ビスフォスフォネート療法に関連した上顎骨壊死の発症から保存的療法により軽快までを経験した1例

抄録

It has become clear that there is not only BRONJ （bisphosphonates; BPs-related osteonecrosis） but also DRONJ （denosumab-related osteonecrosis）. Both are collectively referred to as ARONJ （antiresorptive agents-related osteonecrosis） in a Japanese position paper published in 2016.
We report a successful case in which we conservatively treated osteonecrosis of the maxilla which had developed in connection with a bisphosphonate intravenous agent that had been administered for multiple myeloma and observed a good course in congenital sequestration.
A 78-year-old woman, who was being treated for multiple myeloma, had been intravenously administered zoledronic acid hydrate totaling 52.8mg over a period of 15 months. With the cooperation of her family, oral hygiene after each meal had been done thoroughly, but 8 months after the discontinuation of her medication, we observed the onset of ARONJ. We continued with the maintenance of good oral hygiene, the administration of antibiotics and once-a-week local cleaning. Nine months after the onset of ARONJ, sequestration occurred. The sequestrum-dropout portion was covered by mucous membrane, and even now we have not observed any spread in new bone exposure or in the perforations. We believe that it is crucial to continue to maintain good oral hygiene, prevent relapse and perform long-term follow-up.