Extensive osteonecrosis of the maxilla caused by bisphosphonates: Report of a rare case

Abstract

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. Key words:Osteonecrosis, bisphosphonate, bisphosphonate-associated osteonecrosis of the jaw, maxilla, osteoporosis.

Clinical profile of individuals with bisphosphonate-related osteonecrosis of the jaw: an integrative review

“…The commonest diagnoses relating to BRONJ were: breast cancer, in 60 individuals 9,10,12,16,17,19,21 (46.87%); osteoporosis, 10,[17][18][19][23][24][25][26] in 25 (19.53%); multiple myeloma, 5,9,16,17,20 in 16 (12.50%); and prostate cancer, 9,10,16,18,19 in 16 (12.50%) ( Table 1). 4,5,9,10,12,[16][17][18][19][20][21][23][24][25][26] The types of BPs most related to BRONJ were: zoledronic acid 9,10,12,[16][17][18][19][20][21]26...…”

“…4,5,9,10,12,[16][17][18][19][20][21][23][24][25][26] The types of BPs most related to BRONJ were: zoledronic acid 9,10,12,[16][17][18][19][20][21]26 (ZOE), in a dose of 4 mg intravenously, in 80 cases (62.50%); and alendronate 4,10,[17][18][19][23][24][25][26] (ALE) in a dose of between 70 and 90 mg orally, in 26 cases (20.31%). However, other BPs such as pamidronate 5,9,10,16,19 (PAM) (10.93%), an association of ZOE and PAM 10,19,26 in six cases (4.68%) and an association of ZOE and ALE 10,26 in two cases (1.56%) were also used. The duration of BP use until a manifestation of BRONJ ranged from 5 to 15 months, with a mean of 45.8 ± 39.7 months.…”

“…The duration of BP use until a manifestation of BRONJ ranged from 5 to 15 months, with a mean of 45.8 ± 39.7 months. 4,5,9,[16][17][18][19][20][21][22][23][24][25][26] Regarding the location of the BRONJ, the mandible was the most affected by BRONJ, 4,9,10,[16][17][18][19][20]25 in 70 cases (54.68%), followed by the maxilla 9,10,12,[16][17][18][19]21,[23][24][25][26] manifestations were in both jaws, 16,17,19 the palatine torus 10 and the mylohyoid region 17 ( Table 2). 4,5,9,10,12,[16][17][18][19][20]…”

“…4,5,9,10,12,[16][17][18][19][20][21][23][24][25][26] The main diagnostic criterion was clinical evaluation of bone exposure, 4,5,9,[16][17][18][19][20][21][22][23][24][25][26] which was found to be present in 100% of the cases. The most common complementary examinations were panoramic radiographs, 4,5,9,10,[16][17][18][19][20]23,25 in 114 cases (89.06%); and conebean computed tomography, 4,5,12,16,19,21,[24][25][26] in 52 cases (40.62%).…”

“…In contrast, the histopathological evaluation 4,21 was present only in three cases (2.34%) ( Table 2). 4,5,9,10,12,[16][17][18][19][20][21][23][24][25][26] The local trigger factors for BRONJ were the following: tooth extraction, 5,9,10,12,[16][17][18][19]25,26 in 63 individuals (45.98%); implant placement, 9,17,19,23,25 in 19 (13.86%); prosthetic trauma, 9,10,16,20 in 19 (13.86%); and spontaneous manifestation, 9,10,[16][17][18][19]21 in 19 (13.86%).…”