Bifosfonatos: tipos, mecanismos de ação e efeitos colaterais. Revisão da literatura para orientação de profissionais e estudantes das áreas médica e odontológica

Contenido principal del artículo

Viviann Ruocco-Vetucci
Monique Bergantim
Daniel Pedro Castelo Branco Lopes
Diego Nunes Pim
Gustavo Junqueira de Almeida
Rodrigo Nascimento Turano de Mattos
Tiago Varesche Silva
Ana Paula de Souza Faloni†

Resumen

Os antirreabsortivos são potentes inibidores da reabsorção óssea empregados no tratamento de alterações do metabolismo ósseo associadas ou não a neoplasias. Devido à sua eficácia, antirreabsortivos como bifosfonatos (BPs) são amplamente prescritos. Porém, têm sido associados a efeitos colaterais como a osteonecrose dos maxilares relacionada a medicamentos (MRONJ). Em levantamento da literatura, constatamos falta de conhecimento desta patologia por profissionais e estudantes das áreas médica e odontológica. Diante disto, a presente revisão visa proporcionar a médicos, cirurgiões-dentistas e estudantes destas áreas, uma melhor compreensão dos BPs, seus tipos, mecanismos de ação no tecido ósseo, possíveis efeitos colaterais, com destaque para a MRONJ, sua prevenção e tratamento. Para o levantamento bibliográfico foram utilizadas as bases de dados Pubmed, Scielo e Google Acadêmico, selecionando-se artigos publicados no período de 1981 à 2022. A partir dos dados da literatura, concluiu-se que os BPs reduzem a reabsorção óssea, principalmente por inibir de forma direta os osteoclastos. Apesar de sua efetividade no tratamento de patologias ósseas, os BPs podem levar a alterações no trato gastrointestinal, à toxicidade renal, a alterações na região dos olhos, além de MRONJ. O conhecimento da MRONJ por parte dos profissionais da saúde ainda é restrito e isso parece estar associado à uma deficiência na instrução dos usuários dos BPs a respeito do problema. Mesmo diante de diversos tipos de tratamentos propostos na literatura, a MRONJ ainda apresenta difícil resolução. Por isso, é de extrema relevância a sua prevenção. Com intuito de preveni-la, a interação entre médicos, cirurgiões-dentistas e pacientes torna-se fundamental. Neste artigo, além das orientações para cirurgiões-dentistas, médicos e estudantes destas áreas, são propostas para cirurgiões-dentistas técnicas visando mitigar o risco e tratar a MRONJ.


PALAVRAS-CHAVE: bifosfonatos; conhecimento; reabsorção óssea; osteoclasto; osteonecrose dos maxilares. 

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Ruocco-Vetucci, V. ., Bergantim, . . . . . . M. ., Castelo Branco Lopes, D. P. ., Nunes Pim, D. ., Junqueira de Almeida, G. ., Nascimento Turano de Mattos, R. ., Varesche Silva, T. ., & de Souza Faloni†, A. P. (2023). Bifosfonatos: tipos, mecanismos de ação e efeitos colaterais. Revisão da literatura para orientação de profissionais e estudantes das áreas médica e odontológica. Revista Brasileira Multidisciplinar, 26(1), 94-120. https://doi.org/10.25061/2527-2675/ReBraM/2022.v25i3.1682
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