Images in Clinical Medicine

Bisphosphonate-Associated Contact Stomatitis

Pietro Rubegni, M.D., and Michele Fimiani, M.D.

N Engl J Med 2006; 355:e25November 30, 2006

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Article

A 68-year-old woman with severe postmenopausal osteoporosis was referred because of a 6-month history of erosive mucositis of the hard palate, accompanied by intense pain and dysphagia. The patient had an edentulous superior arch and wore a removable upper denture. Examination showed a large oval ulceration of the hard palate, 2 by 3 cm in diameter, with regular margins and a necrotic center (Panel A). Previous unsuccessful treatment of the lesion included systemic and topical corticosteroids, antibiotic agents, and antimycotic agents. Cytodiagnostic and microbiologic evaluations, including those for cancer, herpesviruses, and Treponema pallidum, were unrevealing. The patient did not report using nonsteroidal antiinflammatory drugs, but she did report taking oral alendronate (10 mg per day) for 8 months for severe osteoporosis. The patient reported that she had difficulty swallowing tablets and that she held the tablet in her mouth behind her upper denture plate before being able to swallow it. Contact stomatitis due to alendronate was diagnosed. The patient was instructed to swallow the alendronate without holding the tablet in her mouth and to always remove the denture beforehand. In 2 weeks, the mucositis had improved substantially (Panel B). At 1 year, the patient continued to take the alendronate, the osteoporosis had stabilized, and the oral ulceration had not recurred.

Pietro Rubegni, M.D.
Michele Fimiani, M.D.
University of Siena, Siena, Italy
rubegni@unisi.it

Citing Articles (9)

Citing Articles

1. 1

   Mohammad Kharazmi, Ulf Persson, Gunnar Warfvinge. (2012) Pharmacovigilance of Oral Bisphosphonates: Adverse Effects Manifesting in the Soft Tissue of the Oral Cavity. Journal of Oral and Maxillofacial Surgery
   CrossRef

2. 2

   Mohammad Kharazmi, Kerstin Sjöqvist, Gunnar Warfvinge. (2012) Oral Ulcers, a Little Known Adverse Effect of Alendronate: Review of the Literature. Journal of Oral and Maxillofacial Surgery 70:4, 830-836
   CrossRef

3. 3

   Madoka Inui, Nana Asakura, Sinnosuke Nakamura, Kenya Okumura, Takashi Takeoka, Toshiro Tagawa. (2011) Chemical burn of the tongue resulting from improper use of oral bisphosphonate. Asian Journal of Oral and Maxillofacial Surgery 23:4, 204-206
   CrossRef

4. 4

   D. A. Tipton, B. A. Seshul, M. Kh. Dabbous. (2011) Effect of bisphosphonates on human gingival fibroblast production of mediators of osteoclastogenesis: RANKL, osteoprotegerin and interleukin-6. Journal of Periodontal Research 46:1, 39-47
   CrossRef

5. 5

   Andreas M. Pabst, Thomas Ziebart, Felix P. Koch, Katherine Y. Taylor, Bilal Al-Nawas, Christian Walter. (2011) The influence of bisphosphonates on viability, migration, and apoptosis of human oral keratinocytes—in vitro study. Clinical Oral Investigations
   CrossRef

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   Nelson B. Watts, Robert D. Marciani. (2008) Osteonecrosis of the Jaw. Southern Medical Journal 101:2, 160-165
   CrossRef

7. 7

   I. R. Reid. (2008) Pathogenesis of Osteonecrosis of the Jaw. IBMS BoneKEy 5:2, 69-77
   CrossRef

8. 8

   Ian R. Reid, Mark J. Bolland, Andrew B. Grey. (2007) Is bisphosphonate-associated osteonecrosis of the jaw caused by soft tissue toxicity?. Bone 41:3, 318-320
   CrossRef

9. 9

   (2007) Current awareness: Pharmacoepidemiology and drug safety. Pharmacoepidemiology and Drug Safety 16:6, i-xii
   CrossRef