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A Case Report of Oral Bisphosphonate Treatment for Osteoporosis Leading to Atypical Femoral Fracture and Pathologic Mandibular Fracture.
Fernandes, Tito Lúcio; Viezzer Fernandes, Bruno; Jitumori, Chigueyuki; Franco, Gilson Cesar Nobre.
Afiliação
  • Fernandes TL; Postgraduate Program in Dentistry, State University of Ponta Grossa (UEPG), Ponta Grossa, PR, Brazil.
  • Viezzer Fernandes B; Unimed General Hospital, Ponta Grossa, PR, Brazil.
  • Jitumori C; Postgraduate Program in Dentistry, State University of Ponta Grossa (UEPG), Ponta Grossa, PR, Brazil.
  • Franco GCN; Unimed General Hospital, Ponta Grossa, PR, Brazil.
Am J Case Rep ; 24: e941144, 2023 Oct 23.
Article em En | MEDLINE | ID: mdl-37867315
BACKGROUND Bisphosphonates inhibit bone resorption in patients with postmenopausal osteoporosis and reduce osteoporotic fracture incidence. Medication-related osteonecrosis of the jaws (MRONJ) and atypical femoral fractures (AFF) are both rare but serious adverse effects of anti-resorptive drugs (ARD) such as bisphosphonates. The most advanced form of MRONJ is termed stage 3 and can lead to severe local sequelae like pathologic mandibular fractures (PMF). This study reports a case of MRONJ-related PMF and AFF with osteomyelitis secondary to bisphosphonate treatment for osteoporosis. CASE REPORT A 63-year-old white woman was diagnosed with PMF related to MRONJ stage 3 during treatment of an AFF with osteomyelitis. She had been treated for postmenopausal osteoporosis with 70 mg of alendronate weekly for 2 years. The PMF was treated by stable internal fixation combined with debridement and sequestrectomy, but further debridement was required and 2 mandibular implants were then removed. Postoperative recovery was uneventful and the mandibular infection was controlled after the second surgery. Three weeks later, she was discharged from the hospital, instructed to discontinue the use of alendronate, and referred for 30 sessions of hyperbaric oxygen therapy. At the 3-year follow-up, the PMF was completely healed without signs of mandibular infection or bone exposure. CONCLUSIONS This report raises awareness of both MRONJ and AFF as possible adverse effects of short-term bisphosphonate therapy for postmenopausal osteoporosis, and highlights the importance of dental and orthopedic follow-ups. It is crucial to emphasize the need for early diagnosis and treatment to prevent MRONJ progression to PMF.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Osteomielite / Osteoporose / Osteoporose Pós-Menopausa / Conservadores da Densidade Óssea / Fraturas do Fêmur / Fraturas Espontâneas / Fraturas Mandibulares Limite: Female / Humans / Middle aged Idioma: En Revista: Am J Case Rep Ano de publicação: 2023 Tipo de documento: Article País de afiliação: Brasil País de publicação: Estados Unidos
Texto completo
Adicionar na Minha BVS
Imprimir
XML
PubMed Links
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Osteomielite / Osteoporose / Osteoporose Pós-Menopausa / Conservadores da Densidade Óssea / Fraturas do Fêmur / Fraturas Espontâneas / Fraturas Mandibulares Limite: Female / Humans / Middle aged Idioma: En Revista: Am J Case Rep Ano de publicação: 2023 Tipo de documento: Article País de afiliação: Brasil País de publicação: Estados Unidos