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Rischio di osteonecrosi della mandibola/mascella associata ai bisfosfonati nell’osteoporosi

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L’Endocrinologo Aims and scope

Riassunto

L’osteonecrosi della mandibola (ONJ) è un raro evento avverso in corso di trattamento con bisfosfonati (BP). L’incidenza è estremamente rara tra gli osteoporotici (0,7-1/100.000/pazienti/anno) rispetto ai pazienti oncologici (111%). L’elemento che maggiormente caratterizza il rischio di osteonecrosi da bisfosfonati (ONJBP) è la dose cumulativa dei BP. Essa è particolarmente elevata in oncologia rispetto a quella nell’osteoporosi. Il tipo di BP e la via di somministrazione (rispetto alla dose e alla frequenza) non sembrano per ora elementi determinanti per un maggior rischio di ONJ. Apparentemente i BP per via endovenosa sembrano determinare più frequentemente ONJ. Ciò in realtà è legato al fatto che la formulazione endovenosa è utilizzata prevalentemente ad alte dosi in oncologia. I maggiori fattori di rischio legati al paziente sono la suscettibilià alle infezioni (diabete, immunosoppressione, cortisone), il fumo, l’alcool e l’età (tutti elementi che influenzano la velocità di guarigione delle lesioni orali e predispongono altresì alla parodontosi). Il quadro clinico di esordio della ONJ nell’osteoporosi appare meno esteso, meno grave e più facilmente gestibile dal punto di vista terapeutico.

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Authors and Affiliations

  1. Medicina Interna D, Policlinico GB Rossi, 37134, Verona, Italia

    Francesco Bertoldo

  2. Reumatologia, Dipartimento di Scienze Biomediche e Chirurgiche, Università degli Studi di Verona, Verona, Italia

    Silvano Adami

Authors
  1. Francesco Bertoldo
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  2. Silvano Adami
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Bertoldo, F., Adami, S. Rischio di osteonecrosi della mandibola/mascella associata ai bisfosfonati nell’osteoporosi. L’Endocrinologo 10, 74–80 (2009). https://doi.org/10.1007/BF03344653

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  • DOI: https://doi.org/10.1007/BF03344653

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