Autopsy and Case Reports
https://app.periodikos.com.br/journal/autopsy/article/doi/10.4322/acr.2020.186
Autopsy and Case Reports
Clinical Case Report

Osteonecrosis of the jaw in a patient under treatment of osteoporosis with oral bisphosphonate

Marília A. Figueiredo; Frederico Buhatem Medeiros; Karem López Ortega

Downloads: 5
Views: 1346

Abstract

ABSTRACT: Although uncommon in patients under oral therapy, bisphosphonate-related osteonecrosis of the jaw (BRONJ) can be a very severe issue. Early intervention with surgical resection should be the preferable method of treating any stage of the disease, resulting in better outcomes and decreasing the morbidity of this condition. A 77-year-old female patient attended the Special Care Dentistry Centre of the University of São Paulo Faculty of Dentistry (CAPE FOUSP) complaining mainly of “an exposed bone that appeared after tooth extraction performed six months earlier”. The patient was diagnosed with osteonecrosis associated with bisphosphonate (sodium ibandronate) and surgically treated with removal of bone sequestration and antibiotic therapy. The patient was followed up for six years (a total of 6 appointments), presenting good general health and no sign of bone exposure. Imaging findings showed no changes related to BRONJ either.

Keywords

Bisphosphonate-Related Osteonecrosis of the Jaw, Ibandronic Acid, Jaw, Osteonecrosis

References

1 Cavalli L, Brandi ML. Targeted approaches in the treatment of osteoporosis: differential mechanism of action of denosumab and clinical utility. Ther Clin Risk Manag. 2012;8:253-66. PMid:22745560.

2 Roelofs AJ, Thompson K, Ebetino FH, Rogers MJ, Coxon FP. Bisphosphonates: molecular mechanisms of action and effects on bone cells, monocytes and macrophages. Curr Pharm Des. 2010;16(27):2950-60. http://dx.doi.org/10.2174/138161210793563635. PMid:20722616.

3 Diab DL, Watts NB. Bisphosphonate drug holiday: who, when and how long. Ther Adv Musculoskelet Dis. 2013;5(3):107-11. http://dx.doi.org/10.1177/1759720X13477714. PMid:23858334.

4 Dodson TB. The frequency of medication-related osteonecrosis of the jaw and its associated risk factors. Oral Maxillofac Surg Clin North Am. 2015;27(4):509-16. http://dx.doi.org/10.1016/j.coms.2015.06.003. PMid:26362367.

5 Fassio A, Bertoldo F, Idolazzi L, Viapiana O, Rossini M, Gatti D. Drug-induced osteonecrosis of the jaw: the state of the art. Reumatismo. 2017;69(1):9-15. http://dx.doi.org/10.4081/reumatismo.2017.983. PMid:28535616.

6 Hasegawa T, Hayashida S, Kondo E, et al. Medication-related osteonecrosis of the jaw after tooth extraction in cancer patients: a multicenter retrospective study. Osteoporos Int. 2019;30(1):231-9. http://dx.doi.org/10.1007/s00198-018-4746-8. PMid:30406309.

7 Japanese Allied Committee on Osteonecrosis of the Jaw, Yoneda T, Hagino H, et al. Antiresorptive agent-related osteonecrosis of the jaw: Position Paper 2017 of the Japanese Allied Committee on Osteonecrosis of the Jaw. J Bone Miner Metab. 2017;35(1):6-19. http://dx.doi.org/10.1007/s00774-016-0810-7.

8 Migliario M, Mergoni G, Vescovi P, et al. Osteonecrosis of the Jaw (ONJ) in Osteoporosis Patients: Report of Delayed Diagnosis of a Multisite Case and Commentary about Risks Coming from a Restricted ONJ Definition. Dent J (Basel). 2017;5(1):5. http://dx.doi.org/10.3390/dj5010013. PMid:29563419.

9 Malden NJ, Pai AY. Oral bisphosphonate associated osteonecrosis of the jaws: three case reports. Br Dent J. 2007;203(2):93-7. http://dx.doi.org/10.1038/bdj.2007.636. PMid:17660780.

10 Fleisher KE, Jolly A, Venkata UD, Norman RG, Saxena D, Glickman RS. Osteonecrosis of the jaw onset times are based on the route of bisphosphonate therapy. J Oral Maxillofac Surg. 2013;71(3):513-9. http://dx.doi.org/10.1016/j.joms.2012.07.049. PMid:22999296.

11 Notarnicola A, Lisi S, Sisto M, De Marino AV, D’Amore M. Possible role of oral ibandronate administration in Osteonecrosis of the Jaw: a case report. Int J Immunopathol Pharmacol. 2012;25(1):311-6. http://dx.doi.org/10.1177/039463201202500138. PMid:22507348.

12 Pispati A, Pandey V, Patel R. Oral bisphosphonate induced recurrent osteonecrosis of jaw with atypical femoral fracture and subsequent mandible fracture in the same patient: a case report. J Orthop Case Rep. 2018;8(3):85-8. PMid:30584526.

13 Molcho S, Peer A, Berg T, Futerman B, Khamaisi M. Diabetes microvascular disease and the risk for bisphosphonate-related osteonecrosis of the jaw: a single center study. J Clin Endocrinol Metab. 2013;98(11):E1807-12. http://dx.doi.org/10.1210/jc.2013-2434. PMid:24037883.

14 Ruggiero SL, Dodson TB, Assael LA, et al. American Association of Oral and Maxillofacial Surgeons position paper on bisphosphonate-related osteonecrosis of the jaws--2009 update. J Oral Maxillofac Surg. 2009;67(5, Suppl):2-12. http://dx.doi.org/10.1016/j.joms.2009.01.009. PMid:19371809.

15 Hong JW, Nam W, Cha IH, et al. Oral bisphosphonate-related osteonecrosis of the jaw: the first report in Asia. Osteoporos Int. 2010;21(5):847-53. http://dx.doi.org/10.1007/s00198-009-1024-9. PMid:19633881.

16 Sedghizadeh PP, Stanley K, Caligiuri M, Hofkes S, Lowry B, Shuler CF. Oral bisphosphonate use and the prevalence of osteonecrosis of the jaw: an institutional inquiry. J Am Dent Assoc. 2009;140(1):61-6. http://dx.doi.org/10.14219/jada.archive.2009.0019. PMid:19119168.

17 Lo JC, O’Ryan FS, Gordon NP, et al. Prevalence of osteonecrosis of the jaw in patients with oral bisphosphonate exposure. J Oral Maxillofac Surg. 2010;68(2):243-53. http://dx.doi.org/10.1016/j.joms.2009.03.050. PMid:19772941.

18 Carlson ER, Schlott BJ. Anti-resorptive osteonecrosis of the jaws: facts forgotten, questions answered, lessons learned. Oral Maxillofac Surg Clin North Am. 2014;26(2):171-91. http://dx.doi.org/10.1016/j.coms.2014.01.005. PMid:24630868.

19 Hasegawa T, Kawakita A, Ueda N, et al. A multicenter retrospective study of the risk factors associated with medication-related osteonecrosis of the jaw after tooth extraction in patients receiving oral bisphosphonate therapy: can primary wound closure and a drug holiday really prevent MRONJ? Osteoporos Int. 2017;28(8):2465-73. http://dx.doi.org/10.1007/s00198-017-4063-7. PMid:28451732.

20 Bindon B, Adams W, Balasubramanian N, Sandhu J, Camacho P. Osteoporotic fractures during bisphosphonate drug holiday. Endocr Pract. 2018;24(2):163-9. http://dx.doi.org/10.4158/EP171975.OR. PMid:29144808.

21 Huntjens KM, Kosar S, van Geel TA, et al. Risk of subsequent fracture and mortality within 5 years after a non-vertebral fracture. Osteoporos Int. 2010;21(12):2075-82. http://dx.doi.org/10.1007/s00198-010-1178-5. PMid:20162259.
 


Submitted date:
10/25/2019

Accepted date:
01/19/2020

Publication date:
12/08/2020

5fcfb3510e88258e644ac228 autopsy Articles
Links & Downloads

Autops Case Rep

Share this page
Page Sections