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| 題 名 | 雙磷酸鹽類藥物可能引發顎骨壞死不良反應=Biphosphonate Associated Osteonecrosis of the Jaw |
|---|---|
| 作 者 | 洪嘉慧; 鄭繼鳳; 林惜燕; | 書刊名 | 藥學雜誌 |
| 卷 期 | 27:2=107 2011.06[民100.06] |
| 頁 次 | 頁126-131 |
| 分類號 | 418.2183 |
| 關鍵詞 | 雙磷酸鹽類藥物; 顎骨壞死; Biphosphonates; Osteonecrosis of the jaws; ONJ; |
| 語 文 | 中文(Chinese) |
| 中文摘要 | 雙磷酸鹽類 (biphosphonates;簡稱 BPs)藥物臨床上常用於骨質疏鬆、高血鈣及癌症骨轉移的病人。在 2009年美國口腔顎顏面外科學會曾發表雙磷酸鹽類藥物造成的顎骨壞死 (osteonecrosis of the jaws; ONJ)不良反應,發生率在注射劑型約 0.8~12%;在口服劑型較低約為 0.01~0.04%,而且在用藥期間,若有進行侵入性的牙科治療,會使發生顎骨壞死不良反應發生率增加 5~21倍。我們在此報告一例可能因使用此藥引起的顎骨壞死。 一位乳癌且骨轉移的 57歲女性病人,在使用注射型雙磷酸鹽類藥物 (zoledronic acid)達9個月後,而出現慢性骨髓炎、上下顎骨壞死,在牙科前後治療達 16個月,歷經清創術、切除術和抗生素治療,才穩定下來,並長出新骨頭。在回顧病人的病史及用藥史,雖然還有其它危險因子,但是還是比較傾向於是雙磷酸鹽類藥物相關的顎骨壞死。希望藉由此病例報告,能讓更多的病患、照護者、醫療人員更加認識此不良反應,能避免一些危險因子,以維護病人的用藥安全。 |
| 英文摘要 | Biphosphonates are frequently used in osteoporosis, hypercalcemia, and cancer patients with bone metastases. In 2009, the American Association of Oral and Maxillofacial Surgeons had reported that the incidence rate of biphosphonate-associated osteonecrosis of the jaw was about 0.8 to 12% in injection form, and that of oral form biphosphonate was much lower in about 0.01 to 0.04%. During the medication period, the incidence might increase 5 to 21 times if extra invasive dental procedure is implemented concomitantly. We are going to report a patient suspected suffering from the adverse reaction after the use of biphosphonate. A 57 year-old female with breast cancer and bone metastases, after 9 months of zoledronic acid injections, chronic osteomyelitis and jaw bone necrosis were diagnosed. The patient then received continued treatments up to 16 months, including debridement, resections and long-term antibiotic treatment, After 16 months of treatment, the damaged bone stabilized and new bone grew. After reviewing the patient's medical history and medication history, we excluded the possibility of other medications taken by the patient during the suffered period, though there were some other risk factors of diseases left, we still think it would be biphosphonate-related. We hope that this case we report may remind the patients, caregivers and medical staff to reconize this severe but rare adverse reaction.Physicians should evaluate and adjust the risk factors and the benefit of treatment before prescription of biphosphonate, and take actions to protect and ensure the safety of medication use. |
本系統中英文摘要資訊取自各篇刊載內容。