Co-Presence of Bisphosphonate-Related Osteonecrosis of the Jaw and Oral Squamous Cell Carcinoma in a Patient with Postmenopausal Osteoporosis: A Role for Chronic Traumatism?

Abstract

Introduction: Postmenopausal osteoporosis is an important global issue. The treatment generally includes the administration of antiresorptive agents, bisphosphonate (BP) or denosumab. The most reported adverse reaction to BP is the Bisphosphonate Related Osteonecrosis of the Jaw (BRONJ). We report a case of BRONJ in an osteoporotic patient, who simultaneously revealed an oral squamous cell carcinoma (OSCC).Case report: A 84-year-old Caucasian female referred to our Department complaining of acute pain of one month's duration on the gingival, to the right side of the mandible. The patient had a history of post-menopausal osteoporosis treated with per osalendronate for 15 years. Clinical examination surprisingly also revealed the suspect of the contemporary presence of OSCC, that was confirmed by radiological features and histopathology. Conclusion:Unlike BRONJ or gastrointestinal damage associate to oral BP, oral ulcerations related to BP are not widely known. There is no clear evidence supporting the role of BP in the development of OSCC, but some cases of OSCC in patients taking BP are reported in literature. It would be prudent to screen and monitor these patients for all adverse reactions that could interest the oral cavity.