Bisphosphonate-treatment of secondary chronic osteomyelitis of the jaw – a case report

Abstract

Secondary chronic osteomyelitis (SCO) is caused by bacterial infection leading to progressive jawbone destruction. Antibiotics are used as first-line treatment; surgical therapy is usually extensive and may not provide a cure. Bisphosphonates have been reported to be successful in patients with primary nonbacterial osteomyelitis, and literature indicates promising results in SCO. A 38-year-old patient presented with a progressive mandible-destruction 17 years after wisdom tooth extraction. Several treatment attempts have been unsuccessful. Seeking a second opinion, the patient was then interdisciplinary treated with 90 mg of intravenous pamidronate every four weeks, three times. The patient did not experience side effects presenting a considerable improvement in mouth opening and reporting a dissolvent of signs of pain or infection. The MRI showed edema reduction and decreased contrast uptake. Therefore, bisphosphonate treatment of secondary chronic osteomyelitis of the jaw is a safe and effective option in selected cases after unsuccessful first- and second-line therapy.

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“…Osteogenic drugs can be categorized as water‐ or fat‐soluble drugs. [ 7 ] Water‐soluble drugs, such as bisphosphonates, can effectively inhibit osteolysis, [ 8 ] but the associated risk of jaw necrosis can last for several years, even after discontinuation. [ 8b,9 ] Moreover, the incidence of bisphosphonate‐associated osteonecrosis of the jaw varies from 1% to 10%.…”

“…[ 7 ] Water‐soluble drugs, such as bisphosphonates, can effectively inhibit osteolysis, [ 8 ] but the associated risk of jaw necrosis can last for several years, even after discontinuation. [ 8b,9 ] Moreover, the incidence of bisphosphonate‐associated osteonecrosis of the jaw varies from 1% to 10%. [ 10 ] Therefore, their application in orthopedics and dental implants should be carefully considered.…”