Fatal Bleeding in Conjunction with Mandibular Medication-related Osteonecrosis of the Jaw (MRONJ)

Abstract

Here, we report a case of fatal bleeding in conjunction with mandibular medicationrelated osteonecrosis of the jaw (MRONJ). A 75-year-old Japanese man was referred to our department with osteonecrosis of the jaw due to bisphosphonate (BP) for multiple bone metastases from prostate cancer. Aggressive surgical intervention was ruled out due to a poor prognosis in terms of life expectancy. Death occurred due to hemorrhagic shock resulting from massive oral bleeding caused by necrosis of the mandible. Numerous reports have suggested that jaw necrosis is induced not only by BP, but also RANKL antibody, steroids, and molecularly-targeted agents. This suggests that the number of cases of MRONJ is likely to increase among elderly patients in whom general health is already poor. The American Association of Oral and Maxillofacial Surgery recommends aggressive treatment only in cases of stage 3 disease. Therefore, such a therapeutic strategy may only be available for cases of jaw necrosis in which the general health status of the patient is otherwise good. To prevent a life-threatening outcome in cases of MRONJ, physicians, who are responsible for determining the drug strategy, should cooperate with oral surgeons in determining the best therapeutic strategy.

Clinicostatistical analyses of medication‐related osteonecrosis of the jaws (MRONJ): Evaluation of the treatment method and prognosis

“…Moreover, there is no consensus on the MRONJ treatment protocol, with disagreement over the recommendation of surgical or nonsurgical treatment 10‐12,17‐27 . In this regard, some recent studies have suggested that surgical treatment is more effective and yielded higher patient QOL than nonsurgical treatment 27‐33 . Although surgical treatment is typically recommended for the later stages, the extent of operative treatment remains controversial 28,34,35 .…”

Effect of Bacterial Infection on Bone Quality and Structure in Osteonecrosis of the Jaw by Bisphosphonate (BP) Administration

“…Bisphosphonate (BP) formulations improve bone mineral density in the long bones and vertebrae, which contributes to the prevention of fragility fractures caused by osteonecrosis and similar conditions [1][2][3] . In the oral and maxillofacial region, however, BP can cause bisphosphonate-related osteonecrosis of the jaw (BRONJ), and the dental treatment strategy for patients taking BP formulations is the subject of vigorous debate [4][5][6] . Cases of serious osteomyelitis of the jaw among patients prescribed bone resorption inhibitors for osteoporosis or malignancies such as breast cancer have also been reported in recent years.…”

Intraoral localized methotrexate‐associated lymphoproliferative disorders concurrent with antiresorptive agent‐related osteonecrosis of the jaw: A case report and literature review

“…The major clinical symptoms of ARONJ are progressive destruction of the jaw, prolonged pain, bone exposure, soft tissue swelling, fistula, and infections. Most of those symptoms are intractable, and many severe cases have been reported 8‐10 . Therefore, the diagnosis and treatment of ARONJ should be made early.…”

“…Most of those symptoms are intractable, and many severe cases have been reported. [8][9][10] Therefore, the diagnosis and treatment of ARONJ should be made early.…”