Alendronic acid/risedronic acid
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Osteonecrosis of the jaw in elderly patients: 2 case reports Two women developed osteonecrosis of the jaw (ONJ) during treatment with risedronic acid or alendronic acid for osteoporosis. A 70-year-old woman, who had been receiving oral risedronic acid 5 mg/day for 4 years, presented with jaw pain for 11 months; pain had developed after wisdom tooth extraction, and persisted despite wound curettage. Examination revealed an unhealed socket at tooth 38, and mild left-sided facial swelling. X-rays revealed osteolysis in her left mandibular alveolus, and a CT scan showed a left mandibular sequestrum and bony defect. Risedronic acid was immediately withdrawn. She underwent sequestrectomy and received antibacterials, and her wound healed well. No further increase in the size of the bony defect was noted on follow-up x-ray. A good edentulous ridge was noted on 5-month review. A 78-year-old woman, who had started receiving oral alendronic acid 70 mg/week three years earlier, presented with a 2-year history of a non-healing wound; the wound had first developed after extraction of teeth 32–34, and persisted despite curettage. On examination, a buccal sinus was found discharging pus at the tooth 33 alveolus. No osteonecrosis was evident on CT scan. She underwent resection of the tooth 33 region of her left mandibular alveolus; osteomyelitis and actinomycetes were noted in the alveolus, and antibacterials were initiated. On 2-week follow-up, the wound was healing well, a good ridge was evident at the resection site, and an x-ray revealed good periapical bone remodelling. She underwent lower jaw rehabilitation with removable partial dentures 1 year after the resection, and returned with pain in the edentulous ridge of the anterior mandible. On examination, an exposed bone chip was noted in her lower anterior alveolus, and an x-ray showed sclerotic changes. Bisphosphonate-induced ONJ was suspected, and alendronic acid was withdrawn. She underwent surgical removal of the necrotic bone, and her wound subsequently healed well. On 3-month followup, she had recovered and was using modified dentures. Tong CK, et al. Osteonecrosis of the jaw after oral bisphosphonate for osteoporosis. Hong Kong Medical Journal 16: 145-8, No. 2, Apr 2010 - Hong 803030539 Kong
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Reactions 7 Aug 2010 No. 1313
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