A Case Report of Oral Bisphosphonate Treatment for Osteoporosis Leading to Atypical Femoral Fracture and Pathologic Mandibular Fracture

Abstract

Patient: Female, 63-year-old Final Diagnosis: Atypical femoral fracture • medication-related osteonecrosis of the jaws • osteomyelitis of the femur pathologic mandibular fracture Symptoms: Chin hyperemia • intraoral suppuration • mandibular bone exposure Clinical Procedure: Antibiotics • debridement • dental implant removal • discontinue bisphosphonate • hyperbaric oxygen treatment • internal fixation • open reduction • sequestrectomy Specialty: Dentistry • Infectious Diseases • Orthopedics and Traumatology Objective: Rare coexistence of disease or pathology Background: Bisphosphonates inhibit bone resorption in patients with postmenopausal osteoporosis and reduce osteoporotic fracture incidence. Medication-related osteonecrosis of the jaws (MRONJ) and atypical femoral fractures (AFF) are both rare but serious adverse effects of anti-resorptive drugs (ARD) such as bisphosphonates. The most advanced form of MRONJ is termed stage 3 and can lead to severe local sequelae like pathologic mandibular fractures (PMF). This study reports a case of MRONJ-related PMF and AFF with osteomyelitis secondary to bisphosphonate treatment for osteoporosis. Case Report: A 63-year-old white woman was diagnosed with PMF related to MRONJ stage 3 during treatment of an AFF with osteomyelitis. She had been treated for postmenopausal osteoporosis with 70 mg of alendronate weekly for 2 years. The PMF was treated by stable internal fixation combined with debridement and sequestrectomy, but further debridement was required and 2 mandibular implants were then removed. Postoperative recovery was uneventful and the mandibular infection was controlled after the second surgery. Three weeks later, she was discharged from the hospital, instructed to discontinue the use of alendronate, and referred for 30 sessions of hyperbaric oxygen therapy. At the 3-year follow-up, the PMF was completely healed without signs of mandibular infection or bone exposure. Conclusions: This report raises awareness of both MRONJ and AFF as possible adverse effects of short-term bisphosphonate therapy for postmenopausal osteoporosis, and highlights the importance of dental and orthopedic follow-ups. It is crucial to emphasize the need for early diagnosis and treatment to prevent MRONJ progression to PMF.

Treatment of Medication-Related Osteonecrosis of the Jaws without Segmental Resections: A Case Series

“…It is essential to emphasize the need for professional and scientific interaction between healthcare professionals for the prevention and treatment of MRONJ, particularly between physicians who treat metabolic and metastatic bone diseases and dental surgeons, who are responsible for the prevention, diagnosis, and treatment of the disease. The lack of diagnosis and correct treatment of MRONJ by healthcare teams can lead to disastrous consequences for patients, such as the occurrence of pathologic mandibular fracture and its complications [ 22 ].…”