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Bisphosphonates and osteonecrosis of the jaw: a case report.

Reiriz AB, De Zorzi Pde M, Lovat CP - Clinics (Sao Paulo) (2008)

View Article: PubMed Central - PubMed

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In addition, patients frequently need radiotherapy or surgery to treat bone pain or to prevent pathological fractures., Because of this, complications from bone metastases heavily impact the quality of life of patients with cancer... Therefore, the prevention or delay of these complications would be of significant benefit to patients with advanced cancer... The bisphosphonates represent a major advance in helping patients with bone metastases... Currently, therapy with bisphosphonates is considered standard in the prevention of skeletal complications in patients with bone metastases... Although serious side-effects have been reported, including acute renal failure after intravenous administration and gastrointestinal toxicities such as esophagitis when used orally, these drugs are generally well tolerated... Recently, however, a new complication associated with the use of bisphosphonates has been described: osteonecrosis of the jaw... Numerous clinical studies have shown that bisphosphonates can reduce the incidence of pathological fractures, bone pain, episodes of hypercalcemia and the need for radiotherapy and surgery in patients with osteolytic bone metastases. – In addition to adverse effects previously associated with the use of bisphosphonates, a new complication has recently been described: avascular osteonecrosis of the jaw. ,,– The incidence of this complication is around 0.03% to 6.2%... However, extended treatments with bisphosphonates increase the risk of osteonecrosis, which is greater with the use of zoledronic acid than with the use of pamidronate in treatments exceeding 36 months., Reports have shown that the majority of patients (69%) had teeth pulled before the development of osteonecrosis... In addition, a regular visual inspection by an oncologist and a routine evaluation by a dentist are important... If osteonecrosis develops, non-surgical access can achieve benefits through antibiotic therapy... Interruption of bisphosphonate therapy can be considered in severe cases if the benefits outweigh the risks of skeletal events, although no improvements have been observed in cases published so far... Similarly, therapy with hyperbaric oxygen did not prove to be effective.

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Ulcered jaw lesion with local purulent secretion due to osteonecrosis after zoledronic acid treatment
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f1-cln63_2p0281: Ulcered jaw lesion with local purulent secretion due to osteonecrosis after zoledronic acid treatment

Mentions: A 57-year-old male patient sought medical help for progressive lumbar pain. Tomographic studies revealed lytic lesions in L1, L2 and L3, and a hypodense lobulated mass in the left kidney. The patient underwent radiotherapy on the lumbar column, followed by a left nephrectomy (renal clearance after this procedure was 80 mL/min) and treatment with 5 MU/m² interferon, three times a week, and 4 mg of intravenous zoledronic acid administered as a 15-minute infusion every 4 weeks. After one year of therapy with no evidence of active disease, the patient required invasive dental treatment due to intense pain in his left molar tooth. Fifteen days after this procedure, he developed an ulcerated lesion in his lower jaw with local purulent secretion (Figure 1). In a radiological evaluation, osteonecrosis with bone rarefaction in the regional jaw was discovered (Figure 2).


Bisphosphonates and osteonecrosis of the jaw: a case report.

Reiriz AB, De Zorzi Pde M, Lovat CP - Clinics (Sao Paulo) (2008)

Ulcered jaw lesion with local purulent secretion due to osteonecrosis after zoledronic acid treatment
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2664202&req=5

f1-cln63_2p0281: Ulcered jaw lesion with local purulent secretion due to osteonecrosis after zoledronic acid treatment
Mentions: A 57-year-old male patient sought medical help for progressive lumbar pain. Tomographic studies revealed lytic lesions in L1, L2 and L3, and a hypodense lobulated mass in the left kidney. The patient underwent radiotherapy on the lumbar column, followed by a left nephrectomy (renal clearance after this procedure was 80 mL/min) and treatment with 5 MU/m² interferon, three times a week, and 4 mg of intravenous zoledronic acid administered as a 15-minute infusion every 4 weeks. After one year of therapy with no evidence of active disease, the patient required invasive dental treatment due to intense pain in his left molar tooth. Fifteen days after this procedure, he developed an ulcerated lesion in his lower jaw with local purulent secretion (Figure 1). In a radiological evaluation, osteonecrosis with bone rarefaction in the regional jaw was discovered (Figure 2).

View Article: PubMed Central - PubMed

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

In addition, patients frequently need radiotherapy or surgery to treat bone pain or to prevent pathological fractures., Because of this, complications from bone metastases heavily impact the quality of life of patients with cancer... Therefore, the prevention or delay of these complications would be of significant benefit to patients with advanced cancer... The bisphosphonates represent a major advance in helping patients with bone metastases... Currently, therapy with bisphosphonates is considered standard in the prevention of skeletal complications in patients with bone metastases... Although serious side-effects have been reported, including acute renal failure after intravenous administration and gastrointestinal toxicities such as esophagitis when used orally, these drugs are generally well tolerated... Recently, however, a new complication associated with the use of bisphosphonates has been described: osteonecrosis of the jaw... Numerous clinical studies have shown that bisphosphonates can reduce the incidence of pathological fractures, bone pain, episodes of hypercalcemia and the need for radiotherapy and surgery in patients with osteolytic bone metastases. – In addition to adverse effects previously associated with the use of bisphosphonates, a new complication has recently been described: avascular osteonecrosis of the jaw. ,,– The incidence of this complication is around 0.03% to 6.2%... However, extended treatments with bisphosphonates increase the risk of osteonecrosis, which is greater with the use of zoledronic acid than with the use of pamidronate in treatments exceeding 36 months., Reports have shown that the majority of patients (69%) had teeth pulled before the development of osteonecrosis... In addition, a regular visual inspection by an oncologist and a routine evaluation by a dentist are important... If osteonecrosis develops, non-surgical access can achieve benefits through antibiotic therapy... Interruption of bisphosphonate therapy can be considered in severe cases if the benefits outweigh the risks of skeletal events, although no improvements have been observed in cases published so far... Similarly, therapy with hyperbaric oxygen did not prove to be effective.

Show MeSH
Related in: MedlinePlus