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Bisphosphonate-related osteonecrosis of jaw: case report A 64-year-old woman developed bisphosphonate-related osteonecrosis of jaw (BRONJ) during treatment with alendronic acid for osteoporosis. The woman was referred to the dermatology department by the maxillofacial surgeons with a 5 months history of a non-healing ulcer to the right jaw. She reported that she developed a small swelling on her jaw, which subsequently ulcerated and increased in size over time without any symptoms. She had a history of kyphosis, osteoporosis and a previous fracture of the femur neck. Her drug history included alendronic acid [route and dosage not stated], which she had been taking intermittently for years and restarted again 8 months before the development of the ulcer. She was non-alcoholic with a history of smoking 40 pack-yearly. Physical examination showed an ulcer 25 x 20mm in size on the right mandible with exposed bone. An intraoral examination was found to be unremarkable except numerous carious teeth. Lymphadenopathy was absent. The biopsy was performed and a histological study showed inflammation of ulcerated epithelium without evidence of malignancy. CT scan of the neck revealed a normal mandible, while increased uptake at the right hemimandible adjacent to the ulceration was observed in nuclear medicine single-photon emission CT scan. A repeated skin biopsy showed mild chronic inflammation without evidence of malignancy or granulomas. In view of symptoms and findings, a differential diagnosis of BRONJ, tuberculous lymphadenitis and pressure-induced ulceration were made. She had a history of kyphosis, but there was no direct pressure on the area of ulceration. However, the initial samples were not obtained for culture study and granulomas were not observed. Based on the presenting symptoms and investigational findings, a diagnosis of BRONJ had confirmed [duration of treatment to reaction onset not stated]. The woman’s alendronic acid treatment was discontinued. Over the next 5 months after cessation of treatment, complete resolution of the ulcer was noted. Due to the resolution of ulcers, testing for tuberculosis was not performed. Also, she was started on calcium supplementation and vitamin D and remained under review by the bone metabolism clinic. McCusker S, et al. A cutaneous presentation of bisphosphonate-related osteonecrosis of the jaw. Clinical and Experimental Dermatology 45: 932-934, No. 7, Oct 2020. 803504524 Available from: URL: http://doi.org/10.1111/ced.14240

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