Osteoquimionecrosis de los maxilares por tratamientos con bisfosfonatos: puesta al día

espanolLos bisfosfonatos (BP),se emplearon inicialmente en la industria y posteriormente como farmaco por su gran afinidad por el tejido oseo y su potente efecto antirresortivo, para tratar diversas osteopatias como la osteoporosis, la enfermedad de Paget o la hipercalcemia asociada a algunos tumores malignos, como el mieloma o el cancer de mama. Se administran por via oral o intravenosa y aunque suelen ser bien tolerados, los efectos secundarios mas frecuentes son los gastrointestinales, ademas de la osteonecrosis cuando se administran por via endovenosa. El objetivo de este trabajo ha sido evaluar las publicaciones existentes en la literatura cientifica acreditada sobre los bifosfonatos, su mecanismo de accion y la relacion con la aparicion de osteonecrosis en los maxilares. Aunque no se conoce exactamente el mecanismo por el que se desarrolla la osteonecrosis de los maxilares, parecen influir la inhibicion de los osteoclastos, la accion antiangiogenica, un efecto inhibitorio en el ciclo celular de los queratinocitos y en pacientes oncologicos tratados con otros farmacos se refuerza la accion quimiotoxica. La clinica va desde una inespecificidad de sintomas hasta lesiones como osteomielitis con necrosis y secuestros oseos que pueden ir acompanadas de un fetor ex oris, apareciendo muchas lesiones contaminadas con Actinomyces. Como antecedentes publicados con osteonecrosis, por tratamiento con bisfosfonatos, encontrados hasta 2006: el 46,5% tenian diagnostico previo de mieloma multiple; el 38,8 % eran pacientes de cancer metastatico de mama; 6,2% de cancer metastatico de prostata; 4,1% padecian osteoporosis; 3,5 % otras enfermedades metastaticas y un 0,8% con enfermedad de Paget. Los farmacos que parecen tener mas incidencia de osteoquimionecrosis: zoledronato, pamidronato, alendronato, risendronato e ibandronato, de mayor a menor. Ademas el riesgo de producirse la osteonecrosis es acumulativo y puede llegar hasta el 21% el tercer ano de uso de bisfosfonatos de uso intravenoso. EnglishBisphosphonates (BP),were initially used in industry and later as a drug due to their great affinity to osseous tissue, because of their powerful antiresorptive effect as a treatment in various osteopathies, such as osteoporosis, Paget disease or hypercalcemia associated with some malignant tumors, as myeloma or breast cancer. They are administered orally or intravenously, and although well tolerated, the most frequent side effects are gastrointestinal, in addition to osteonecrosis when they are administered via endovenous. The aim of this work has been to evaluate the existing publications in accredited scientific literature on biphosphonates and their action mechanism and the relationship with the appearance of osteonecrosis of the jaws. Although the mechanism by which osteonecrosis of the jaws develops is not known exactly, there seems to be influence by osteoclast inhibiton, antiangiogenic action, an inhibitory effect on the cellular cycle by the keratinocytes, as well as, reinforcement of the chemiotoxic action in oncological patients treated with other drugs. Clinically, it ranges from a non-specificity of symptoms to lesions such as osteomyelitis with necrosis and osseous sequesters that may be accompanied by fetor ex oris, with the appearance of many Actinomyces contaminated lesions As for published antecedents on osteonecrosis due to bisphosphonate treatment found until 2006: 46.5% had a previous diagnosis of multiple myeloma; 38.8% were patients with metastatic breast cancer; 6.2% patients of metastatic prostate cancer; 4.1% suffered from osteoporosis; 3.5% from other metastatic diseases and 0.8% had Paget disease. The drugs that seem to have the highest incidence of osteochemionecrosis are: zoledronate, pamidronate, alendronate, risendronate and ibandronate, from the greatest to the least. Additionally, the risk of osteonecrosis being produced is accumulative and may reach 21% in the third year of intravenous bisphosphonate use.