Osteonecrosis caused by Bisphosphonates: a clinical case

International Journal of Oral and Maxillofacial Surgery, 2011

Bisphosphonates (BP) are used as anti-osteoclastic and anti-resorptive agents for the management of osteoporosis, multiple myeloma, Paget's disease and hypercalcemia of malignancy. Their function is to improve bone morphology, prevent bone destruction and pathologic fractures while decelerating bone resorption. However, BP-induced osteonecrosis of the jaw (BRONJ) is one of the complications of BP intake. The aim of this paper is to report a case of BRONJ in a patient on oral BP for osteoporosis, which healed spontaneously on cessation of offending drug.

Journal of Clinical and Experimental Dentistry, 2019

Bisphosphonates are drugs indicated for the treatment of bone metabolic diseases or malignant hypercalcemia. They are generally well-tolerated drugs, however, recent reports have described osteonecrosis of the jaw bones as a potentially serious complication related to the long-term use of these drugs. We report a case of severe osteonecrosis in a 52-years-old white woman that was taking bisphosphonates (zoledronic acid and alendronate) for the management of osteoporosis. Following a long exposure to these drugs and after being subjected to multiples exodontias, developed bisphosphonate-related osteonecrosis of the jaw compromising the whole maxilla and that extended toward the base of skull. Due to the extent of osteonecrosis, total maxillectomy and removal of all adjacent necrotic bone were planned guided by ultraviolet light. fluorescence. This case illustrates that if not treated correctly, bisphosphonate-related osteonecrosis of the jaw may cause significant morbidity, affect the quality of life and can eventually produce significant morbidity with the dissemination to noble structures and potentially causing life-threatening complications.

The authors make a review of the current literature on the subject of bisphosphonate-associated osteonecrosis of the jaw bones. The modern theories about the occurrence of this complication resulting from bisphosphonate treatment of diseases characterized with high bone resorption are discussed. Modern understandings about the causes, risk factors and triggers for the occurrence of this disease are described. Attention is paid to the modern concepts of medication therapy and surgical treatment. A case of bisphosphonate-associated osteonecrosis of the maxilla with involvement of the maxillary sinus is reported. Surgical intervention comprising sequestrectomy, radical maxillary sinus surgery and plastic closure of the formed oroantral communication is described.

Romanian journal of morphology and embryology = Revue roumaine de morphologie et embryologie, 2011

Osteonecrosis of the jaws is increasing worldwide in patients treated with bisphosphonates. A retrospective review of 52 patients who were treated during 2007-2010 for bisphosphonate related maxillofacial symptoms of the jaws was conducted. Patient characteristics and other factors that influenced the disease process were studied. Thirteen patients received bisphosphonates for the prevention or treatment of osteoporosis; 39 for preventing bone metastases from malignant tumors. Thirty-six patients were females (age range 32-87 years, median 64 years); 16 were males (age range 30-81 years, median 73.5 years). Bisphosphonate used was ibandronic acid in four cases, alendronate sodium in 14 cases, and zoledronic acid in 34 cases. Mean bisphosphonate treatment period was 22.44 months (95%CI 19.33-25.55). Thirty patients received intravenous, 22 received oral bisphosphonate. The average period until occurrence of maxillofacial symptoms was 6 months (range 0.5-24 months) in subjects with in...

The Surgeon, 2012

Maxilla Dentistry a b s t r a c t

Archiv Euromedica, 2020

Bisphosphonates have been used for many years worldwide for the treatment of osteoporosis, Paget's disease, but especially for the treatment of various bone density disorders such as tumour formations, bone metastases associated with osteolysis and hypercalcemia. The effects of bisphosphonates on the bones are due to their action on osteoclasts by inhibiting them. Although the existence of the risk of osteonecrosis of the jaw in patients undergoing bisphosphonate treatment is known, this pathology has been considered very rare for a long period and many times the risk of its occurrence has been ignored. Since the use of bisphosphonates is becoming more prevalent and the duration of such treatment is steadily increasing, the incidence of osteonecroses associated with this treatment is also increasing. OBJECTIVE. The objective of this study is to highlight the fact that the incidence of cases of bisphosphonate-related osteonecrosis of the jaw has been increasing in recent years. METHODS. We have carried out a search and analysis of all cases with osteonecrosis as main diagnosis in the Oral Maxillo-Facial Surgery Clinic during the period from January 2009 and December 2018. RESULTS. We found 84 patients with osteonecrosis of the jaw following bisphosphonate treatment. Of these, 37 were men and 47 women with an average age of 67 and 59 respectively. There were 26 cases (31%) with incidence in the jaw, 52 cases (62%) with incidence in the mandible, and 6 patients (7%) manifested bilateral osteonecrosis of the jaw. Of these, 20% were on the left side, 36% on the right side and 44% on the median line. CONCLUSIONS. The incidence of bisphosphonate-related osteonecrosis of the jaw is steadily increasing due to the more frequent use of a class of bisphosphonates with a strong impact on the oro-facial bone system. K E Y w O R D S-Medication-related osteonecrosis of the jaw, osteonecrosis, Bisphosphonates, Tooth extraction, Side effect, oral and maxillofacial surgery, anti-angiogenic.

Oral Diseases, 2015

Introduction: Osteonecrosis results from local and systemic factors that compromise blood flow in bone tissues, being relatively frequent in maxillary bones. In recent years, there has been an increase in the incidence of new cases of medication-related osteonecrosis of the jaw (MRONJ). Objective: The aim of this study is to report a case of hard palate osteonecrosis associated with the use of bisphosphonate and to review the literature on the major clinical features, diagnosis, and management of this disorder. Case report: An 84-year-old female patient presented with a lesion to the midline of the hard palate with exposed necrotic bone. Family members reported that the patient had been on ibandronate sodium for nearly 5 years. Based on clinical and radiographic findings, the diagnosis indicated MRONJ. The patient underwent a surgical procedure for debridement of necrotic bone and closure of the exposed tissue by means of Z-plasty. After a 4-month follow-up, there were no clinical and radiographic signs of recurrence. Conclusion: The present case and the literature highlight the importance of proper anamnesis combined with clinical, radiographic, and laboratory findings to make an accurate diagnosis in order to provide the best therapeutic approach. In addition, the importance of dental surgeons knowledge aboutthe association between bisphosphonate therapy and osteonecrosis is very important, given the several indications of this drug and, thus, the high probability of attending to patients treated with this medication, with the aim of reducing the occurrence of new cases of MRONJ and, consequently, morbidities and their aggravation.

Bisphosphonate therapy is used extensively to treat osteoporosis and osteolytic bone lesions. Recently, a special form of osteonecrosis limited to the maxillofacial skeleton has been discovered especially with the use of IV nitrogen containing Bisphosphonates. Bisphosphonates accumulate almost exclusively in maxillofacial skeleton due to high bone turnover remodeling to maintain mechanical competence. The pathogenesis, and why it commonly appears in maxillofacial skeletons, and the fixed treatment strategies remains unknown. The aim of this study was to improve the clinician understanding of Bisphosphonates associated osteonecrosis of the jaws by reviewing the past 10 year literature.

Journal of Oral Health and Community Dentistry, 2010

Bisphosphonates are compound used in the treatment of many skeletal disorders such as bone metastases, osteoporosis, Paget's disease, hypercalcaemia of malignancy and bone pain. A new complication of bisphosphonate therapy administration i.e. osteonecrosis of jaw also known as bisphosphonate related osteonecrosis of the jaws seems to be developing. Over suppression of bone turn over is probably the primary mechanism for the development of this condition, although there may be contributing comorbid factors. Complete prevention of this complication is not currently possible. However, preventive dental care reduces this incidence. Conservative debridement of necrotic bone, pain control, infection management, use of antimicrobial oral rinses and withdrawal of bisphosphonates are preferable to aggressive surgical measures for treating this condition.

2005

Bisphosphonate-related osteonecrosis of the jaws (BRONJ) is a severe complication seen most frequently in patients on intravenous bisphosphonates treatment for malignant diseases. High potency bisphosphonates are generally implicated and risk factors also include dental extractions. Prevention is of paramount importance. Management is controversial but there is little evidence basis and the consensus is to be conservative. Recent advances in this area are summarised in this concise review.