ; BRONJ; anket; farkındalık
ABSTRACT
 Objective: The number of patients using bisphosphonates is increasing day by day and the increase in medication-related osteonecrosis of the jaw (MRONJ) cases increases the possibility of physicians to encounter this complication. In this study, it is aimed to evaluate the awareness and approaches of medical doctors who prescribe antiresorptive and antiangiogenic drugs about MRONJ, which is a serious complication. Material and Methods: Some researchers working in university hospitals, education and research hospitals and private health institutions; orthopedics, internal medicine, rheumatology, physical therapy-rehabilitation and oncology specialists are included in this study. To the attending physicians; they were asked to answer a questionnaire consisting of 15 questions about their knowledge about bisphosphonates and MRONJ and their approach to the treatment process. Results: Fourty six percent of the physicians participating in the study were residents and 54% were specialists. Seventy four percent of the physicians prescribed these drugs for osteoporosis treatment, while 47% preferred alendronate. While 21% of the physicians recommended dental examination before treatment, 51% reported that they recommended dental treatment when the patient complained. 22% of physicians reported that they encountered jaw necrosis due to drug use in the bisphosphonate group. In addition, there is a statistically significant difference between the specialties of the physicians in terms of knowledge distribution of jaw necrosis due to bisphosphonate. However, 16% of physicians reported that they did not know about chin necrosis related to the use of bisphosphonate drugs. Conclusion: Training strategies about bisphosphonates and MRONJ should be developed in order to increase the awareness of the physicians who prescribe bisphosphonate group drugs about the developing MRONJ.

Keywords: MRONJ; BRONJ; questionnaire; awarness
REFERENCES:
  1. Allen MR, Burr DB. Bisphosphonate effects on bone turnover, microdamage, and mechanical properties: what we think we know and what we know that we don't know. Bone. 2011;49(1):56-65. [Crossref] [PubMed] 
  2. Marx RE. Oral and Intravenous Bisphosphonate-Induced Osteonecrosis of the Jaws. 2nd ed. Quintessence Publishing; 2007. [Link] 
  3. Migliorati CA, Casiglia J, Epstein J, Jacobsen PL, Siegel MA, Woo SB, et al. Managing the care of patients with bisphosphonate-associated osteonecrosis: an American Academy of Oral Medicine position paper. J Am Dent Assoc. 2005;136(12):1658-68. Erratum in: J Am Dent Assoc. 2006;137(1):26. [Crossref] [PubMed] 
  4. 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. [Crossref] [PubMed] 
  5. Dimitrakopoulos I, Magopoulos C, Karakasis D. Bisphosphonate-induced avascular osteonecrosis of the jaws: a clinical report of 11 cases. Int J Oral Maxillofac Surg. 2006;35(7):588-93. [Crossref] [PubMed] 
  6. Advisory Task Force on Bisphosphonate-Related Ostenonecrosis of the Jaws, American Association of Oral and Maxillofacial Surgeons. American Association of Oral and Maxillofacial Surgeons position paper on bisphosphonate-related osteonecrosis of the jaws. J Oral Maxillofac Surg. 2007;65(3):369-76. [Crossref] [PubMed] 
  7. Ruggiero SL, Dodson TB, Assael LA, Landesberg R, Marx RE, Mehrotra B, et al; American Association of Oral and Maxillofacial Surgeons. American Association of Oral and Maxillofacial Surgeons position paper on bisphosphonate-related osteonecrosis of the jaws--2009 update. J Oral Maxillofac Surg. 2009;67(5 Suppl):2-12. [Crossref] [PubMed] 
  8. Ruggiero SL, Dodson TB, Fantasia J, Goodday R, Aghaloo T, Mehrotra B, et al; American Association of Oral and Maxillofacial Surgeons. 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. Erratum in: J Oral Maxillofac Surg. 2015;73(7):1440. Erratum in: J Oral Maxillofac Surg. 2015;73(9):1879. [Crossref] [PubMed] 
  9. Gross C, Weber M, Creutzburg K, Möbius P, Preidl R, Amann K, et al. Osteoclast profile of medication-related osteonecrosis of the jaw secondary to bisphosphonate therapy: a comparison with osteoradionecrosis and osteomyelitis. J Transl Med. 2017;6;15(1):128. [Crossref] [PubMed] [PMC] 
  10. 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. [Crossref] [PubMed] 
  11. Benford HL, McGowan NW, Helfrich MH, Nuttall ME, Rogers MJ. Visualization of bisphosphonate-induced caspase-3 activity in apoptotic osteoclasts in vitro. Bone. 2001;28(5):465-73. [Crossref] [PubMed] 
  12. Fan TM. Intravenous aminobisphosphonates for managing complications of malignant osteolysis in companion animals. Top Companion Anim Med. 2009;24(3):151-6. [Crossref] [PubMed] 
  13. Ruggiero SL, Woo SB. Biophosphonate-related osteonecrosis of the jaws. Dent Clin North Am. 2008;52(1):111-28. [Crossref] [PubMed] 
  14. Russell RG. Bisphosphonates: the first 40 years. Bone. 2011;49(1):2-19. [Crossref] [PubMed] 
  15. Kyrgidis A, Verrou E. Fatigue in bone: a novel phenomenon attributable to bisphosphonate use. Bone. 2010;46(2):556-8. [Crossref] [PubMed] 
  16. Reid IR, Cornish J. Epidemiology and pathogenesis of osteonecrosis of the jaw. Nat Rev Rheumatol. 201129;8(2):90-6. [Crossref] [PubMed] 
  17. Kim JW, Jeong SR, Kim SJ, Kim Y. Perceptions of medical doctors on bisphosphonate-related osteonecrosis of the jaw. BMC Oral Health. 2016;7;16(1):92. [Crossref] [PubMed] [PMC] 
  18. Khosla S, Burr D, Cauley J, Dempster DW, Ebeling PR, Felsenberg D, et al; American Society for Bone and Mineral Research. Bisphosphonate-associated osteonecrosis of the jaw: report of a task force of the American Society for Bone and Mineral Research. J Bone Miner Res. 2007;22(10):1479-91. [Crossref] [PubMed] 
  19. Lam DK, Sándor GK, Holmes HI, Evans AW, Clokie CM. A review of bisphosphonate-associated osteonecrosis of the jaws and its management. J Can Dent Assoc. 2007;73(5):417-22. [PubMed] 
  20. Khan AA, Morrison A, Hanley DA, Felsenberg D, McCauley LK, O'Ryan F,et al; International Task Force on Osteonecrosis of the Jaw. Diagnosis and management of osteonecrosis of the jaw: a systematic review and international consensus. J Bone Miner Res. 2015;30(1):3-23. [Crossref] [PubMed] 
  21. Bagán J, Blade J, Cozar JM, Constela M, García Sanz R, Gómez Veiga F, et al. Recommendations for the prevention, diagnosis, and treatment of osteonecrosis of the jaw (ONJ) in cancer patients treated with bisphosphonates. Med Oral Patol Oral Cir Bucal. 2007;1;12(4):E336-40. [PubMed] 
  22. Vahtsevanos K, Kyrgidis A, Verrou E, Katodritou E, Triaridis S, Andreadis CG, et al. Longitudinal cohort study of risk factors in cancer patients of bisphosphonate-related osteonecrosis of the jaw. J Clin Oncol. 2009;10;27(32):5356-62. [Crossref] [PubMed] 
  23. Saad F, Brown JE, Van Poznak C, Ibrahim T, Stemmer SM, Stopeck AT, et al. Diel IJ, Incidence, risk factors, and outcomes of osteonecrosis of the jaw: integrated analysis from three blinded active-controlled phase III trials in cancer patients with bone metastases. Ann Oncol. 2012;23(5):1341-7. [Crossref] [PubMed] 
  24. Fehm T, Beck V, Banys M, Lipp HP, Hairass M, Reinert S, et al. Bisphosphonate-induced osteonecrosis of the jaw (ONJ): incidence and risk factors in patients with breast cancer and gynecological malignancies. Gynecol Oncol. 2009;112(3):605-9. [Crossref] [PubMed] 
  25. Senturk MF, Cimen E, Tuzuner Oncul AM, Cambazoglu M. Oncologists awareness about bisphosphonate related osteonecrosis of the jaws. J Pak Med Assoc. 2016;66(7):880-3. [PubMed] 
  26. Dickinson M, Prince HM, Kirsa S, Zannettino A, Gibbs SD, Mileshkin L, et al. Osteonecrosis of the jaw complicating bisphosphonate treatment for bone disease in multiple myeloma: an overview with recommendations for prevention and treatment. Intern Med J. 2009;39(5):304-16. [Crossref] [PubMed] 
  27. Kwon YD, Kim YR, Choi BJ, Lee DW, Kim DY. Oral bisphosphonate-related osteonecrosis of the jaws: favorable outcome after bisphosphonate holiday. Quintessence Int. 2009;40(4):277-8. [PubMed] 
  28. Vescovi P, Merigo E, Meleti M, Manfredi M, Guidotti R, Nammour S, et al. Bisphosphonates-related osteonecrosis of the jaws: a concise review of the literature and a report of a single-centre experience with 151 patients. J Oral Pathol Med. 2012;41(3):214-21. [Crossref] [PubMed] 
  29. Patel V, McLeod NM, Rogers SN, Brennan PA. Bisphosphonate osteonecrosis of the jaw--a literature review of UK policies versus international policies on bisphosphonates, risk factors and prevention. Br J Oral Maxillofac Surg. 2011;49(4):251-7. [Crossref] [PubMed] 
  30. García-Martínez L, Martín-Payo R, Pelaz-García A, Sierra-Vega M, Junquera-Gutiérrez LM. Intervention to improve awareness of the risk factors for osteonecrosis of the jaw in patients under treatment with bisphosponates. Randomised clinical trial. Enferm Clin. 2017;27(6):352-60. [Crossref] [PubMed] 
  31. 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. [Crossref] [PubMed] 
  32. 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. [Crossref] [PubMed] 
  33. Mah YJ, Kang GY, Kim SJ. Survey on awareness and perceptions of bisphosphonate-related osteonecrosis of the jaw in dental hygienists in Seoul. Int J Dent Hyg. 2015;13(3):222-7. [Crossref] [PubMed] 
  34. Yoo JY, Park YD, Kwon YD, Kim DY, Ohe JY. Survey of Korean dentists on the awareness on bisphosphonate-related osteonecrosis of the jaws. J Investig Clin Dent. 2010;1(2):90-5. [Crossref] [PubMed] 
  35. Park YD, Kim YR, Kim DY, Chung YS, Lee JK, Kim YG, et al. Awareness of Korean dentists on bisphosphonate related osteonecrosis of the jaws: preliminary report. J Korean Assoc Oral Maxillofac Surg. 2009;35(3):153-7. [Link] 
  36. McLeod NM, Brennan PA, Ruggiero SL. Bisphosphonate osteonecrosis of the jaw: a historical and contemporary review. Surgeon. 2012;10(1):36-42. [Crossref] [PubMed] 

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