Chronic erosive and ulcerative oral lesions caused by incorrect administration of alendronate

Krasagakis, Konstantin; Krüger‐Krasagakis, Sabine; Ioannidou, Despoina; Tosca, Androniki

doi:10.1016/j.jaad.2003.07.030

Cited by 34 publications

(24 citation statements)

References 3 publications

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“…sucking the tablets instead of swallowing them, was the cause of contact stomatitis with oral ulcerations in several cases. [96][97][98][99][100] In our opinion, some of these cases are remarkable in that they could be misdiagnosed as cases of osteonecrosis of the jaw and raise the question that, habitual contact of the bisphosphonate tablet with the gingival mucosa could possibly lead to osteonecrosis of the jaw.…”

Section: Miscellaneous Adverse Eventsmentioning

confidence: 91%

Bisphosphonate-associated adverse events

Papapetrou

2009

253

174

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The adverse events of the nitrogen-containing bisphosphonates are reviewed. Oral bisphosphonates (alendronate, risedronate and ibandronate), mainly used for the treatment of osteoporosis, have been associated with adverse events from the upper gastrointestinal tract, acute phase response, hypocalcaemia and secondary hyperparathyroidism, musculoskeletal pain, osteonecrosis of the jaw and ocular events. Intravenous bisphosphonates (pamidronate, ibandronate and zoledronic acid), used in oncology and for the treatment of osteoporosis, have been associated with all the above adverse events, except those from the upper gastrointestinal tract. Moreover, pamidronate and zoledronic acid have been associated with renal toxicity. Association of bisphosphonates with atrial fibrillation and atypical fractures of the femoral diaphysis remains uncertain. There are a few case reports relating bisphosphonates to cutaneous reactions, oral ulcerations, hepatitis and esophageal cancer. Generally, intravenous are more potent than oral bisphosphonates and the frequency and severity of some of the bisphosphonate-associated adverse events are dose and potency dependent.

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Section: Miscellaneous Adverse Eventsmentioning

confidence: 91%

Bisphosphonate-associated adverse events

Papapetrou

2009

253

174

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“…Discontinuation of the inappropriate use allowed healing of the mucosa ulcers, even with maintained oral intake, but taken according to the prescription instructions [172]. …”

Section: Bisphosphonatesmentioning

confidence: 99%

Extraskeletal benefits and risks of calcium, vitamin D and anti-osteoporosis medications

et al. 2012

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SummaryDrugs used for the prevention and the treatment of osteoporosis exert various favourable and unfavourable extra-skeletal effects whose importance is increasingly recognized notably for treatment selection.IntroductionThe therapeutic armamentarium for the prevention and the treatment of osteoporosis is increasingly large, and possible extra-skeletal effects of available drugs could influence the choice of a particular compound.MethodsThe present document is the result of a national consensus, based on a systematic and critical review of the literature.ResultsObservational research has suggested an inverse relationship between calcium intake and cardiovascular diseases, notably through an effect on blood pressure, but recent data suggest a possible deleterious effect of calcium supplements on cardiovascular risk. Many diverse studies have implicated vitamin D in the pathogenesis of clinically important non-skeletal functions or diseases, especially muscle function, cardiovascular disease, autoimmune diseases and common cancers. The possible effects of oral or intravenous bisphosphonates are well-known. They have been associated with an increased risk of oesophageal cancer or atrial fibrillation, but large-scale studies have not found any association with bisphosphonate use. Selective oestrogen receptor modulators have demonstrated favourable or unfavourable extra-skeletal effects that vary between compounds. Strontium ranelate has a limited number of non-skeletal effects. A reported increase in the risk of venous thromboembolism is not found in observational studies, and very rare cases of cutaneous hypersensitivity reactions have been reported. Denosumab has been introduced recently, and its extra-skeletal effects still have to be assessed.ConclusionSeveral non-skeletal effects of bone drugs are well demonstrated and influence treatment choices.

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“…The oral lesions were considered the result of prolonged BP remaining in the oral cavity, due to chewing of the tablet by the patient before swallowing, thus causing local tissue irritation. In our case, oral manifestations including labial ulceration, as well as gingival-osseous necrosis adjacent to the lower right canine are associated, for the first time, with intravenous use of ZA, and not oral aledronate, as in other cases [7][8][9][10][11][12].…”

Section: Discussionmentioning

confidence: 84%

“…Similarly, oral mucosal ulcerations of the tongue, the buccal mucosa, the floor of the mouth, or the lip are thought to be related to orally administrated BP (aledronate). These cases have been considered to arise because of incorrect, prolonged, local mucosal exposure or contact with the drug during oral (per os) administration [7][8][9][10][11][12].…”

Section: Introductionmentioning

confidence: 99%

Lip Ulceration Associated with Intravenous Administration of Zoledronic Acid: Report of a Case

Andreadis

Mauroudis

Poulopoulos

et al. 2011

Head and Neck Pathol

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Although osteonecrosis of the jaw is a wellknown adverse reaction of bisphosphonates (BPs), random cases of oral mucosal ulceration after per os administration of BP-aledronate have been attributed to prolonged mucosal irritation. This report, for the first time, describes the mucosal ulceration related to intravenous use of zoledronic acid (ZA). A 52-year-old female patient presented with painful ulcers on both cutaneous/mucosal surfaces of the lower lip and a 2-month history of osteonecrosis of the mandible beside the right lower canine. Her medical record included intravenous administration of ZA for 10 months for primary breast cancer metastatic to bone. Examination of the peripheral blood showed severe anemia and a slightly increased white blood cell count, due to urinary tract infection by E. coli, but no evidence of a viral infection. The treatment of anemia and E. coli infection did not improve the labial ulcers. Biopsy from the mucosal lesion revealed a nonspecific ulceration with moderate inflammatory infiltration. There was no evidence of infection or malignancy. ZA administration was discontinued and within 3 months the lesions were resolved after treatment with systemic antibiotics (amoxicillin), vitamins A and E, chlorexidine and H 2 O 2 (hydrogen peroxide) solutions and local pantothenic acid/ vitamin A creams. Recurrence was detected a month after ZA re-administration. Nevertheless, after new treatment, the patient was free of oral/skin lesions 18 months later. This case, which is the first report of ulceration associated with intravenous administration of bisphosphonates, suggests that systemic mechanisms may be implicated in BP-induced oral mucosal ulceration. Furthermore, ZA appears to cause the same oral mucosal manifestations as alendronate. This emphasizes the need for oral examination in all cases of BP therapy, whether per os or intravenously administrated.

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Chronic erosive and ulcerative oral lesions caused by incorrect administration of alendronate

Cited by 34 publications

References 3 publications

Bisphosphonate-associated adverse events

Bisphosphonate-associated adverse events

Extraskeletal benefits and risks of calcium, vitamin D and anti-osteoporosis medications

Lip Ulceration Associated with Intravenous Administration of Zoledronic Acid: Report of a Case

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