Possible Role of Oral Ibandronate Administration in Osteonecrosis of the Jaw: A Case Report

We describe a case of Osteonecrosis of the Jaw (ONJ) that developed in a 65-year-old Caucasian woman with osteopenia and other risk factors who was receiving low doses of oral bisphosphonate therapy (ibandronate, 150 mg monthly). Computed tomography (CT), panoramic radiographs (OPT), 99mTc-Sn-MDP scintigraphy, and magnetic resonance imaging (MRI) were performed to study the diseased area; cytological examination also revealed the presence of suppurative material around the area of exposed bone. A diagnosis of bisphosphonate-related osteonecrosis of the jaw complicated by osteomyelitis was made. The patient was prescribed a drug protocol consisting of metronidazole 250 mg 2 times daily, chlorhexidine mouthwashes 3 times daily and chewing exercises for two months. Ibandronate was stopped and replaced with strontium ranelate. The symptoms improved and the patient is still under close follow-up. Assessment of the benefits versus risks is particularly necessary in patients with several risk factors to ascertain their eligibility for treatment with antiresorptive drugs and when this is not possible to choose alternative medications.

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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?

Osteoporosis International ◽

10.1007/s00198-017-4063-7 ◽

2017 ◽

Vol 28 (8) ◽

pp. 2465-2473 ◽

Cited By ~ 33

Author(s):

T. Hasegawa ◽

◽

A. Kawakita ◽

N. Ueda ◽

R. Funahara ◽

...

Keyword(s):

Risk Factors ◽

Retrospective Study ◽

Tooth Extraction ◽

Wound Closure ◽

Osteonecrosis Of The Jaw ◽

Bisphosphonate Therapy ◽

Drug Holiday ◽

Factors Associated ◽

Primary Wound Closure ◽

Oral Bisphosphonate

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Advanced peri-implantitis and implant removal as risk factors for osteonecrosis of the jaw in patients on oral bisphosphonate therapy

Journal of Oral Implantology ◽

10.1563/aaid-joi-d-20-00298 ◽

2020 ◽

Author(s):

Won-Bae Park ◽

Yeek Herr ◽

Yong-Dae Kwon ◽

Seung-Il Shin ◽

Hyun-Chang Lim

Keyword(s):

Risk Factors ◽

Private Practice ◽

Osteonecrosis Of The Jaw ◽

Bisphosphonate Therapy ◽

Implant Removal ◽

The Other ◽

University Hospitals ◽

Implant Placement ◽

Oral Bisphosphonate ◽

Number Of Patients

The present study aimed to identify and report the association of bisphosphonate-related osteonecrosis of the jaw (BRONJ) with advanced peri-implantitis and implant removal, and further promote the awareness of this newly emerging complication. Four female patients presented with discomfort and pain on the dental implants placed 5–16 years ago. They were prescribed oral bisphosphonate after 3–14 years of post-implant osseointegration. Owing to advanced peri-implantitis, all the patients underwent implant removal, following which, they developed BRONJ. Initially, in a clinical setting of private practice, antibiotic medications were prescribed, and surgical debridement was performed. However, only one patient could be successfully treated. The symptoms persisted and worsened in the other three patients. They were subsequently referred to University hospitals for further treatment. Many dentists assess the risk of BRONJ before implant placement. However, an increasing number of patients initiate bisphosphonate medication for osteoporosis and other reasons because of increased life expectancy and availability of medical care; these factors may pose a significant impact on patients with advanced peri-implantitis. Therefore, in light of these findings, dentists should be aware of the possibility of BRONJ in such cases.

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Oral Bisphosphonate Related Osteonecrosis of the Jaw: A Challenging Adverse Effect

ISRN Rheumatology ◽

10.1155/2013/215034 ◽

2013 ◽

Vol 2013 ◽

pp. 1-6 ◽

Cited By ~ 9

Author(s):

Ilke Coskun Benlidayi ◽

Rengin Guzel

Keyword(s):

Risk Factors ◽

Adverse Effect ◽

Current Knowledge ◽

Osteonecrosis Of The Jaw ◽

Oral Bisphosphonates ◽

Treatment Of Osteoporosis ◽

Preventative Measures ◽

Oral Bisphosphonate ◽

Surgical Methods ◽

Antiresorptive Drugs

Oral bisphosphonates are the most commonly prescribed antiresorptive drugs for the treatment of osteoporosis. However, there are several adverse effects associated with oral bisphosphonates including the bisphosphonate related osteonecrosis of the jaw (BRONJ). With a better understanding of this side effect, reported incidences for BRONJ in oral bisphosphonate users have increased in time. The pathogenesis of BRONJ has not been well determined. Several risk factors such as dentoalveolar surgery, therapy duration, and concomitant steroid usage have been linked to BRONJ. Conservative and surgical methods can be preferred in the treatment. Preventative measures are of great importance for the patients at high risk. In this paper, osteonecrosis of the jaw secondary to oral bisphosphonates was reviewed in order to increase awareness as well as to renew the current knowledge.

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Psychological Resilience Provides No Independent Protection From Suicidal Risk

Crisis ◽

10.1027/0227-5910/a000364 ◽

2016 ◽

Vol 37 (2) ◽

pp. 130-139 ◽

Cited By ~ 9

Author(s):

Danica W. Y. Liu ◽

A. Kate Fairweather-Schmidt ◽

Richard Burns ◽

Rachel M. Roberts ◽

Kaarin J. Anstey

Keyword(s):

Risk Factors ◽

Well Being ◽

Current Status ◽

Psychological Resilience ◽

Cross Sectional ◽

Life Project ◽

Resilience Factors ◽

First Time

Abstract. Background: Little is known about the role of resilience in the likelihood of suicidal ideation (SI) over time. Aims: We examined the association between resilience and SI in a young-adult cohort over 4 years. Our objectives were to determine whether resilience was associated with SI at follow-up or, conversely, whether SI was associated with lowered resilience at follow-up. Method: Participants were selected from the Personality and Total Health (PATH) Through Life Project from Canberra and Queanbeyan, Australia, aged 28–32 years at the first time point and 32–36 at the second. Multinomial, linear, and binary regression analyses explored the association between resilience and SI over two time points. Models were adjusted for suicidality risk factors. Results: While unadjusted analyses identified associations between resilience and SI, these effects were fully explained by the inclusion of other suicidality risk factors. Conclusion: Despite strong cross-sectional associations, resilience and SI appear to be unrelated in a longitudinal context, once risk/resilience factors are controlled for. As independent indicators of psychological well-being, suicidality and resilience are essential if current status is to be captured. However, the addition of other factors (e.g., support, mastery) makes this association tenuous. Consequently, resilience per se may not be protective of SI.

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Medication-Related Osteonecrosis of the Jaw (MRONJ): Are Antiresorptive Drugs the Main Culprits or Only Accomplices? The Triggering Role of Vitamin D Deficiency

Nutrients ◽

10.3390/nu13020561 ◽

2021 ◽

Vol 13 (2) ◽

pp. 561

Author(s):

Luca Dalle Carbonare ◽

Monica Mottes ◽

Maria Teresa Valenti

Keyword(s):

Vitamin D ◽

Clinical Condition ◽

Case Series ◽

Osteonecrosis Of The Jaw ◽

First Case ◽

Vitamin D Levels ◽

Exposed Bone ◽

Antiresorptive Drugs ◽

Almost All

Osteonecrosis of the jaw (ONJ) is a severe clinical condition characterized mostly but not exclusively by an area of exposed bone in the mandible and/or maxilla that typically does not heal over a period of 6–8 weeks. The diagnosis is first of all clinical, but an imaging feedback such as Magnetic Resonance is essential to confirm clinical suspicions. In the last few decades, medication-related osteonecrosis of the jaw (MRONJ) has been widely discussed. From the first case reported in 2003, many case series and reviews have appeared in the scientific literature. Almost all papers concerning this topic conclude that bisphosphonates (BPs) can induce this severe clinical condition, particularly in cancer patients. Nevertheless, the exact mechanism by which amino-BPs would be responsible for ONJ is still debatable. Recent findings suggest a possible alternative explanation for BPs role in this pattern. In the present work we discuss how a condition of osteomalacia and low vitamin D levels might be determinant factors.

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Radiology of the head and neck

10.1093/med/9780199682874.003.0218 ◽

2021 ◽

pp. 973-976

Author(s):

Ivan Zammit-Maempel

Keyword(s):

Head And Neck ◽

Imaging Techniques ◽

Cone Beam Ct ◽

Neck Mass ◽

Positron Emission ◽

Pet Ct ◽

Magnetic Resonance Imaging Mri ◽

Video Fluoroscopy

Various imaging techniques are used in the staging and follow-up of head and neck cancer and evaluating patients presenting with a neck mass. The workhorses in imaging the neck are ultrasonography, computed tomography (CT), and magnetic resonance imaging (MRI) with positron emission tomography CT (PET-CT) increasingly being requested. Plain radiographs, contrast studies, video fluoroscopy, angiography, and cone beam CT have limited but important roles. This chapter discusses the role of some of these modalities.

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