Medication-Related Osteonecrosis: A Clinical Case Report
Keywords:Bone, Osteoporosis, Osteonecrosis, Diphosphonates.
Introduction: Medication-related osteonecrosis is a debilitating pathology that affects patients who undergo or have undergone treatment for metabolic bone tissue diseases with antiresorptive and/or antiangiogenic drugs. It is the exposure of necrotic bone tissue in the maxillofacial region, persisting for more than 8 weeks, which can be probed through intra- or extraoral fistula in patients who take these medications and do not have a previous history of radiotherapy in the head and neck region. Countless treatments aim to solve the lesions triggered by the disease. However, none of them was consolidated in the literature as the choice one.
Methods: This paper consisted of a clinical case study, with a 32-month clinical follow-up of a patient with postmenopausal osteoporosis. She developed an osteonecrotic lesion post-exodontia in the left inferior quadrant.
Results: After outpatient conservative therapy, hospital surgery, and laser therapy, the clinical lesion was solved, without recurrence.
Conclusion: Medication-related osteonecrosis is a difficult-to-treat condition that causes morbidity in those affected. The conservative handling of the clinical case resulted in beneficial effects to solve the painful symptomatology and infection. However, it was not enough to close the wound and solve the lesion in stage 2, which only happened after hospital surgery.
Drake MT, Clarke BL, Khosla S. Bisphosphonates: mechanism of action and role in clinical practice. Mayo Clin Proc 2008; 83(9): 1032-45. https://doi.org/10.4065/83.9.1032
Ballantyne E. Bisphosphonates: possible modes of action and implications for dental implant treatment. A review of the literature. J Gen Pract 2016; 3(1): 1-28.
Marx RE. Pamidronate (Aredia) and zoledronate (Zometa) induced avascular necrosis of the jaws: a growing epidemic. J Oral Maxillofac Surg 2003; 61(9): 1115-17. https://doi.org/10.1016/S0278-2391(03)00720-1
Khan AA, Morrison A, Hanley DA, Felsenberg D, McCauley LK, O'Ryan F, et al. Diagnosis and management of osteon-ecrosis of the jaw: a systematic review and international consensus. J Bone Miner Res 2015; 30(1): 3-23. https://doi.org/10.1002/jbmr.2405
Atanes-Bonome P, Atanes-Bonome A, Ríos-Lage P, Atanes-Sandoval AD. Osteonecrosis de los maxilares relacionada con el tratamiento con bifosfonatos [Bisphosphonate-related osteonecrosis of the jaw]. Semergen 2014; 40(3): 143-8. Spanish. https://doi.org/10.1016/j.semerg.2013.05.005
Favia G, Tempesta A, Limongelli L, Crincoli V, Maiorano E. Medication-related osteonecrosis of the jaw: Surgical or non-surgical treatment? Oral Dis 2018; 24(1-2): 238-242. https://doi.org/10.1111/odi.12764
Tardast A, Sjöman R, Løes S, Abtahi J. Bisphosphonate associated osteomyelitis of the jaw in patients with bony exposure: prevention, a new way of thinking. J Appl Oral Sci 2015; 23(3): 310-4. https://doi.org/10.1590/1678-775720140506
Fernández E, González H, Castro A, Lisboa D. Osteología: relevancia de conceptos médicos en el ámbito odontológico. Rev Clín Periodoncia Implantol Rehabil Oral 2015; 8(1): 83-92. https://doi.org/10.1016/j.piro.2015.02.010
Migliorati CA, Brennan MT, Peterson DE. Medication-related osteonecrosis of the jaws. J Natl Cancer Inst Monogr 2019; 2019(53): 107-15. https://doi.org/10.1093/jncimonographs/lgz009
Ribeiro GH, Chrun ES, Dutra KL, Daniel FI, Grando LJ. Osteonecrosis of the jaws: a review and update in etiology and treatment. Braz J Otorhinolaryngol 2017; 84(1): 102-8. https://doi.org/10.1016/j.bjorl.2017.05.008
Rodriguez-Lozano FJ, Oñate-Sánchez RE. Treatment of osteonecrosis of the jaw related to bisphosphonates and other antiresorptive agents. Med Oral Patol Oral Cir Bucal 2016; 21(5): 595-600. https://doi.org/10.4317/medoral.20980
Shibahara T, Morikawa T, Yago K, Kishimoto H, Imai Y, Kurita K. National survey on bisphosphonate-related osteonecrosis of the jaws in Japan. J Oral Maxillofac Surg 2018; 76(10): 2105-12. https://doi.org/10.1016/j.joms.2018.04.009
Shibahara T. Antiresorptive agent-related osteonecrosis of the jaw (ARONJ): a twist of fate in the boné. Tohoku J Exp Med 2019; 247(2): 75-86. https://doi.org/10.1620/tjem.247.75
Mauceri R, Panzarella V, Maniscalco L, Bedogni A, Licata ME, Albanese A, et al. Conservative surgical treatment of bisphosphonate-related osteonecrosis of the jaw with Er, Cr: YSGG laser and platelet-rich plasma. Biomed Res Int 2018; 2018: 1-10. https://doi.org/10.1155/2018/3982540
Akashi M, Kusumoto J, Takeda D, Shigeta T, Hasegawa T, Komori T. A literature review of perioperative antibiotic ad-ministration in surgery for medication-related osteonecrosis of the jaw. Oral Maxillofac Surg 2018; 22(4): 369-378. https://doi.org/10.1007/s10006-018-0732-8
Nicolatou-Galitis O, Schiødt M, Mendes RA, Ripamonti C, Hope S, Drudge-Coates L, et al. Medication-related osteonecrosis of the jaw: definition and best practice for prevention, diagnosis, and treatment. Oral Surg Oral Med Oral Pathol Oral Radiol 2019; 127(2): 117-135. https://doi.org/10.1016/j.oooo.2018.09.008
Altay MA, Tasar F, Tosun E, Kan B. Low-level laser therapy supported surgical treatment of bisphosphonate-related osteonecrosis of jaws: a retrospective analysis of 11 cases. Photomed Laser Surg 2014; 32(8): 468-75. https://doi.org/10.1089/pho.2014.3742
Vescovi P, Merigo E, Meleti M, Manfredi M, Guidotti R, Nammour S. Bisphosphonates-related osteonecrosis of the jaws: a concise review of the literature and a report of a single-centre experience with 151 patients. J Oral Pathol Med 2012; 41(3): 214-21. https://doi.org/10.1111/j.1600-0714.2011.01091.x
da Guarda MG, Paraguassú GM, Cerqueira NS, Cury PR, Farias JG, Ramalho LM. Laser GaAlAs (k860 nm) photobiomodulation for the treatment of bisphosphonate-induced osteonecrosis of the jaw. Photomed Laser Surg 2012; 30(5): 293-7. https://doi.org/10.1089/pho.2011.3219
Scoletta M, Arduino PG, Reggio L, Dalmasso P, Mozzati M. Effect of low-level laser irradiation on bisphosphonate-induced osteonecrosis of the jaws: preliminary results of a prospective study. Photomed Laser Surg 2010; 28(2): 179-84. https://doi.org/10.1089/pho.2009.2501
Romeo U, Galanakis A, Marias C, Vecchio AD, Tenore G, Palaia G, et al. Observation of pain control in patients with bisphosphonate-induced osteonecrosis using low-level laser therapy: preliminary results. Photomed Laser Surg 2011; 29(7): 447-52. https://doi.org/10.1089/pho.2010.2835
Epstein MS, Wicknick FW, Epstein JB, Berenson JR, Gorsky M. Management of bisphosphonate-associated osteonecrosis: pentoxifylline and tocopherol in addition to antimicrobial therapy. An initial case series. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010; 110(5): 593-6. https://doi.org/10.1016/j.tripleo.2010.05.067
Otto S, Pautke C, Van den Wyngaert T, Niepel D, Schiødt M. Medication-related osteonecrosis of the jaw: prevention, diagnosis and management in patients with cancer and bone metastases. Cancer Treat Rev 2018; 69: 177-187. https://doi.org/10.1016/j.ctrv.2018.06.007
Reich W, Bilkenroth U, Schubert J, Wickenhauser C, Eckert AW. Surgical treatment of bisphosphonate-associated osteonecrosis: prognostic score and long-term results. J Craniomaxillofac Surg 2015; 43(9): 1809-1822. https://doi.org/10.1016/j.jcms.2015.07.035
Hayashida S, Soutome S, Yanamoto S, Fujita S, Hasegawa T, Komori T, et al. Evaluation of the treatment strategies for medication-related osteonecrosis of the jaws (MRONJ) and the factors affecting treatment outcome: a multicenter retrospective study with propensity score matching analysis. J Bone Miner Res 2017; 32(10): 2022-2029. https://doi.org/10.1002/jbmr.3191
Duque MGB, Ribeiro AS, Burzlaff JB, Silveira VS, Tonietto L, Calcagnotto T. Osteonecrose mandibular associada ao uso de bisfosfonatos tratada com plasma rico em fibrina leucocitária: relato de caso. RFO-UPF 2018; 22(3): 368-73. https://doi.org/10.5335/rfo.v22i3.7612
Longo F, Guida A, Aversa C, Pavone E, Di Costanzo G, Ramaglia L, et al. Platelet-rich plasma in the treatment of bisphosphonate-related osteonecrosis of the jaw: personal experience and review of the literature. Int J Dent 2014; 2014. https://doi.org/10.1155/2014/298945