porozendoОстеопороз и остеопатииOsteoporosis and Bone Diseases2072-26802311-0716Endocrinology Research Centre10.14341/osteo13135porozendo-13135Research ArticleНаучный обзорReviewОстеонекроз челюсти на антирезорбтивной терапии остеопороза: профилактика, диагностика, ведение пациентаOsteonecrosis of the jaw on antiresorptive therapy of osteoporosis: prevention, diagnosis, patient management.https://orcid.org/0000-0002-0143-0614ЛеснякО. М.LesnyakO. M.

Ольга Михайловна Лесняк, доктор медицинских наук, профессор,  профессор кафедры семейной медицины

Scopus Author ID:: 56769681100Researcher ID: J-5512-2013

190068 г. Санкт-Петербург, ул. Большая Подъяческая, д. 30

Olga M. Lesnyak,  MD, PhD, professor of Family Medicine Departmentntent/view/1640/87/

SCOPUS Author ID: 56769681100Researcher ID: J-5512-2013

30, Bolshaya Pod’yacheskaya street, 190068 St.Petersburg, Russia

olga.m.lesnyak@yandex.ruСеверо-Западный государственный медицинский университет им. И.И. МечниковаРоссияNorthern West State Medical University named after I.I. MechnikovRussian Federation202320042023261412Copyright © Лесняк О.М., 20232023Лесняк О.М.Lesnyak O.M.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.osteo-endojournals.ru/jour/article/view/13135

Проведен анализ современных публикаций, посвященных проблеме медикаментозного остеонекроза челюсти (МОНЧ) у пациентов, получающих антирезорбтивную терапию. Поскольку одним из важнейших факторов риска МОНЧ является доза антирезорбента, это осложнение встречается значительно реже у пациентов с остеопорозом по сравнению с пациентами онкологического профиля. Риск развития МОНЧ после экстракции зуба при приеме бисфосфонатов по поводу остеопороза составляет от 0 до 0,15%, при приеме деносумаба — 1%. Сформулированы основные правила ведения пациента с остеопорозом, получающего антирезорбтивную терапию, с тем, чтобы уменьшить риск развития МОНЧ. К ним относятся консультирование стоматологом перед началом лечения остеопороза, особенно пациентов с высоким риском МОНЧ. Необходимы санация полости рта и проведение инвазивных стоматологических вмешательств до начала антирезорбтивной терапии. В течение всего периода лечения остеопороза необходимо уделять внимание гигиене полости рта и своевременному консервативному лечению возникающих проблем. Пациента также необходимо предупредить о том, что при обращении к стоматологу он должен сообщать о том, что получает лечение остеопороза. Клиницист, занимающийся лечением остеопороза, должен знать признаки МОНЧ и информировать о них пациента. При развитии МОНЧ важно ведение пациента информированным стоматологом/челюстно-лицевым хирургом. При необходимости инвазивного стоматологического вмешательства решение о перерыве в лечении бисфосфонатами следует принимать индивидуально на основе анализа факторов риска МОНЧ и тяжести вмешательства, а при лечении деносумабом — проводить через 3–4 мес после последнего введения деносумаба. В части случаев может оказаться эффективным добавление терипаратида к комплексной терапии МОНЧ, проводимой стоматологом/челюстно-лицевым хирургом.

The analysis of contemporary publications devoted to the problem of medication-related osteonecrosis of the jaw (MRONJ) in patients receiving antiresorptive therapy is carried out. Since one of the most important risk factors for MRONJ is the dosage of the drug, this complication is much less common in patients with osteoporosis compared to cancer patients. The risk of MRONJ after tooth extraction when taking bisphosphonates for osteoporosis ranges from 0 to 0.15%, when taking denosumab — 1%. The basic rules for the management of a patient with osteoporosis receiving antiresorptive therapy in order to reduce the risk of developing MRONJ are formulated. These include consulting with a dentist before starting treatment for osteoporosis, especially in patients with high risk of MRONJ. It is necessary to maintain oral hygiene and perform invasive dental interventions before starting antiresorptive therapy. During the entire period of treatment of osteoporosis, it is necessary to pay attention to oral hygiene and timely conservative treatment of emerging problems. The patient should also be warned that when contacting the dentist, he should inform that he is receiving treatment for osteoporosis. A clinician engaged in the treatment of osteoporosis should know the signs of MRONJ and inform the patient about them. With the development of MRONJ, it is important to guide the patient with an informed dentist / maxillofacial surgeon. If an invasive dental intervention is necessary, the decision to discontinue treatment with bisphosphonates should be taken individually based on an analysis of the risk factors of the MRONJ and the severity of the intervention, and in the case of denosumab treatment, it should be carried out after 3–4 months after the last administration of denosumab. In some cases, it may be effective to add teriparatide to the combined therapy of MRONJ performed by a dentist / maxillofacial surgeon.

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The authors declare that there are no conflicts of interest present.