Osteonecrosis of the jaws associated with use of risedronate: report of 2 new cases.
Use of various bisphosphonates has been associated with the development of osteonecrosis of the jaws (ONJ). At least 865 cases of ONJ attributed to these agents have been reported in the English-language literature. Approximately 96% of these published cases were seen with administration of the intravenous agents pamidronate and zoledronate, whereas only 26 cases have been associated with oral bisphosphonates, 25 of them with alendronate. Only a single case of ONJ associated with the oral bisphosphonate risedronate has been previously cited. We report 2 cases of ONJ attributed to risedronate administration. The patients developed osteonecrosis 15 and 24 months after treatment for osteopenia. A regimen of antibiotics and chlorhexidine mouthrinse resolved the osseous defect in the mandible caused by complete exfoliation of a lingual torus in 1 patient. The other patient required sequestrectomy, repeated courses of antibiotics, surgical debridement, and steroids to promote closure of an oroantral fistula and management of sinusitis after bone grafting and implant placement in the posterior maxilla. A demographic profile of reported oral bisphosphonate users affected by ONJ is also provided. With the millions of patients receiving various oral bisphosphonates for osteopenia and osteoporosis, health care practitioners should be aware of the potential for the onset of osteonecrosis and familiar with its management.
Brooks
John K
JK
Department of Diagnostic Sciences and Pathology, University of Maryland Dental School, Baltimore, Maryland 21201-1586, USA. oralpath5@comcast.net
Gilson
Allen J
AJ
Sindler
Arnold J
AJ
Ashman
Steven G
SG
Schwartz
Kevin G
KG
Nikitakis
Nikolaos G
NG
D000284:Administration, Oral; D000368:Aged; D050071:Bone Density Conservation Agents / Q000008:administration & dosage / Q000009:adverse effects*; D003758:Dental Implantation, Endosseous; D012968:Etidronic Acid / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D005260:Female; D006801:Humans; D007571:Jaw Diseases / Q000139:chemically induced*; D008875:Middle Aged; D009957:Oroantral Fistula / Q000601:surgery; D010020:Osteonecrosis / Q000139:chemically induced*; D000068296:Risedronic Acid
D050071:Bone Density Conservation Agents; D000068296:Risedronic Acid; D012968:Etidronic Acid