Images in Clinical Medicine

Bisphosphonate-Associated Osteonecrosis of the Jaw

Nathaniel Treister, D.M.D., D.M.Sc., and Sook-Bin Woo, D.M.D.

N Engl J Med 2006; 355:2348November 30, 2006

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A 54-year-old man with a 3-year history of IgG myeloma, complicated by hypercalcemia, who was being treated with dexamethasone, lenalidomide, filgrastim, darbepoetin alfa, and pamidronate, presented with a 1-month history of severe bilateral jaw pain. He had no known bone involvement from his myeloma, nor did he recall any specific trauma to his jaw. Clinical examination revealed areas of exposed bone 1 to 1.5 cm in length with surrounding erythema on the posterior lingual mandible bilaterally (Panel A, lesion on the left mylohyoid ridge). A diagnosis of bisphosphonate-associated osteonecrosis of the jaw was made, and pamidronate, which he had been taking for 3 years without any change in the dose (infusion of 90 mg monthly), was discontinued. He was treated with clindamycin and chlorhexidine gluconate rinses for 3 months. At 2 months of follow-up, the bony lesions were larger, raised, slightly mobile, and asymptomatic (Panel B). At 4 months, both bony lesions were completely healed and the mucosa was reepithelialized (Panel C). At 1 year of follow-up, the patient remains free of lesions and symptoms, and his myeloma is stable without the use of pamidronate.

Nathaniel Treister, D.M.D., D.M.Sc.
Sook-Bin Woo, D.M.D.
Brigham and Women's Hospital, Boston, MA 02115
ntreister@partners.org

Citing Articles (7)

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   Rahul Mhaskar, Jasmina Redzepovic, Keith Wheatley, Otavio Augusto Camara Clark, Branko Miladinovic, Axel Glasmacher, Ambuj Kumar, Benjamin Djulbegovic, Ambuj Kumar. 2010. Bisphosphonates in multiple myeloma. .
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   Jennifer Lee. (2009) Complication Related to Bisphosphonate Therapy. Journal of Infusion Nursing 32:6, 330-335
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3. 3

   Sunil J Wimalawansa. (2008) Insight into bisphosphonate-associated osteomyelitis of the jaw: pathophysiology, mechanisms and clinical management. Expert Opinion on Drug Safety 7:4, 491-512
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   S Yao, P L McCarthy, L M Dunford, D M Roy, K Brown, P Paplham, M Syta, D Lamonica, S Smiley, M Battiwalla, S Padmanabhan, T Hahn. (2008) High prevalence of early-onset osteopenia/osteoporosis after allogeneic stem cell transplantation and improvement after bisphosphonate therapy. Bone Marrow Transplantation 41:4, 393-398
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   Nelson B. Watts, Robert D. Marciani. (2008) Osteonecrosis of the Jaw. Southern Medical Journal 101:2, 160-165
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   (2007) Current awareness: Pharmacoepidemiology and drug safety. Pharmacoepidemiology and Drug Safety 16:6, i-xii
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