title: Osteonecrosis of the jaw in a Crohn's disease patient following a course of Bisphosphonate and Adalimumab therapy: a case report.
abstract: BACKGROUND
  Bisphosphonates have a widespread indication for osteoporosis and are also applied in cancer patients with skeletal-related conditions. Bisphosphonate-associated osteonecrosis of the jaw (BRONJ) is a feared side effect which is hard to treat and often affects patient's quality of life in an extensive manner. Adalimumab (Humira®), a fully human recombinant antibody specific for tumor necrosis factor- α, is approved for treatment in patients with Inflammatory Bowel Disease like ulcerative colitis or Crohn's disease.
  
  
  METHODS
  In March 2013, a 36-year-old female presented with right-sided perimandibular swelling, recurrent facial pain and exposed necrotic bone after previous extraction of tooth 47. She had the medical history of Crohn's disease for more than one decade with chronic active enterocolitis, fistula disease as well as previous oral manifestation and was currently treated with Adalimumab since September 2008. Due to steroid-induced osteoporosis, diagnosed in 2004, she received oral Bisphosphonates (Risedronate) from 2004 until 2007 followed by two infusions of Zoledronic acid in 2008 and 2009.
  
  
  CONCLUSIONS
  This patient with a medical history of Crohn's disease and gastrointestinal remission under Adalimumab therapy presented with osteonecrosis of the jaw after suspended oral and intravenous Bisphosphonate therapy implicating that the biologic therapy with an anti-TNF-α antibody might promote the manifestation of osteonecrosis and compromise oral healing capacity.
authors.affiliation: Department of Oral and Maxillofacial Surgery, University of Erlangen, Glückstraße 11, Erlangen 91054, Germany. raimund.preidl@uk-erlangen.de.
authors.forename: Raimund H M
authors.initials: RH
authors.lastname: Preidl
authors.forename: Tobias
authors.initials: T
authors.lastname: Ebker
authors.forename: Martin
authors.initials: M
authors.lastname: Raithel
authors.forename: Falk
authors.initials: F
authors.lastname: Wehrhan
authors.forename: Friedrich W
authors.initials: FW
authors.lastname: Neukam
authors.forename: Philipp
authors.initials: P
authors.lastname: Stockmann
mesh_terms: D000068879:Adalimumab; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000009:adverse effects*; D061067:Antibodies, Monoclonal, Humanized / Q000009:adverse effects*; D059266:Bisphosphonate-Associated Osteonecrosis of the Jaw / Q000209:etiology*; D050071:Bone Density Conservation Agents / Q000009:adverse effects*; D003424:Crohn Disease / Q000188:drug therapy*; D004164:Diphosphonates / Q000009:adverse effects*; D005260:Female; D006801:Humans; D010020:Osteonecrosis / Q000188:drug therapy
chemical_list: D000893:Anti-Inflammatory Agents; D061067:Antibodies, Monoclonal, Humanized; D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D000068879:Adalimumab