TITLE:
Osteonecrosis of the jaw in a patient taking once-yearly infusion of zoledronic acid for osteopenia
AUTHORS:
Takako Imai Tanaka, Charles Donald Taylor
KEYWORDS:
Osteopenia; Osteoporosis;Bisphosphonates; Osteonecrosis; Letrozole; Once-Yearly Zoledronic Acid; ONJ; ARONJ; BRONJ
JOURNAL NAME:
Case Reports in Clinical Medicine,
Vol.2 No.9,
December
18,
2013
ABSTRACT:
Osteonecrosis of the
jaw (ONJ) is an adverse effect of nitrogen-containing bisphosphonates.
Advancing age, intravenous administration of zoledronic acid (ZOL), history of
dento-alveolar surgery, and concomitant systemic diseases such as diabetes are
known as risk factors for developing ONJ. However, despite numerous studies,
the exact pathophysiology remains unclear and management strategies are largely
anecdotal. Once-yearly intravenously administered 5 mg ZOL was approved by the
US Food and Drug Administration in 2007 for the treatment of osteoporosis and
its efficacy with 3 year-regimen had been recently proven in preventing new
clinical fracture. Although occurrences of ONJ have been reported to be rare
with this drug administration, available data is very limited and long-term
outcomes are lacking. We present a case of ONJ identified in an osteopenic patient
with an intermittent but long standing sore mouth related to exposed mandibular
bone. Once-yearly infusion of zoledronic acid used in the treatment of
osteopenia may contribute to the spontaneous development of ONJ, especially in
those presenting with multiple comorbidity factors. This report suggests the
importance of health care professionals keeping abreast of new developments in
this area and providing appropriate information to their patients.