title: Possible role of oral ibandronate administration in Osteonecrosis of the Jaw: a case report.
abstract: We describe a case of Osteonecrosis of the Jaw (ONJ) that developed in a 65-year-old Caucasian woman with osteopenia and other risk factors who was receiving low doses of oral bisphosphonate therapy (ibandronate, 150 mg monthly). Computed tomography (CT), panoramic radiographs (OPT), 99mTc-Sn-MDP scintigraphy, and magnetic resonance imaging (MRI) were performed to study the diseased area; cytological examination also revealed the presence of suppurative material around the area of exposed bone. A diagnosis of bisphosphonate-related osteonecrosis of the jaw complicated by osteomyelitis was made. The patient was prescribed a drug protocol consisting of metronidazole 250 mg 2 times daily, chlorhexidine mouthwashes 3 times daily and chewing exercises for two months. Ibandronate was stopped and replaced  with strontium ranelate. The symptoms  improved and the patient is still under close follow-up. Assessment of the benefits versus risks is particularly necessary in patients with several risk factors to ascertain their eligibility for treatment with antiresorptive drugs and when this is not possible to choose alternative medications.
authors.forename: A
authors.initials: A
authors.lastname: Notarnicola
authors.forename: S
authors.initials: S
authors.lastname: Lisi
authors.forename: M
authors.initials: M
authors.lastname: Sisto
authors.forename: A V
authors.initials: AV
authors.lastname: De Marino
authors.forename: M
authors.initials: M
authors.lastname: D'Amore
mesh_terms: D000368:Aged; D059266:Bisphosphonate-Associated Osteonecrosis of the Jaw / Q000209:etiology*; D050071:Bone Density Conservation Agents / Q000009:adverse effects*; D004164:Diphosphonates / Q000009:adverse effects*; D005260:Female; D006801:Humans; D000077557:Ibandronic Acid; D008279:Magnetic Resonance Imaging; D014057:Tomography, X-Ray Computed
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D000077557:Ibandronic Acid