Alendronic acid/pamidronic acid/risedronic acid
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Alendronic acid/pamidronic acid/ risedronic acid Osteonecrosis of the jaw and osteomyelitis: 3 case reports
Three patients developed osteonecrosis of the jaw (ONJ) and mandibular osteomyelitis while receiving risedronic acid, alendronic acid and pamidronic acid, respectively [dosages not stated]; two of the patients suffered fractures as a result of ONJ. A 74-year-old woman received risedronic acid for corticosteroid-induced osteoporosis. During treatment, she was placed with subperiosteal dental implants. Eight years later, ONJ developed in her left mandible [time to reaction onset not clearly stated]. She subsequently experienced a pathologic fracture, managed with debridement and surgical fixation. Acute osteomyelitis of the anterior mandibular was diagnosed. Multiple bacteria were grown on bone and tissue cultures, treated with moxifloxacin. In the fourth week of antibiotic treatment, she developed a mandibular fistula, draining exudate. Further moxifloxacin was administered, along with hyperbaric oxygen. She underwent fistula excision, along with debridement, reconstruction and plating of her mandible. Many anaerobes were cultured. After 8 weeks of clindamycin treatment, the infection had not recurred. A 61-year-old woman with osteoporosis had been treated with alendronic acid for over 10 years, when she presented with pain in her left mandible and a submandibular fistula, draining exudate. She was diagnosed with ONJ with an infection superimposed. The necrotic tissue and bone was debrided, and extensive acute inflammation was seen histopathologically. Multiple bacteria were grown on bone and tissue cultures, treated with cefuroxime for 6 weeks. Her infection resolved. An 88-year-old man with bone metastases of prostate cancer had been receiving pamidronic acid for more than 5 years. He presented with a left mandibular pathologic fracture. After debridement and surgical fixation, nonviable bone and acute inflammation were seen on histology, along with Actinomyces bacteria. After 12 weeks’ treatment with amoxicillin, the fracture had completely healed. Three months after treatment had ended, there was no sign of recurrent infection. Author comment: "Mandibular osteomyelitis is an uncommon clinical condition, but one that may be increasingly recognized in patients with bisphosphonateassociated ONJ." Cennimo DJ, et al. Bisphosphonate-associated osteonecrosis of jaw and osteomyelitis. JK Science 11: 133-135, No. 3, Jul-Sep 2009 - USA
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Reactions 13 Mar 2010 No. 1292
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