ISSN : 0376-4672
골괴사(Osteonecrosis)는 일반적으로 골조직에로의 혈행장애가 원인이 되어 일으키는 골의 생물학적 활성이 소실되는 상황을 일컫는다. 이러한 골괴사는 주로 정형외과에서 대퇴골두나 관절부에 호발하는 것으로, 다양한 전신질환이나 외상 또는 투약과 연관되어 있음이 꾸준히 보고되어져 왔다. 턱뼈의 경우 방사선 치료후, 박테리아 또는 바이러스 감염 등에 의하여 골괴사가 초래될수 있으며,formocresol 혹은 비소(arsen) 와 같은 약물, 마약흡입으로 인한 비중격괴사과 관련된 골괴사도 보고되어 있다4). 이중 최근들어 가장 많은 빈도로 보고되고 있는것이 bisphosphonate(BP) 약물치료후의 턱뼈 골괴사이다. BP의 경우 골다공증이나 악성종양의 골전이를 억제하기 위하여 처방되며, 이약이 처방된지 수년이 경과한 이후부터 이 약물의장기투여후 생기는 골괴사, 즉 비스포스포네이트연관 턱뼈의 골괴사(Bisphosphonate-relatedosteonecrosis of the jaw, BRONJ)가 꾸준히보고되었으며 현재까지 다양한 임상적, 기초적인 연구가 이루어지고 있다. BRONJ와 방사선성 골괴사, 그리고 골수염간에는 명확한 차이가 있다는 주장이 있는 반면5) 골괴사후 장기간 노출된 골에 필연적으로 미생물의 침범으로 인한 골조직의 염증성 변화가 수반된다는 점에서 이러한 BRONJ와 화농성골수염간의 조직학적 차이를 발견하기 어렵다는 주장도 있다.
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