Case of the Week
Section Editors: Matylda Machnowska1 and Anvita Pauranik2
1University of Toronto, Toronto, Ontario, Canada
2BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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August 20, 2015
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
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