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Publication
Osteonecrose dos maxilares provocada por terapia medicamentosa
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Advisor(s)
Abstract(s)
A Osteonecrose dos maxilares associada ao uso de medicamentos (MRONJ) é uma
entidade clínica que resulta mais frequentemente do uso de fármacos anti-reabsortivos tais como os bifosfonatos e o denosumab, bem como de fármacos antiangiogénicos.
O diagnóstico de MRONJ compreende alguns critérios, tais como, ter sido sujeito a
alguma terapêutica mencionada anteriormente, a existência de uma exposição óssea há́ mais de 8 semanas com presença de fistula intra ou extra oral com o mesmo tempo de duração, finalmente, que este não tenha sido sujeito a radioterapia na região da cabeça e pescoço e que se confirme a ausência de metástases ósseas na região maxilar.
Nos dias de hoje, a sua etiopatogenia não é completamente compreendida, porém,
considera-se que inúmeros fatores de risco estejam associados ao seu desenvolvimento. O seu diagnóstico é fundamentalmente clínico, no entanto, exames complementares de diagnostico são a chave para um diagnóstico mais fidedigno.
A MRONJ é classificada em estadios, variando de 0 a 3, que dependem da apresentação da patologia. Quando as formas de prevenção falham, devem então ser implementados tratamentos específicos adequados a cada caso.
Assim sendo, o objetivo da presente revisão é o de rever as diferentes classes de agentes anti-reabsortivos, as suas indicações, os seus modos de ação, rever os mecanismos propostos na fisiopatologia do desenvolvimento da osteonecrose, sinais e sintomas, fatores de risco, estadios e analisar as diferentes formas de prevenção assim como os tratamentos.
Medication-related osteonecrosis of the jaw (MRONJ) is a clinical entity that arises most frequently from the use of antiresorptive drugs, such as bisphosphonates and denosumab, and antiangiogenic drugs. The diagnosis of MRONJ comprises a list of criteria, such as having been subjected to one of the therapies previously mentioned, the existence of bone exposure for more than 8 weeks with the presence of an intra- or extraoral fistula for the same period of time, and finally, that the patient has not been subjected to radiotherapy in the head and neck region with confirmed absence of bone metastasis in the jaw region. Nowadays, its etiopathogenesis is not fully understood, although innumerous risk factors are considered to be associated with its development. Its diagnosis is often clinical, however complementary exams are essential for a reliable diagnosis. MRONJ is divided in stages, from 0 to 3, that depend on the pathology presentation. When prevention strategies fail, it is necessary to implement specific treatments suitable to each case. Therefore, the point of this review is to reassess the different classes of antiresorptive agents, their indications and modes of action, to examine the suggested mechanisms for the pathophysiology of the development of the osteonecrosis, its signals and symptoms, risk factors, staging, and analyze its prevention and treatment
Medication-related osteonecrosis of the jaw (MRONJ) is a clinical entity that arises most frequently from the use of antiresorptive drugs, such as bisphosphonates and denosumab, and antiangiogenic drugs. The diagnosis of MRONJ comprises a list of criteria, such as having been subjected to one of the therapies previously mentioned, the existence of bone exposure for more than 8 weeks with the presence of an intra- or extraoral fistula for the same period of time, and finally, that the patient has not been subjected to radiotherapy in the head and neck region with confirmed absence of bone metastasis in the jaw region. Nowadays, its etiopathogenesis is not fully understood, although innumerous risk factors are considered to be associated with its development. Its diagnosis is often clinical, however complementary exams are essential for a reliable diagnosis. MRONJ is divided in stages, from 0 to 3, that depend on the pathology presentation. When prevention strategies fail, it is necessary to implement specific treatments suitable to each case. Therefore, the point of this review is to reassess the different classes of antiresorptive agents, their indications and modes of action, to examine the suggested mechanisms for the pathophysiology of the development of the osteonecrosis, its signals and symptoms, risk factors, staging, and analyze its prevention and treatment
Description
Dissertação para obtenção do grau de Mestre no Instituto Universitário Egas Moniz
Keywords
Osteonecrose Mandíbula MRONJ BRONJ Bifosfonatos e Denosumab