| Abstract (croatian) | Antiresorptivni lijekovi primjenjuju se u liječenju različitih koštanih stanja i patologija kao što su osteoporoza, stanja povezana s malignim bolestima (maligna hiperkalcemija, patološke frakture), koštane metastaze od solidnih tumora (dojke, prostate, pluća i bubrega), multipli mijelom te razna rjeđa koštana stanja poput Pagetove bolesti, osteomalacije i dr. Među lijekove s antiresorptivnim učinkom ubrajaju se bisfosfonati te denosumab, dok romosozumab uz antiresorptivni ima i osteoanabolički učinak. U antiresorptivne lijekove spadaju i hormonsko nadomjesno liječenje koje se danas relativno rijetko primjenjuje, te SERM-ovi koji trenutno nisu dostupni u Hrvatskoj. Svi ovi lijekovi pokazali su dobar terapeutski učinak na osnovnu bolest ili stanja. Međutim, posljednjih se godina češće susrećemo s nuspojavama u usnoj šupljini kod nekih od njih. Visoko potentni antiresorptivni lijekovi dokazano se nakupljaju na mjestima aktivne remodelacije od kojih je alveolarni greben u čeljusti najizloženiji. To se očituje specifičnom sklerozacijom alveolarnog dijela kosti oko zuba, što može rezultirati smanjenim, otežanim ili čak potpunim odsustvom cijeljenja nakon zahvata u usnoj šupljini. Najteža komplikacija spomenutih lijekova u usnoj šupljini je pojava specifične osteonekroze nazvana medikamentna osteonekroza čeljusti nastala najčešće nakon invazivnih kirurških zahvata poput ekstrakcije zuba. Terapija osteonekroze je nespecifična, komplicirana s nepredvidljivim ishodom. Liječenje i prevencija ove bolesti je multidisciplinarna te zahtijeva suradnju liječnika različitih specijalnosti i pacijenta. |
| Abstract (english) | Antiresorptive drugs are used in the treatment of various bone conditions such as osteoporosis, conditions associated with
malignant diseases (malignant hypercalcemia, pathological fractures), bone metastases from solid tumors (breast, prostate, lung and kidney), multiple myeloma, and rare bone conditions such as Paget's disease, osteomalacia, etc. Drugs with an antiresorptive effect include bisphosphonates and denosumab, while romosozumab has an antiresorptive and osteoanabolic effect. Hormonal replacement therapy and SERMs are also antiresorptive drugs, but their usage is rare today. SERMs, for example, is currently unavailable in Croatia. All of these drugs have shown a high therapeutic effect
on the underlying disease or condition, however, in recent years, there are increasing amounts of side effects of certain drug classes in the oral cavity. Highly potent antiresorptive drugs are proven to accumulate in places of active remodeling, of which the alveolar ridge of the jaw bone is the most exposed. This results in specific sclerosing of the alveolar bone around the tooth, which can cause reduced, difficult or even complete absence of healing after dental procedures in the oral cavity. The most serious complication of the mentioned drugs in the oral cavity is the occurrence of a specific osteonecrosis called “medication-related osteonecrosis of the jaw”. Therapy for osteonecrosis is non-specific, complicated, and with an unpredictable outcome. Treatment and prevention of osteonecrosis is multidisciplinary, and requires the cooperation of different specialists and the patient himself. |
