Retrospective evaluation of pathologic fractures in medication related osteonecrosis of the jaw

Yasan, Goknur Topaloglu; Adiloğlu, Selen; Köseoǧlu, Özgen

doi:10.1016/j.jcms.2021.03.007

Cited by 3 publications

(4 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Pathologic fractures are more likely to appear in the mandible than in the maxilla because of its morphology and, when compared to the mandible, a maxillary pathological fracture rarely reaches large dimensions [ 6 , 17 , 22 ]. There are limited data on the incidence of MRONJ-related PMF, with previous studies reporting incidence rated of 2.9–4.31% of MRONJ cases [ 13 , 17 ]. The possible predisposing factors for MRONJ-related PMF may include medical comorbidities, systemic factors, additive toxic effects of other medications such as corticosteroids and chemotherapeutic agents, genetic factors, and specific pathogens [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

“…To prevent PMF, it is necessary to know the causative factors and appropriate treatment protocols for MRONJ. Traumatic extractions and implant placement surgeries without the necessary preventive measures in susceptible patients should be avoided, as they present high risk for MRONJ-related PMF [ 13 ]. Other precautions include informing patients about the severity of the disease and the importance of regular follow-up, as well as removing the necrotic bone and strengthening the weakened mandible with reconstruction plates as an early surgical intervention [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, Actinomyces sp. is the bacteria most commonly involved in the pathogenesis of MRONJ, and opportunistic infections may be an important risk factor for PMF [ 13 ].…”

Section: Introductionmentioning

confidence: 99%

“…MRONJ-related PMF treatment options range from conservative therapies, with the use of teriparatide [ 14 , 15 ], mouth rinses, and oral antibiotics [ 16 ], to surgical treatment. These include relatively simple surgical approaches combined with intermaxillary fixation [ 13 ], as well as more extensive and aggressive surgeries such as resection and musculocutaneous free-flap mandibular reconstructions [ 8 ], using internal or external fixations [ 17 ].…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

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

Fernandes,

Viezzer Fernandes,

Jitumori

et al. 2023

Am J Case Rep

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…Furthermore, Actinomyces sp. is the bacteria most commonly involved in the pathogenesis of MRONJ, and opportunistic infections may be an important risk factor for PMF [ 13 ].…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

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

Fernandes,

Viezzer Fernandes,

Jitumori

et al. 2023

Am J Case Rep

View full text Add to dashboard Cite

show abstract

Antineoplastics

2021

Reactions Weekly

View full text Add to dashboard Cite

Osteonecrosis of the jaw and pathologic fracture of mandible: 5 case reportsA retrospective study involving 116 patients referred between 2012 and 2020, described 5 men aged 56-81 years old; they developed medication-related osteonecrosis of jaw (MRONJ) during treatment with zoledronic-acid, cabozantinib or sunitinib for metastatic prostate cancer or metastatic renal cancer. Additionally, they also developed pathologic fracture of mandible during treatment with leuprorelin, natalizumab, eculizumab or nilutamide for metastatic prostate cancer or metastatic renal cancer [dosages not stated; not all routes and duration of treatments to reactions onsets and outcomes stated].Patient 1: The 81-year-old man, who had metastatic prostate cancer received IV zoledronic-acid [zoledronate] for 24 months and developed stage 1 MRONJ. Subsequently, he also received leuprorelin [leuprolide]. He had asymptomatic, exposed, necrotic bone at the extraction site. Panoramic dental radiograph, showed changes in trabecular pattern and persistence of unremodeled bone in the associated area. He did not report for follow-up for 2 years. After 24 months, there were intraoral and extraoral fistulas and pus drainage. The region occasionally became infected and he used unspecified antibiotics. Thus, right mandibular canine was extracted, and curettage of the necrotic area was done twice, at an external center. However, cone beam CT (CBCT) evaluation revealed a severe defective non-displaced jaw fracture of the right mandibular molar secondary to leuprorelin therapy and severe progression of stage 1 MRONJ lesion following tooth extraction. Due to his poor general systemic condition, surgical treatment could not be performed; thus, debridement was done to relieve soft tissue irritation. Microbiological culture of bone specimens showed bacterial infections including Actinomyces odontolyticus, Prevotella disiens, Veillonella parvula. Therefore, he was referred to the infectious diseases department and received IV amoxicillin for two weeks, followed by oral administration for 6 months. At the 36 month follow-up, bone healing was observed in panoramic radiographs along with complete mucosal healing.Patient 2: The 68-year-old man, who had metastatic prostate cancer received IV zoledronic-acid [zoledronate] and cabozantinib for 12 months and developed stage 1 MRONJ. Subsequently, he also received natalizumab and eculizumab. He had asymptomatic, exposed, necrotic bone at multiple extraction sites. Panoramic dental radiograph showed, non-healed extraction sockets. After 2 months, the extraction area became infected and progressed to stage 2 MRONJ. He refused surgical treatment because of poor systemic condition, and received only unspecified antibiotics. He could not be reached until 48 months. After 48 months follow-up, cone beam CT (CBCT) evaluation revealed, a severe defective jaw fracture of right mandibular anterior and premolar secondary to natalizumab and eculizumab therapy and severe progression of stage 1 MRONJ lesion following tooth extraction....

show abstract

Anti-resorptive related osteonecrosis of the jaw in a patient with hemodialysis: Rapid progression and pathologic fracture in a short phase

Kanno

Kitabatake

Kojima

et al. 2022

J Case Rep Images Dent

View full text Add to dashboard Cite

Introduction: Anti-resorptive agent-related osteonecrosis of the jaw (ARONJ) is a slowly progressive disease occurring due to the chronic use of antiresorptive agents (e.g., bisphosphonates) and rarely presents with pathologic fractures. The frequency of pathologic fractures is rare, especially in patients with osteoporosis who are prescribed, low-dose bone-modifying agents. Herein, we report a case of rapidly progressive ARONJ with a pathologic fracture in a patient with hemodialysis. Case Report: A 64-year-old woman with hemodialysis due to the microscopic polyangiitis who was treated with corticosteroids, immunosuppressants, and ibandronate presented with tooth pain of left mandibular second premolar and second molar, necessitating extraction. After extraction, ARONJ developed in the left mandibular. Anti-resorptive agent-related osteonecrosis of the jaw progressed rapidly during the follow-up at the 12th and 15th months, furthermore, ARONJ also developed in the right mandibular second premolar and second molar lesion, requiring extensive surgery. We performed curative segmental and marginal mandibulectomy in the left and right hemimandible, respectively. The postoperative course was uneventful. Conclusion: We report a rare case of rapidly progressive ARONJ with pathologic fracture in a patient with hemodialysis. This report suggests a potential role of hemodialysis as a risk factor for disease progression and pathologic fracture development. Further studies regarding factors that inhibit the healing of ARONJ are still needed.

show abstract

Retrospective evaluation of pathologic fractures in medication related osteonecrosis of the jaw

Cited by 3 publications

References 21 publications

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

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

Antineoplastics

Anti-resorptive related osteonecrosis of the jaw in a patient with hemodialysis: Rapid progression and pathologic fracture in a short phase

Contact Info

Product

Resources

About