title: Unusual case of a conservatively treated pathological fracture after sequestrectomy in a patient with long-term oral bisphosphonate use.
abstract: Bisphosphonates are used in the management of metastatic bone disease, Paget's disease of bone and osteoporosis. A long-term complication of these drugs is bisphosphonate-related osteonecrosis of the jaws (BRONJ). Treatment of BRONJ can be quite challenging, and remains a topic of debate. We report the case of a 74-year-old woman who had used Fosamax(®) (alendronate sodium) orally for four years. After 3½ years she developed pain, swelling, and a fistula in the left mandible. After exploration and sequestrectomy in combination with antibiotic treatment, osteolysis with a pathological fracture developed. Given the extent of the disorder and a decrease in complaints after the surgery, a non-surgical approach was chosen with continuation of the antibiotic treatment for 10 weeks, a soft diet and not wearing of dentures. During follow-up complaints subsided, the intra-oral fistula disappeared and the fracture healed. This is the first report of healing of a BRONJ patient stage III with pathological fracture. It illustrates the remaining healing potential of the bisphosphonate-treated bone.
authors.affiliation: Department of Oral and Maxillofacial Surgery, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Sophie C C
authors.initials: SC
authors.lastname: Kuijpers
authors.forename: Erik W
authors.initials: EW
authors.lastname: van Roessel
authors.forename: J P Richard
authors.initials: JP
authors.lastname: van Merkesteyn
mesh_terms: D000284:Administration, Oral; D000368:Aged; D019386:Alendronate / Q000008:administration & dosage / Q000009:adverse effects*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D050071:Bone Density Conservation Agents / Q000008:administration & dosage / Q000009:adverse effects*; D004164:Diphosphonates / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D017102:Fracture Healing / Q000502:physiology; D005598:Fractures, Spontaneous / Q000139:chemically induced / Q000601:surgery*; D006801:Humans; D008336:Mandibular Diseases / Q000139:chemically induced / Q000601:surgery; D008337:Mandibular Fractures / Q000139:chemically induced / Q000601:surgery*; D016155:Oral Fistula / Q000139:chemically induced; D010014:Osteolysis / Q000139:chemically induced / Q000601:surgery; D010020:Osteonecrosis / Q000139:chemically induced / Q000601:surgery; D014060:Tongue Diseases / Q000139:chemically induced
chemical_list: D000900:Anti-Bacterial Agents; D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D019386:Alendronate