Mandibular osteonecrosis due to bisphosphonate use

Abstract

Due to their efficient osteoclastic inhibitor effect in bone metabolism and antiangiogenic activity, bisphosphonates are widely used in many cancer diseases particularly in prostate cancers with bone metastasis, lung cancer, breast cancer and multiple myeloma, as well as in systemic diseases such as osteoporosis, osteopenia, Paget disease and osteogenesis imperfect for the last 13 years. Prostate cancer is a common cancer in males and it is the leading cause of bone metastasis. Mandibular metastasis is rarely encountered during the course of prostate cancer. Mandibular osteonecrosis as well has begun to be observed along with the availability of more efficient and stronger formulations developed following the use of bisphosphonates. Zolendronic acid, which has been used also by our patient, has widely come into practice as a 3 rd generation bisphosphonate. Because of prostate cancer and widespread bone metastases, our patient has been receiving zolendronic acid with maximum androgen blockage for 4 years. Tomography of the patient, who has undergone intensive treatment because of submandibular abscess, demonstrated extensive osteonecrosis in the fovea sublingual region of the mandible corpus. In large series, although, mandibular osteonecrosis was widely seen due to bisphosphonate use for the metastases of lung and breast cancers, this rate was between 9.6% and 11% for prostate cancer within the series. Although our patient had no mandibular metastasis before, mandibular necrosis was observed due to long-term bisphosphonate use. We are going to present our patient who had this rare complication with his clinical picture.

Saber tibia

“…Tienen también propiedades antiangiogénicas y una vida media de hasta 11 años tras la incorporación ósea. Antes de iniciar el tratamiento, cualquiera que sea la enfermedad y la vía de administración, sería conveniente realizar una revisión odontológica y exodonciar dientes periodontales sobre o adyacentes a la lesión, en aras de prevenir una osteonecrosis 2,[17][18][19] .…”

Osteonecrosis Mandibular Extended to Bisphosphonates: A Very Rare Extensive Case

“…However, local factors in the oral cavity, despite being absent from the formal definition of MRONJ, also increase risk and play a crucial role in the disease process [8][9][10]. This complication often occurs in patients at risk such as the age, immune status, nutritional status, and Karnofsky's "performance status" [11][12][13]. In our case, the ONJ appears to be linked to the zoledronate (Zometa) treatment with potential promoters of osteonecrosis as chemotherapy, corticotherapy, and poor oral status.…”

“…Bisphosphonates are inhibitors of osteoclastic resorption used to treat bone-remodeling disturbances and, therefore, used to prevent bone loss and preserve the integrity of the bone structure [5,14]. They are indicated in osteoporosis, Paget's disease, multiple myeloma like our patient and bone metastases from solid tumors and in malignant hypercalcaemia as well [12][13][14]. Only lesions of maxilla-mandibular necrosis are reported in the context of BP intake [12] and mandibule is reached twice than the maxillary probably because of the terminal vascularization [15].…”

Adenocarcinoma de próstata metastásico y enfermedad ósea de Paget mandibular

“…They also have anti-angiogenic properties and a half-life of up to 11 years after bone incorporation. Before starting treatment, whatever the disease and route of administration, a dental examination and extraction of periodontal teeth on or adjacent to the lesion, in order to prevent osteonecrosis are recommended 2,[17][18][19] .…”