Zoledronic acid
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Osteonecrosis of the jaw: 3 case reports Three women developed osteonecrosis of the jaw after receiving zoledronic acid. A 70-year-old woman with multiple myeloma, type 2 diabetes mellitus and arterial hypertension, who had been receiving monthly IV infusions of zoledronic acid 4mg for approximately 30 months, presented with maxillary osteomyelitis. She had also been receiving chemotherapy with vincristine and doxorubicin. On examination, she had a total necrotic, mobile, partially edentulous maxilla. X-rays showed greater destruction of the osseous tissue of the maxilla. She underwent successful surgical debridement with total maxillectomy; histopathological analyses of the surgical specimen identified necrotic bone. Her postoperative course was uneventful. A 62-year-old woman with metastatic breast cancer, who had been receiving IV zoledronic acid 4 mg/day for 2 years, in addition to doxorubicin, cyclophosphamide, paclitaxel and exemestane, presented with severe bilateral mandibular periodontitis that had developed over the preceding 6 months. She reported both provoked and spontaneous bleeding. Examination identified exposed osseous tissue with areas of sequestra. She failed to respond to antibacterial therapy and local curettage. X-rays of the mandibular body showed an extended bilateral zone with mixed radiolucency of mottled bone, consistent with sequestrum formation. She underwent bilateral sequestrectomy; bone necrosis was confirmed by histopathological analysis of a surgical specimen. No further regions of necrosis were detected over 9 months’ follow-up. A 91-year-old woman with a 10-year history of metastatic breast cancer with osseous metastases had been receiving treatment for 4 years, of which the first 3 years comprised IV zoledronic acid 4 mg/month; she then presented with a swollen right perimandibular region with an ulcerous lesion and exposed osseous tissue that had not healed for 3 months. She failed to respond to antibacterial therapy. CT scans showed destruction of the right mandibular body. She underwent a conservative debridement; histopathological analysis of surgical samples identified necrotic bone with no evidence of metastatic disease. A subsequent 6-month followup was uneventful. Author comment: "It has been determined that bisphosphonates have important antiangiogenic activity, which is one possible cause of the maxillary osteonecrosis seen in our cases. . . In addition, bisphosphonates may cause a decrease in osseous perfusion". Herbozo PJ, et al. Severe spontaneous cases of bisphosphonate-related osteonecrosis of the jaws. Journal of Oral and Maxillofacial Surgery 65: 1650-1654, No. 8, Aug 2007 - Chile
801091731
0114-9954/10/1173-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
Reactions 13 Oct 2007 No. 1173
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