August 20, 2015
A 66-year-old man with known metastatic breast cancer, on Zometa (bisphosphonate) for the last 5 years, who presented with difficulty opening his mouth and chewing on left side for last 2 months
Bisphosphonate-Associated Osteonecrosis of the Jaws
- Background:
- Bisphosphonates are a class of drugs that decrease bone turnover by inhibiting osteoclast activity.
- They are used to treat osteoporosis, multiple myeloma (MM), Paget disease, pain from osseous metastases, and malignancy-related hypercalcemia.
- Recently, an association between use of bisphosphonate and osteonecrosis of the jaws has been found.
- Relevant Clinical Information:
- Bisphosphonate-associated osteonecrosis (BAO) of the jaws usually presents with nonhealing extraction sockets and painful bone exposure.
- It is more common in the mandible than the maxilla.
- Diagnosis of BAO is mainly clinical.
- It is better to avoid biopsy in these patients, because of poor bone healing.
- Key Diagnostic Features:
- Cortical destruction
- Osseous sclerosis
- Fragmentation and sequestration
- Periosteal bone formation
- Cortical thickening
- DDx:
- Neuralgia-inducing cavitatory osteonecrosis (NICO)
- Osteomyelitis
- Osteoradionecrosis
- Metastasis
- Paget disease
- Rx:
- Discontinuation of bisphosphonate
- Medical therapy with antimicrobial rinses, systemic antibiotics, and analgesics
- Surgical intervention in the advanced stage
