BISPHOSPHONATE THERAPY IN PATIENTS WITH PERIODONTAL DISEASE

Bisfosfonati su skupina snažnih antiresorptivnih lijekova koji se već desetljećima koriste u terapiji koštanih bolesti. Zbog visoke učinovitosti i afiniteta za kost danas predstavljaju zlatni standard liječenja osteoporoze. Koštana pregradnja je iznimno dobro reguliran proces od strane brojnih hormona i citokina te je za zdravlje pojedinca izuzetno važno da su njena dva procesa - razgradnja stare te odlaganje nove kosti, uravnoteženi. Kod uznapredovalog parodontitisa, zbog neravnoteže između bakterijske agresije i obrane imunološkog sustava, dolazi do povećane resorpcije kosti što će posljedično uzrokovati gubitak alveolarne kosti. Pod pretpostavkom da imunološka obrana domaćina nije savršena, razvile su se nove terapijske mogućnosti utemeljene na konceptu modulacije domaćinove reakcije na bakterijsku agresiju. Kao jedni od modulirajućih lijekova predloženi su bisfosfonati. Još uvijek nisu dio rutinske parodontne terapije, ali istraživanja upućuju da imaju mogućnost prevenirati ili dijelom smanjiti resorpciju alveolarne kosti. Kako bi postali neizostavni dio u terapiji parodontisa, nužno je da se odredi optimalna doza, točan način primjene kao i dodatno ispita njihova sigurnost.Bisphosphonates are a class of powerful antiresorptive drugs which for decades have been used in treatment of bone diseases. Due to their high efficiency and affinity to the bone, they represent the golden standard in treatment of osteoporosis. Bone remodeling is a process well regulated by many hormones and cytokines and for the health of an individual, the balance of two processes, resorption of the old bone and formation of new bone, is extremely important. In severe periodontitis, due to the imbalanced relation between the bacterial aggression and the immune system defense, there is an increased bone resorption which will lead to the alveolar bone loss. Based on the assumption that the host’s immune defense is not perfect, new treatments based on the concept of “modulation of host response” as a method against bacterial aggression have been developed. Bisphosphonates have been proposed as one of the modulators of host response. Although they are still not the part of the routine periodontal treatment, numerous research results show that they have the ability to prevent or reduce resorption of the alveolar bone. Optimal dosage needs to be determined, precise method of use, as well as further research into their safety are all necessary so that they could become a very important method in managing periodontal disease