Multiple drugs
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Medication-related osteonecrosis of the jaw: 3 case reports In a retrospective analysis of non-interventional data of patients (aged >18 years), who had osteoporosis and inflammatory rheumatic diseases and were recruited from University Hospital Wurzburg, Germany between June 2015 and September 2016, three elderly women [exact ages not stated] were described, who developed medication-related osteonecrosis of the jaw (MRONJ) during treatment with abatacept, alendronic acid, azathioprine, ciclosporin, denosumab, ibandronic acid, infliximab, leflunomide, methotrexate, raloxifene, risedronic acid, rituximab, sulfasalazine, unspecified glucocorticoids or zoledronic acid for large vessel vasculitis, rheumatoid arthritis or osteoporosis [not all routes stated; dosages, times to reactions onsets and outcomes not stated]. Case 1: An elderly woman, who was a non-smoker, had rheumatoid arthritis and osteoporosis, along with several other comorbidities. Subsequently, she started receiving immunosuppressive therapy with methotrexate, sulfasalazine, unspecified glucocorticoids, ciclosporin, rituximab, infliximab and leflunomide. She also received anti-osteoporotic therapy with oral risedronic acid from 2004 to 2009. In 2009, she started receiving anti-osteoporotic therapy with IV zoledronic acid. In Dec 2011, she developed MRONJ at the lower jaw region of 46–47. Hence, she was hospitalised and underwent decortication and plastic coverage with mucosal flap. Her treatment with zoledronic acid was stopped in 2012. Case 2: An elderly woman, who was a non-smoker, had large vessel vasculitis and osteoporosis, along with several other comorbidities. Subsequently, she started receiving immunosuppressive therapy with azathioprine and unspecified glucocorticoids. She also received anti-osteoporotic therapy with oral raloxifene from 1996 to 2011. In 2008, she started receiving anti-osteoporotic therapy with oral risedronic acid, and in 2012, treatment with oral ibandronic acid was initiated. In Dec 2012, she developed MRONJ at the upper jaw region of 25. Hence, she was hospitalised, and underwent decortication and plastic coverage with mucosal flap. Her treatment with ibandronic acid and risedronic acid was stopped. Case 3: An elderly woman, who was a non-smoker, had rheumatoid arthritis and osteoporosis, along with several other comorbidities. Subsequently, she started receiving immunosuppressive therapy with methotrexate, unspecified glucocorticoids, leflunomide and abatacept. She also received anti-osteoporotic therapy with oral alendronic acid from 2008 to 2013. In 2013, she started receiving anti-osteoporotic therapy with SC denosumab. In April 2015, she developed MRONJ at the upper jaw regions of 23–24 and 26–28. Hence, she was hospitalised, and underwent decortication and plastic coverage with corpus adiposum buccae and mucosal flap. Her treatment with denosumab was stopped in 2015. Schwaneck EC, et al. Osteoporosis therapy in patients with inflammatory rheumatic diseases and osteonecrosis of the jaw. Zeitschrift fur Rheumatolo
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