OSTEONECROSIS DE LA MANDÍBULA RELACIONADA CON MEDICAMENTOS EN PACIENTES ONCOLÓGICOS: ESTRATEGIAS PREVENTIVAS Y TERAPÉUTICAS A TRAVÉS DE UNA REVISIÓN INTEGRATIVA DE LA LITERATURA
DOI:
https://doi.org/10.61164/rmnm.v1i3.3520Palabras clave:
Oncología, Osteonecrosis, Calidad de vidaResumen
Abstracto
Introducción: En pacientes con cáncer, el uso de Agentes Modificadores Óseos (AMO) es parte del protocolo de tratamiento de la enfermedad osteolítica relacionada con el cáncer de mama, mieloma múltiple, entre otros. Entre los medicamentos que pueden provocar el desarrollo de MRONJ destacan los bifosfonatos (BFs) y el denosumab (DMAB). Estos medicamentos pueden estar relacionados con el desarrollo de MRONJ, lo que puede afectar negativamente la calidad de vida de los pacientes con cáncer. Objetivo: Identificar, a través de una revisión integradora, enfoques preventivos y terapéuticos para MRONJ. Metodología: Se realizó una búsqueda bibliográfica en la base de datos electrónica PubMed, entre julio y octubre de 2023, utilizando descriptores definidos según la temática. Los artículos fueron seleccionados de acuerdo a criterios de inclusión y exclusión previamente establecidos. Resultados: Se encontraron 354 artículos en las bases de datos. Luego de analizar los títulos y resúmenes, se preseleccionaron 107 artículos y se leyeron en su totalidad. Posteriormente se incluyeron 16 artículos en la presente revisión. Conclusión: Siempre se debe fomentar el ajuste oral antes de iniciar la BMA. Dada la necesidad de realizar procedimientos invasivos en pacientes sometidos a BMA, se deben considerar alternativas como la terapia con antibióticos y la pentoxifilina y tocoferol (PENTO) para tratar de minimizar la posibilidad de su ocurrencia. En los casos de desarrollo de MRONJ, los tratamientos dependerán de su estadificación y la literatura brinda alternativas como terapia antibiótica, cirugía, PENTO, Láser Er,Cr:YSGG, Terapia Láser de Baja Intensidad (LLLT), Terapia Fotodinámica Antimicrobiana (aPDT), Reducción de Plaquetas y Fibrina rica en leucocitos (L-PRF), plasma rico en fibrina (PRF) y plasma rico en plaquetas (PRP).
Palabras clave: Oncología; Osteonecrosis; Calidad de vida.
Citas
ALMEIDA, M. V. DA C. et al. Photodynamic therapy as an adjunct in the treatment of medication-related osteonecrosis of the jaw: A case report. Journal of lasers in medical sciences, v. 12, p. e12, 2021.
BLATT, S. et al. Non-interventional prospective observational study of platelet rich fibrin as a therapy adjunctive in patients with medication-related osteonecrosis of the jaw. Journal of clinical medicine, v. 11, n. 3, p. 682, 2022.
BROOME, M. E. Integrative literature reviews for the development of concepts. In: RODGERS, B. L.; KNAFL, K. A. (orgs.). Concept development in nursing: foundations, techniques and applications. Philadelphia: W.B. Saunders Company, 2000. p. 231-250.
CAMPISI, G. et al. Medication-Related Osteonecrosis of Jaws (MRONJ) Prevention and Diagnosis: Italian Consensus Update 2020. International journal of environmental research and public health, v. 17, n. 16, 2020.
CAPOCCI, M. et al. Medication-related osteonecrosis of the jaws (MRONJ) and quality of life evaluation: a pilot study. La Clinica terapeutica, v. 168, n. 4, p. e253–e257, 2017.
CHALEM, M. et al. Therapeutic approach and management algorithms in medication-related osteonecrosis of the jaw (MONJ): recommendations of a multidisciplinary group of experts. Archives of osteoporosis, v. 15, n. 1, p. 101, 2020.
COROPCIUC, R. et al. Risk of medication-related osteonecrosis of the jaw after dental extractions in patients receiving antiresorptive agents - A retrospective study of 240 patients. Bone, v. 170, n. 116722, p. 116722, 2023.
DI FEDE, O. et al. The Dental Management of Patients at Risk of Medication-Related Osteonecrosis of the Jaw: New Paradigm of Primary Prevention. BioMed research international, v. 2018, 2018.
EPSTEIN, M. S. et al. Management of bisphosphonate-associated osteonecrosis: pentoxifylline and tocopherol in addition to antimicrobial therapy. An initial case series. Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics, v. 110, n. 5, p. 593–596, 2010.
FLEISHER, Kenneth E.; KONTIO, Risto; OTTO, Sven. Antiresorptive Drug-related Osteonecrosis of the Jaw (ARONJ)—a Guide to Research. Davos, Switzerland: AO Foundation, 2016. ISBN 978-3-905363-10-4.
GOKER, F. et al. Treatment of medication-related osteonecrosis of the jaw (MRONJ). A systematic review. European review for medical and pharmacological sciences, v. 25, n. 6, p. 2662–2673, 2021.
HASEGAWA, T. et al. Denosumab-related osteonecrosis of the jaw after tooth extraction and the effects of a short drug holiday in cancer patients: a multicenter retrospective study. Osteoporosis international, v. 32, n. 11, p. 2323–2333, 2021.
HE, L. et al. Pathogenesis and multidisciplinary management of medication-related osteonecrosis of the jaw. International journal of oral science, v. 12, n. 1, p. 30, 2020.
KEMP, A. P. T. et al. Risk factors for medication-related osteonecrosis of the jaw and salivary IL-6 IN cancer patients. Brazilian journal of otorhinolaryngology, v. 88, n. 5, p. 683–690, 2022.
LEONARDI, N. et al. Alternativas terapéuticas de osteonecrosis maxilar asociada a medicamentos (ONMAM): Reportes de dos casos clínicos y revisión de la literatura. Revista de la Facultad de Ciencias Medicas (Cordoba, Argentina), v. 79, n. 4, p. 379–382, 2022.
MAGALHÃES, J. M. I. et al. Pentoxifylline and tocopherol as prophylaxis for osteonecrosis of the jaw due to bone-modifying agents in patients with cancer submitted to tooth extraction: a case series. Supportive care in cancer, v. 31, n. 8, p. 462, 2023.
MARTINS, M. A. T. et al. Osteonecrose dos maxilares associada ao uso de bisfosfonatos: importante complicação do tratamento oncológico. Revista brasileira de hematologia e hemoterapia, v. 31, n. 1, p. 41–46, 2009.
MAUCERI, R. et al. Conservative surgical treatment of bisphosphonate-related osteonecrosis of the jaw with Er,Cr:YSGG laser and platelet-rich plasma: A longitudinal study. BioMed research international, v. 2018, p. 3982540, 2018.
MENDES, K. D. S.; SILVEIRA, R. C. DE C. P.; GALVÃO, C. M. Revisão integrativa: método de pesquisa para a incorporação de evidências na saúde e na enfermagem. Texto & contexto enfermagem, v. 17, n. 4, p. 758–764, 2008.
MORENO-RABIÉ, C. et al. Radiographic predictors for MRONJ in oncologic patients undergoing tooth extraction. Scientific reports, v. 12, n. 1, p. 11280, 2022.
NIECKULA, P.; STEMPNIEWICZ, A.; TUBAJA, M. Prophylaxis of osteonecrosis in the case of patients treated with bisphosphonates: A review paper. Dental and medical problems, v. 55, n. 4, p. 425–429, 2018.
AMADOR SALOMÃO, P. E. .; TEIXEIRA OLIVEIRA SANTOS, A. . EVOLUÇÃO E DESAFIOS NA AVALIAÇÃO CIENTÍFICA: DA CLASSIFICAÇÃO DE PERIÓDICOS À QUALIDADE INTRÍNSECA DOS ARTIGOS. Revista Multidisciplinar do Nordeste Mineiro, [S. l.], v. 1, n. 1, p. 1–18, 2025. DOI: 10.61164/rmnm.v1i1.3481.
OTTO, S. et al. Medication-related osteonecrosis of the jaw: Prevention, diagnosis and management in patients with cancer and bone metastases. Cancer treatment reviews, v. 69, p. 177–187, 2018.
PARISE, G. K. et al. Efficacy of fibrin-rich platelets and leukocytes (L-PRF) in tissue repair in surgical oral procedures in patients using zoledronic acid-case-control study. Oral and maxillofacial surgery, v. 27, n. 3, p. 507–512, 2023.
PASSERI, L. A.; BÉRTOLO, M. B.; ABUABARA, A. Osteonecrose dos maxilares associada ao uso de bisfosfonatos. Revista brasileira de reumatologia, v. 51, n. 4, p. 404–407, 2011.
RUGGIERO, S. L. et al. American Association of Oral and Maxillofacial Surgeons’ position paper on medication-related osteonecrosis of the jaws-2022 update. Journal of oral and maxillofacial surgery, v. 80, n. 5, p. 920–943, 2022.
ŞAHIN, O. et al. Prevention of medication related osteonecrosis of the jaw after dentoalveolar surgery: An institution’s experience. Journal of clinical and experimental dentistry, v. 12, n. 8, p. e771–e776, 2020.
SOUZA, S. L. X. et al. Terapia fotodinâmia como coadjuvante no tratamento da osteonecrose dos maxilares associada ao uso de medicamentos (OMAM). SALUSVITA, v. 38, n. 4, p. 1093-1105, 2019.
TENORE, G. et al. Management of medication-related osteonecrosis of the jaw (MRONJ) using leukocyte- and platelet-rich fibrin (L-PRF) and photobiomodulation: A retrospective study. Journal of clinical medicine, v. 9, n. 11, p. 3505, 2020.
TORRES, A. A. et al. Medication-related osteonecrosis of the jaw and low-level laser therapy as adjuvant treatment: A case report. Journal of lasers in medical sciences, v. 11, n. 4, p. 497–499, 2020.
UEDA, N. et al. Oral risk factors associated with medication-related osteonecrosis of the jaw in patients with cancer. Journal of bone and mineral metabolism, v. 39, n. 4, p. 623–630, 2021.
WILCOCK, A. et al. Denosumab: AHFS 92:24. Journal of pain and symptom management, v. 56, n. 2, p. 295–301, 2018.
YAROM, N. et al. Medication-related osteonecrosis of the jaw: MASCC/ISOO/ASCO clinical practice guideline. Journal of clinical oncology: official journal of the American Society of Clinical Oncology, v. 37, n. 25, p. 2270–2290, 2019.
Descargas
Publicado
Cómo citar
Número
Sección
Licencia
Derechos de autor 2025 Revista Multidisciplinar do Nordeste Mineiro

Esta obra está bajo una licencia internacional Creative Commons Atribución-NoComercial-CompartirIgual 4.0.