J Korean Assoc Oral Maxillofac Surg 2017; 43(1): 16~22
Relationship between disease stage and renal function in bisphosphonate-related osteonecrosis of the jaw
Yun-Ho Kim1, Han-Kyul Park1, Na-Rae Choi1, Seong-Won Kim1, Gyoo-Cheon Kim2, Dae-Seok Hwang1, Yong-Deok Kim1, Sang-Hun Shin1, Uk-Kyu Kim1
Departments of 1Oral and Maxillofacial Surgery and 2Oral Anatomy, School of Dentistry, Pusan National University, Yangsan, Korea
Uk-Kyu Kim
Department of Oral and Maxillofacial Surgery, School of Dentistry, Pusan National University, 49 Busandaehak-ro, Mulgeum-eup, Yangsan 50612, Korea
TEL: +82-55-360-5100   FAX: +82-55-360-5104
E-mail: kuksjs@pusan.ac.kr
ORCID: http://orcid.org/0000-0003-1251-7843
Received September 29, 2016; Revised December 2, 2016; Accepted December 25, 2016.; Published online February 28, 2017.
© Korean Association of Oral and Maxillofacial Surgeons. All rights reserved.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
 Abstract
Objectives: Bisphosphonate is the primary cause of bisphosphonate-related osteonecrosis of the jaw (BRONJ). Bisphosphonates are eliminated from the human body by the kidneys. It is anticipated that bisphosphonate levels in the body will increase if the kidney is in a weak state or if there is systemic disease that affects kidney function. The aim of this study was to analyze the relevance of renal function in the severity of BRONJ.
Materials and Methods: Ninety-three patients diagnosed with BRONJ in Pusan National University Dental Hospital from January 2012 to December 2014 were included in this study. All patients underwent a clinical exam, radiographs, and serologic lab test, including urine analysis. The patient’s medical history was also taken, including the type of bisphosphonate drug, the duration of administration and drug holiday, route of administration, and other systemic diseases. In accordance with the guidelines of the 2009 position paper of American Association of Oral and Maxillofacial Surgeons, the BRONJ stage was divided into 4 groups, from stage 0 to 3, according to the severity of disease. IBM SPSS Statistics version 21.0 (IBM Co., USA) was used to perform regression analysis with a 0.05% significance level.
Results: BRONJ stage and renal factor (estimated glomerular filtration rate) showed a moderate statistically significant correlation. In the group with higher BRONJ stage, the creatinine level was higher, but the increase was not statistically significant. Other factors showed no significant correlation with BRONJ stage. There was a high statistically significant correlation between BRONJ stage and ‘responder group’ and ‘non-responder group,’ but there was no significant difference with the ‘worsened group.’ In addition, the age of the patients was a relative factor with BRONJ stage.
Conclusion: With older age and lower renal function, BRONJ is more severe, and there may be a decrease in patient response to treatment.
Keywords: Osteomyelitis, Bisphosphonate-associated osteonecrosis of the jaw, Chronic renal diseases


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30 April 2017
Vol. 43
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