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| DC 欄位 | 值 | 語言 |
|---|---|---|
| dc.contributor.advisor | 李正喆 | zh_TW |
| dc.contributor.advisor | Jang-Jaer Lee | en |
| dc.contributor.author | 鄭宜文 | zh_TW |
| dc.contributor.author | YI-WEN CHENG | en |
| dc.date.accessioned | 2024-08-21T16:21:34Z | - |
| dc.date.available | 2024-08-22 | - |
| dc.date.copyright | 2024-08-21 | - |
| dc.date.issued | 2024 | - |
| dc.date.submitted | 2024-08-10 | - |
| dc.identifier.citation | Aghaloo, T., Hazboun, R., & Tetradis, S. (2015). Pathophysiology of Osteonecrosis of the Jaws. Oral Maxillofac Surg Clin North Am, 27(4), 489-496. doi:10.1016/j.coms.2015.06.001
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(2008). Frequency and risk factors associated with osteonecrosis of the jaw in cancer patients treated with intravenous bisphosphonates. J Bone Miner Res, 23(6), 826-836. doi:10.1359/jbmr.080205 Ishimaru M, Ono S, Morita K, Matsui H, Hagiwara Y, Yasunaga H. Prevalence, Incidence Rate, and Risk Factors of Medication-Related Osteonecrosis of the Jaw in Patients With Osteoporosis and Cancer: A Nationwide Population-Based Study in Japan. J Oral Maxillofac Surg. 2022 Apr;80(4):714-727. doi: 10.1016/j.joms.2021.12.007 Kalita F, Gupta DS, Gehlot N, Mitra S, Singh S, Pillai SS. Osteonecrosis of the Jaws: An Update and Review of Literature. J Maxillofac Oral Surg. 2023 Jun;22(2):344-351. doi: 10.1007/s12663-023-01876-w. Khan, A. A., Morrison, A., Hanley, D. A., Felsenberg, D., McCauley, L. K., O'Ryan, F., . . . Compston, J. (2015). Diagnosis and management of osteonecrosis of the jaw: a systematic review and international consensus. J Bone Miner Res, 30(1), 3-23. doi:10.1002/jbmr.2405 Kunchur, R., Need, A., Hughes, T., & Goss, A. (2009). Clinical investigation of C-terminal cross-linking telopeptide test in prevention and management of bisphosphonate-associated osteonecrosis of the jaws. J Oral Maxillofac Surg, 67(6), 1167-1173. doi:10.1016/j.joms.2009.02.004 Kwon, Y. D., Kim, D. Y., Ohe, J. Y., Yoo, J. Y., & Walter, C. (2009). Correlation between serum C-terminal cross-linking telopeptide of type I collagen and staging of oral bisphosphonate-related osteonecrosis of the jaws. J Oral Maxillofac Surg, 67(12), 2644-2648. doi:10.1016/j.joms.2009.04.067 Landesberg, R., Cozin, M., Cremers, S., Woo, V., Kousteni, S., Sinha, S., . . . Raghavan, S. (2008). Inhibition of oral mucosal cell wound healing by bisphosphonates. J Oral Maxillofac Surg, 66(5), 839-847. doi:10.1016/j.joms.2008.01.026 Lazarovici, T. S., Mesilaty-Gross, S., Vered, I., Pariente, C., Kanety, H., Givol, N., . . . Yarom, N. (2010). Serologic bone markers for predicting development of osteonecrosis of the jaw in patients receiving bisphosphonates. J Oral Maxillofac Surg, 68(9), 2241-2247. doi:10.1016/j.joms.2010.05.043 Lorenzo-Pouso, A. I., Pérez-Sayáns, M., Chamorro-Petronacci, C., Gándara-Vila, P., López-Jornet, P., Carballo, J., & García-García, A. (2020). Association between periodontitis and medication-related osteonecrosis of the jaw: A systematic review and meta-analysis. J Oral Pathol Med, 49(3), 190-200. doi:10.1111/jop.12963 Manfredi, M., Mergoni, G., Goldoni, M., Salvagni, S., Merigo, E., Meleti, M., & Vescovi, P. (2017). A 5-year retrospective longitudinal study on the incidence and the risk factors of osteonecrosis of the jaws in patients treated with zoledronic acid for bone metastases from solid tumors. Med Oral Patol Oral Cir Bucal, 22(3), e342-e348. doi:10.4317/medoral.21728 Manolagas, S. C. (2000). Birth and death of bone cells: basic regulatory mechanisms and implications for the pathogenesis and treatment of osteoporosis. Endocr Rev, 21(2), 115-137. doi:10.1210/edrv.21.2.0395 Marx, R. E., Cillo, J. E., Jr., & Ulloa, J. J. (2007). Oral bisphosphonate-induced osteonecrosis: risk factors, prediction of risk using serum CTX testing, prevention, and treatment. J Oral Maxillofac Surg, 65(12), 2397-2410. doi:10.1016/j.joms.2007.08.003 McClung, M. R. (2013). Chapter 83 - Denosumab for the Treatment of Osteoporosis. In R. Marcus, D. Feldman, D. W. Dempster, M. Luckey, & J. A. Cauley (Eds.), Osteoporosis (Fourth Edition) (pp. 1923-1934). San Diego: Academic Press. McGowan, K., McGowan, T., & Ivanovski, S. (2018). Risk factors for medication-related osteonecrosis of the jaws: A systematic review. Oral Dis, 24(4), 527-536. doi:10.1111/odi.12708 Migliorati, C. A. (2003). Bisphosphanates and oral cavity avascular bone necrosis. J Clin Oncol, 21(22), 4253-4254. doi:10.1200/jco.2003.99.132 Osteoporosis prevention, diagnosis, and therapy. (2001). Jama, 285(6), 785-795. doi:10.1001/jama.285.6.785 Qvist, P., Christgau, S., Pedersen, B. J., Schlemmer, A., & Christiansen, C. (2002). Circadian variation in the serum concentration of C-terminal telopeptide of type I collagen (serum CTX): effects of gender, age, menopausal status, posture, daylight, serum cortisol, and fasting. Bone, 31(1), 57-61. doi:10.1016/s8756-3282(02)00791-3 Raisz, L. G., & Seeman, E. (2001). Causes of age-related bone loss and bone fragility: an alternative view. J Bone Miner Res, 16(11), 1948-1952. doi:10.1359/jbmr.2001.16.11.1948 Rosen, H. N., Moses, A. C., Garber, J., Iloputaife, I. D., Ross, D. S., Lee, S. L., & Greenspan, S. L. (2000). Serum CTX: a new marker of bone resorption that shows treatment effect more often than other markers because of low coefficient of variability and large changes with bisphosphonate therapy. Calcif Tissue Int, 66(2), 100-103. doi:10.1007/pl00005830 Ruggiero, S. L., Dodson, T. B., Aghaloo, T., Carlson, E. R., Ward, B. B., & Kademani, D. (2022). American Association of Oral and Maxillofacial Surgeons' Position Paper on Medication-Related Osteonecrosis of the Jaws-2022 Update. J Oral Maxillofac Surg, 80(5), 920-943. doi:10.1016/j.joms.2022.02.008 Ruggiero, S. L., Dodson, T. B., Fantasia, J., Goodday, R., Aghaloo, T., Mehrotra, B., & O'Ryan, F. (2014). American Association of Oral and Maxillofacial Surgeons position paper on medication-related osteonecrosis of the jaw--2014 update. J Oral Maxillofac Surg, 72(10), 1938-1956. doi:10.1016/j.joms.2014.04.031 Saia, G., Blandamura, S., Bettini, G., Tronchet, A., Totola, A., Bedogni, G., . . . Bedogni, A. (2010). Occurrence of bisphosphonate-related osteonecrosis of the jaw after surgical tooth extraction. J Oral Maxillofac Surg, 68(4), 797-804. doi:10.1016/j.joms.2009.10.026 Schwech, N., Nilsson, J., & Gabre, P. (2023). Incidence and risk factors for medication-related osteonecrosis after tooth extraction in cancer patients-A systematic review. Clin Exp Dent Res, 9(1), 55-65. doi:10.1002/cre2.698 Soutome, S., Hayashida, S., Funahara, M., Sakamoto, Y., Kojima, Y., Yanamoto, S., & Umeda, M. (2018). Factors affecting development of medication-related osteonecrosis of the jaw in cancer patients receiving high-dose bisphosphonate or denosumab therapy: Is tooth extraction a risk factor? PLoS One, 13(7), e0201343. doi:10.1371/journal.pone.0201343 Sözen, T., Özışık, L., & Başaran, N. (2017). An overview and management of osteoporosis. Eur J Rheumatol, 4(1), 46-56. doi:10.5152/eurjrheum.2016.048 Steiniche, T. (1995). Bone histomorphometry in the pathophysiological evaluation of primary and secondary osteoporosis and various treatment modalities. APMIS Suppl, 51, 1-44. Wang X, Yang KH, Wanyan P, Tian JH. Comparison of the efficacy and safety of denosumab versus bisphosphonates in breast cancer and bone metastases treatment: A meta-analysis of randomized controlled trials. Oncol Lett. 7: 1997, 2014. Walter, C., Al-Nawas, B., Grötz, K. A., Thomas, C., Thüroff, J. W., Zinser, V., . . . Wagner, W. (2008). Prevalence and risk factors of bisphosphonate-associated osteonecrosis of the jaw in prostate cancer patients with advanced disease treated with zoledronate. Eur Urol, 54(5), 1066-1072. doi:10.1016/j.eururo.2008.06.070 Wright, N. C., Looker, A. C., Saag, K. G., Curtis, J. R., Delzell, E. S., Randall, S., & Dawson-Hughes, B. (2014). The recent prevalence of osteoporosis and low bone mass in the United States based on bone mineral density at the femoral neck or lumbar spine. J Bone Miner Res, 29(11), 2520-2526. doi:10.1002/jbmr.2269 Yamazaki, T., Yamori, M., Ishizaki, T., Asai, K., Goto, K., Takahashi, K., . . . Bessho, K. (2012). Increased incidence of osteonecrosis of the jaw after tooth extraction in patients treated with bisphosphonates: a cohort study. Int J Oral Maxillofac Surg, 41(11), 1397-1403. doi:10.1016/j.ijom.2012.06.020 | - |
| dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/94899 | - |
| dc.description.abstract | 目的：骨質疏鬆症患者常使用抗骨吸收藥物防止骨質流失，而抗骨吸收藥物最令人注意之後遺症為藥物相關顎骨壞死。此研究為一回溯性病例對照研究，旨在研究接受抗骨吸收藥物治療後接受拔牙的骨質疏鬆症患者與藥物相關顎骨壞死產生的相關危險因子。
材料與方法：收集了自 2003 年 1 月至 2022 年 5 月期間的 937 名患者，共計 1,067 次拔牙的數據，其中519名患者接受每週口服一次Alendronate(Fosamax®)治療，276名患者接受每6個月Denosumab(Prolia®)皮下治療，172名患者接受每年Zoledronic acid(Aclasta®)靜脈注射治療。採用單變數及多變數羅吉斯迴歸模型分析來評估潛在的危險因子。 結果：依據羅吉斯多變數迴歸模型顯示年齡較大（AOR=1.09/年；95% CI=1.06-1.12；P value<0.001）和藥物治療超過24個月（AOR=2.07；95% CI =1.29-3.30；P value=0.002）是顯著的危險因子。拔牙前中斷藥物3個月或以上可降低藥物相關顎骨壞死風險（AOR=0.11；95% CI=0.07-0.17；P value< 0.001）。依藥物類型分類，與使用其他藥物的患者相比，Denosumab使用者在拔牙後發生藥物相關顎骨壞死的風險顯著降低（AOR=0.14；95% CI=0.07-0.27；P value<0.001）。協同作用的統計研究下，藥物持續時間≥24個月、拔牙前停藥<3個月、以及拔牙部位在下顎後牙等因素協同作用下導致藥物相關顎骨壞死風險最高（AOR=80.29；95% CI=33.05-195.09）。 結論：為了降低骨質疏鬆症患者拔牙後藥物相關顎骨壞死產生風險，拔牙前建議至少停藥3個月；在藥物種類方面，使用人類單株抗體Denosumab之骨質疏鬆症患者拔牙後產生顎骨壞死發生率較低，使用雙磷酸鹽類之病人需更加提高警覺。除此之外年紀愈大，拔牙後產生藥物相關顎骨壞死風險愈大，故在使用抗骨吸收藥物前的拔牙評估，越高齡的骨質疏鬆症患者應做更謹慎的治療。 | zh_TW |
| dc.description.abstract | Aim: For osteoporotic patient, anti-resorptive medications are one of the choice to prevent bone loss. This retrospective case-control study aimed to identify the risk factors associated with medication-related osteonecrosis of the jaw in osteoporotic patients receiving dental extraction after using anti-resorptive medications.
Materials and Methods: Data were collected from 937 patients with 1,067 dental extractions conducted between January 2003 and May 2022, including 519 patients on oral alendronate, 276 on denosumab, and 172 on zoledronic acid. Univariate and multivariate regression analysis was employed to assess potential risk factors. Results: Regression model revealed older age (AOR=1.09 per year; 95% CI=1.06-1.12; p value<0.001) and drug treatment exceeding 24 months (AOR=2.07; 95% CI=1.29-3.30; p value=0.002) as significant risk factors. A drug interruption of 3 or more months prior to tooth extraction lowered risk (AOR 0.11; 95% CI=0.07-0.17; p value<0.001). Stratified by drug type, denosumab users had significantly lower risk of after extraction (AOR 0.14; 95% CI, 0.07-0.27; p value<0.001) compared to those on other medications. Synergistically, factors of drug duration ≥24 months, <3 months interruption, and lower posterior tooth extraction posed the highest risk (AOR 80.29; 95% CI=33.05-195.09; p <0.001). Conclusion: Denosumab reveals less risk of MRONJ for osteoporotic patients after tooth extraction. After anti-resorptive medicine is used, an interruption of 3 months before tooth extraction is recommended. For dental evaluation before anti-resorptive therapy for osteoporotic patients, tooth extraction should be considered more actively. | en |
| dc.description.provenance | Submitted by admin ntu (admin@lib.ntu.edu.tw) on 2024-08-21T16:21:33Z No. of bitstreams: 0 | en |
| dc.description.provenance | Made available in DSpace on 2024-08-21T16:21:34Z (GMT). No. of bitstreams: 0 | en |
| dc.description.tableofcontents | 誌謝 ............................................................................................................................................i
中文摘要 ....................................................................................................................................ii 英文摘要 ....................................................................................................................................iii 目次 ……………………………………………………………………………………………iv 表次 ............................................................................................................................................vii 第一章 導論 ...............................................................................................................................1 1.1 骨質疏鬆症疾病介紹..........................................................................................................1 1.1.1 骨質疏鬆症之簡介.............................................................................................................1 1.1.2 骨質疏鬆症之治療.............................................................................................................2 1.1.3 抗骨吸收藥物:雙磷酸鹽類藥物及人類單株抗體............................................................3 1.2 骨質疏鬆症藥物相關顎骨壞死..........................................................................................3 1.2.1 藥物相關顎骨壞死與定義.................................................................................................3 1.2.2 骨質疏鬆症患者藥物相關顎骨壞死之發生率.................................................................5 1.2.3 影響骨質疏鬆症患者藥物相關顎骨壞死之危險因子 .............................................. ....5 1.3 拔牙與口腔手術對顎骨壞死的影響.....................................................................................7 第二章 實驗目的 ........................................................................................................................9 第三章 材料與方法 ..................................................................................................................10 3.1 病人資料來源 .....................................................................................................................10 3.2 臨床評估與資料收集 .........................................................................................................10 3.3 病況追蹤與回診 .................................................................................................................11 3.4 統計分析 .............................................................................................................................11 3.5 名詞定義 .............................................................................................................................11 第四章 實驗結果 ......................................................................................................................12 4.1 樣本臨床資料統計 .............................................................................................................12 4.2 產生藥物相關顎骨壞死與沒有藥物相關顎骨壞死之臨床資料統計差…………………12 4.3 使用Alendronate(Fosamax®)病人拔牙後藥物相關顎骨壞死危險因子之單變數及多變數分析…………………………………………………………………………………………………16 4.3.1使用Alendronate(Fosamax®)病人拔牙後藥物相關顎骨壞死危險因子之單變數分析…..16 4.3.2使用Alendronate(Fosamax®)病人拔牙後藥物相關顎骨壞死危險因子之多變數分析…..17 4.4 使用Denosumab(Prolia®)病人拔牙後藥物相關顎骨壞死危險因子之單變數及多變數分析.17 4.4.1使用Denosumab(Prolia®)病人拔牙後藥物相關顎骨壞死危險因子之單變數分析………17 4.4.2使用Denosumab(Prolia®)病人拔牙後藥物相關顎骨壞死危險因子之多變數分析………17 4.5 使用Zoledronic acid(Aclasta®)病人拔牙後藥物相關顎骨壞死危險因子之單變數及多變數分析…………………………………………………………………………………………………18 4.5.1使用Zoledronic acid(Aclasta®)病人拔牙後藥物相關顎骨壞死危險因子之單變數分析…18 4.5.2使用Zoledronic acid(Aclasta®)病人拔牙後藥物相關顎骨壞死危險因子之多變數分析…18 4.6 整體影響拔牙後產生藥物相關顎骨壞死危險因子單變數及多變數分析………………...19 4.6.1單變數分析…………………………………………………………………………………..19 4.6.2多變數分析…………………………………………………………………………………..20 第五章 討論 ..................................................................................................................................21 5.1使用Alendronate之藥物相關顎骨壞死患者分析討論…. …………………………………...21 5.2使用Denosumab之藥物相關顎骨壞死患者分析討論………………………………………..22 5.3 使用Zoledronic acid之藥物相關顎骨壞死患者分析討論……………………….………….23 5.4 整體相關顎骨壞死患者分析討論………………………………………………………..….23 5.5 本研究之限制及未來應研究改善之方向…………………………………………………...27 第六章 結論………………………………………………………………………………………29 第七章 未來展望…………………………………………………………………………………30 參考文獻…………………………………………………………………………………………...31 | - |
| dc.language.iso | zh_TW | - |
| dc.subject | 藥物相關顎骨壞死 | zh_TW |
| dc.subject | 抗骨吸收藥物 | zh_TW |
| dc.subject | 拔牙 | zh_TW |
| dc.subject | 骨質疏鬆症 | zh_TW |
| dc.subject | 危險因子 | zh_TW |
| dc.subject | MRONJ | en |
| dc.subject | risk factors | en |
| dc.subject | anti-resorptive medication | en |
| dc.subject | tooth extraction | en |
| dc.subject | osteoporosis | en |
| dc.title | 影響骨質疏鬆症患者拔牙後 發生藥物相關性顎骨壞死的危險因子分析 | zh_TW |
| dc.title | Analysis of Risk Factors Affecting Medication-Related Osteonecrosis of the Jaws After Dental Extraction among Osteoporotic Patients | en |
| dc.type | Thesis | - |
| dc.date.schoolyear | 112-2 | - |
| dc.description.degree | 碩士 | - |
| dc.contributor.oralexamcommittee | 郭生興;邱偉益 | zh_TW |
| dc.contributor.oralexamcommittee | SANG-HENG KOK;Wei-Yih Chiu | en |
| dc.subject.keyword | 藥物相關顎骨壞死,骨質疏鬆症,拔牙,抗骨吸收藥物,危險因子, | zh_TW |
| dc.subject.keyword | MRONJ,osteoporosis,tooth extraction,anti-resorptive medication,risk factors, | en |
| dc.relation.page | 36 | - |
| dc.identifier.doi | 10.6342/NTU202404179 | - |
| dc.rights.note | 同意授權(限校園內公開) | - |
| dc.date.accepted | 2024-08-12 | - |
| dc.contributor.author-college | 醫學院 | - |
| dc.contributor.author-dept | 臨床牙醫學研究所 | - |
| dc.date.embargo-lift | 2029-08-10 | - |
| 顯示於系所單位： | 臨床牙醫學研究所 | |
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