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Abstract：
Purpose Medication-related osteonecrosis of the jaw (MRONJ) is a serious side effect of antiresorptive agents such as bisphosphonates (BPs) and denosumab (DMB). We investigated whether a difference exists between BP- and DMB-related osteonecrosis of the jaw (ONJ). Patients and methods Histological images of 30 patients with BP-related ONJ and 13 patients with DMB-related ONJ were observed using hematoxylin-eosin and cathepsin K staining. Moreover, bone metabolism markers in the blood and bone mineral density were measured in 18 patients with BP-related ONJ and five patients with DMB-related ONJ. Furthermore, we conducted a quantitative analysis of local bone metabolism-related genes using surgical specimens through real-time reverse transcription polymerase chain reaction. Additionally, a retrospective study of 298 patients with MRONJ examined the differences in the characteristics of BP- and DMB-related ONJ and the factors associated with treatment outcomes. Results Histological examination revealed that patients treated with DMB had more severe osteoclast suppression than those treated with BP. No significant difference was observed in blood-bone metabolism markers between the two drugs; however, the suppression of local bone metabolism-related genes was stronger in patients treated with DMB. Clinical studies indicate that DMB-related ONJ is more frequently observed without osteolysis. Conclusion BP-associated ONJ and DMB-associated ONJ were shown to differ slightly. Clinical studies indicate that osteolysis is often unclear in DMB-related ONJ, and methods of bone resection during surgery need to be established.
摘要：
目的与药物相关的颌骨坏死（MRONJ）是抗再吸收剂如二膦酸盐（BP）和denosumab（DMB）的严重副作用。我们调查了BP和DMB相关的颌骨坏死（ONJ）之间是否存在差异。患者和方法采用苏木精-伊红和组织蛋白酶K染色观察30例BP相关ONJ和13例DMB相关ONJ患者的组织学图像。此外，在18例BP相关的ONJ患者和5例DMB相关的ONJ患者中测定了血液中的骨代谢标志物和骨密度.此外，我们使用手术标本通过实时逆转录聚合酶链反应对局部骨代谢相关基因进行了定量分析.此外,一项针对298例MRONJ患者的回顾性研究检查了BP和DMB相关ONJ特征的差异以及与治疗结局相关的因素.结果组织学检查显示，DMB治疗的患者比BP治疗的患者具有更严重的破骨细胞抑制。两种药物之间的血骨代谢标志物没有显着差异；然而，在接受DMB治疗的患者中,局部骨代谢相关基因的抑制更强.临床研究表明，DMB相关的ONJ在没有骨质溶解的情况下更常见。结论BP相关的ONJ和DMB相关的ONJ显示略有不同。临床研究表明，在DMB相关的ONJ中骨质溶解通常不清楚，需要建立手术中骨切除的方法。
