비스포스포네이트 관련 악골괴사환자의 혈청 C-terminal cross linking telopeptide 수치에 따른 위험도 평가와 질환의 심도 및 조기 수술 후 치유 사이의 상관관계
Clinical study of correlation between C-terminal cross-linking telopeptide of type I collagen and risk assessment, severity of disease, healing after early surgical intervention in patients with bisphophonate-related osteonecrosis of the jaws
송진우, 김기현, 송재민, 전병도, 김용덕, 김욱규, 신상훈,
소속 상세정보
송진우 ( Song Jin-Woo ) - 부산대학교 치의학전문대학원 구강악안면외과학교실
김기현 ( Kim Ki-Hyun ) - 부산대학교 치의학전문대학원 구강악안면외과학교실
송재민 ( Song Jae-Min ) - 부산대학교 치의학전문대학원 구강악안면외과학교실
전병도 ( Chun Byung-Do ) - 부산대학교 치의학전문대학원 구강악안면외과학교실
김용덕 ( Kim Yong-Deok ) - 부산대학교 치의학전문대학원 구강악안면외과학교실
김욱규 ( Kim Uk-Kyu ) - 부산대학교 치의학전문대학원 구강악안면외과학교실
신상훈 ( Shin Sang-Hun ) - 부산대학교 치의학전문대학원 구강악안면외과학교실
KMID : 0355620110370010001
Abstract
Introduction: The utility of the C-terminal cross-linking telopeptide test (CTX) as a method for staging Bisphosphonate-related osteonecrosis of the jaws (BRONJ) and its healing process was examined.
Materials and Methods : A total 19 patients who were diagnosed with BRONJ underwent a fasted morning CTX test, were enrolled in this study. The serum CTX values ranged from 50 to 630 pg/mL (mean 60). The risk assessment was rated according to the CTX values of the individual patient (minimal risk, ≥150 pg/mL, moderate, 100 to 150 pg/mL, high, ≤100 pg/mL). The BRONJ scores were then calculated according to the number of BRONJ lesions and their stage. The operation was done as soon as possible, regardless of BORNJ stage.
Results: The mean duration of bisphosphonate therapy was 4.1 years. Of the 19 patients, 15, 2 ans 2 received alendronate, risedronate and zoledronate, respecively. Of the 19 patients who underwent a sequestrectomy, saucerization and smoothing, 15 healed after the initial surgery, 1 patient healed after one more surgical procedure, 3 patients did not heal completely but showed improvement in symptoms. Therefore, 17 out of the 19 patients healed completely with complete mucosal coverage and the elimination of pain. The risk assessment using the CTX value and disease severity were not correlated (r=-0.264, P=0.275). In addition, the risk assessment using CTX value and healing after surgery were not correlated (r=-0.147, P=0.547).
Conclusion: The serum CTX should be considered carefully by clinicians as part of overall management. Early surgical intervention is of benefit in
the treatment of stage II BRONJ.
키워드
Bisphosphonates; Osteonecrosis; Bisphosphonate-related osteonecrosis of the jaws (BRONJ); Jaw diseases; Collagen type I trimeric
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