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

Abstract The aim of this report was to document a rare case of medication-related osteonecrosis of the jaw (MRONJ) that developed around the already osseointegrated implants in the maxillary right molar region. A 73-year-old woman presented at our university dental hospital in May 2017 with a chief complaint of discomfort near a maxillary implant. During the implant maintenance period, the patient began taking alendronate sodium hydrate (Fosamac ® tablets 35 mg once weekly), an oral bisphosphonate (BP), for treatment of osteoporosis. Eight years after starting implant maintenance, peri-implantitis occurred, for which mechanical cleaning and antimicrobial therapy was performed. Peri-implantitis symptoms disappeared, and the medical condition improved. However, MRONJ developed 4 years after she commenced taking the BP. The patient underwent implant removal and sequestrectomy. There was no postoperative recurrence. The events this patient experienced imply that a local infection around an implant and type 1 diabetes are factors in MRONJ development. It is important to note that implants in patients taking BPs should be more carefully maintained. In addition, we performed literature review and discovered only a few similar 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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Drug-induced jaw osteonecrosis

Ozone Therapy ◽

10.4081/ozone.2019.8698 ◽

2019 ◽

Vol 4 (3) ◽

pp. 48-54

Author(s):

Girolamo Donati

Keyword(s):

Osteonecrosis Of The Jaw ◽

Ozone Therapy ◽

Drug Induced ◽

Treatment Of Osteoporosis ◽

Oral Bisphosphonate ◽

Tissue Healing ◽

Biological Target ◽

Infection And Inflammation ◽

Antiangiogenic Drugs ◽

Efficient Alternative

Medication-related osteonecrosis of the jaw (MRONJ), an adverse reaction to medication, has been reported since 2002, at first in cancer patients with bone metastases treated intravenously with pamidronate or zoledronate, and later in patients taking oral bisphosphonate for the treatment of osteoporosis. Several cases of MRONJ have also been described in patients treated with antiangiogenic drugs with a so-called biological target (bevacizumab, sunitinib, sorafenib). Oxygen/ozone therapy for MRONJ treatment represents a possible and efficient alternative to the two main therapeutic approaches currently in use, antibiotic therapy and surgery. Since 2010, I have diagnosed 51 MRONJ cases at ASST Fatebenefratelli-Sacco. Subsequently and following the approval of the Ethics Committee (2015), patients with MRONJ level 1 and 2 have been included in an experimental protocol with oxygen/ozone therapy: Treatment of bisphosphonate-related osteonecrosis of the jaw with oxygen/ozone therapy and surgical debridement with piezoelectric scalpel. The study is currently running and up to now six out of fourteen patients healed perfectly. Among these six, four spontaneously or almost spontaneously have expelled the necrotic part without undergoing surgery. In three cases, there was only an improvement in symptoms. Five patients are currently being treated. Because of its antiseptic properties, oxygen ozone therapy reduced the effects of infection and inflammation, while the bio stimulant action of this therapy promoted the demarcation of bone sequestration and soft tissue healing.

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Development of Antiresorptive Agent-Related Osteonecrosis of the Jaw After Dental Implant Removal: A Case Report

Journal of Oral Implantology ◽

10.1563/aaid-joi-d-18-00032 ◽

2018 ◽

Vol 44 (5) ◽

pp. 359-364

Author(s):

Shinsuke Yamamoto ◽

Keigo Maeda ◽

Izumi Kouchi ◽

Yuzo Hirai ◽

Naoki Taniike ◽

...

Keyword(s):

Dental Implants ◽

Dental Implant ◽

Osteonecrosis Of The Jaw ◽

Japanese Woman ◽

Implant Removal ◽

Antiresorptive Agent ◽

Oral Bisphosphonate ◽

Antiresorptive Agents ◽

The Right ◽

Implant Treatment

Dental implant treatment is a highly predictable therapy, but when potentially lethal symptoms or complications occur, dentists must remove the implant fixture. Recently, reports on antiresorptive agent-related osteonecrosis of the jaw have increased in the field of dental implants, although the relationship between dental implant treatment and antiresorptive agents remains unclear. Here, we report a case of antiresorptive agent-related osteonecrosis of the jaw that developed after dental implant removal. A 67-year-old Japanese woman with a medical history of osteoporosis and 7 years of oral bisphosphonate treatment was referred to our hospital with a chief complaint of painful right mandibular bone exposure. A family dentist removed the dental implants from the right mandible using a trephine drill without flap elevation in August 2016. However, the healing was impaired; she was referred to our hospital 3 months after the procedure. We performed a sequestrectomy of the mandible under general anesthesia. In conclusion, this patient's course has two important implications: First, the removal of dental implants from patients who are prescribed oral bisphosphonates for long durations can cause antiresorptive agent-related osteonecrosis of the jaw. Second, meticulous procedures are required to prevent and treat the development of antiresorptive agent-related osteonecrosis of the jaw after dental implant removal.

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Necrotizing fasciitis as a complication of osteonecrosis of the jaw related to oral bisphosphonate application in a patient with osteoporosis: a case report

Oral and Maxillofacial Surgery ◽

10.1007/s10006-018-0725-7 ◽

2018 ◽

Vol 23 (1) ◽

pp. 83-89 ◽

Cited By ~ 1

Author(s):

David Steybe ◽

Pit Jacob Voss ◽

Michael Andreas Ermer ◽

Marc Anton Fuessinger ◽

Rainer Schmelzeisen ◽

...

Keyword(s):

Case Report ◽

Necrotizing Fasciitis ◽

Osteonecrosis Of The Jaw ◽

Oral Bisphosphonate

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Resolution of Oral Bisphosphonate and Steroid-Related Osteonecrosis of the Jaw—A Serial Case Analysis

Journal of Oral and Maxillofacial Surgery ◽

10.1016/j.joms.2009.12.030 ◽

2010 ◽

Vol 68 (5) ◽

pp. 1055-1063 ◽

Cited By ~ 45

Author(s):

Chang-Ta Chiu ◽

Wei-Fan Chiang ◽

Ching-Ya Chuang ◽

Sung-Wen Chang

Keyword(s):

Case Analysis ◽

Osteonecrosis Of The Jaw ◽

Oral Bisphosphonate

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Oral Bisphosphonate Use and Risk of Postmenopausal Endometrial Cancer

Journal of Clinical Oncology ◽

10.1200/jco.2014.58.6842 ◽

2015 ◽

Vol 33 (10) ◽

pp. 1186-1190 ◽

Cited By ~ 13

Author(s):

Polly A. Newcomb ◽

Michael N. Passarelli ◽

Amanda I. Phipps ◽

Garnet L. Anderson ◽

Jean Wactawski-Wende ◽

...

Keyword(s):

Endometrial Cancer ◽

Cancer Risk ◽

Postmenopausal Women ◽

Treatment Of Osteoporosis ◽

Endometrial Cancer Risk ◽

Patients With Cancer ◽

Oral Bisphosphonate ◽

Intact Uterus ◽

The Relationship

Purpose Bisphosphonates are common medications used for the treatment of osteoporosis and are also used to reduce metastases to bone in patients with cancer. Several studies, including the Women's Health Initiative (WHI), have found that use of bisphosphonates is associated with reduced risk of developing breast cancer, but less is known about associations with other common malignancies. This study was aimed at examining the effects of bisphosphonates on the risk of endometrial cancer. Methods We evaluated the relationship between use of oral bisphosphonates and endometrial cancer risk in a cohort of 89,918 postmenopausal women participating in the WHI. A detailed health interview was conducted at baseline, and bisphosphonate use was ascertained from an inventory of regularly used medications at baseline and over follow-up. All women had an intact uterus at the time of study entry. Results During a median follow-up of 12.5 years, 1,123 women were diagnosed with incident invasive endometrial cancer. Ever use of bisphosphonates was associated with reduced endometrial cancer risk (adjusted hazard ratio, 0.80; 95% CI, 0.64 to 1.00; P = .05), with no interactions observed with age, body mass index, or indication for use. Conclusion In this large prospective cohort of postmenopausal women, bisphosphonate use was associated with a statistically significant reduction in endometrial cancer risk.

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