Medication-Related Osteonecrosis of the Jaw (MRONJ) due to Simvastatin: An Unusual Case Report

Abstract

Medication-related osteonecrosis of the jaw (MRONJ) is a serious pathological condition that usually results from anti-resorptive or anti-angiogenic drugs. We aimed to report an unusual MRONJ in a female patient due to long-term simvastatin administration. A 48-year female was referred to the Department of Oral and Maxillofacial, Mashhad Dental School, Mashhad, Iran in Dec 2019. She complained of pain, swelling, and infection in the right mandibular area with a history of extraction. Based on medical history, the patient received 40 mg of simvastatin daily for ten years to control hypercholesterolemia. According to clinical and radiographic examinations, as well as previous medical and dental records, the lesion diagnosis was detected as MRONJ. Moreover, histopathological examination of the lesion confirmed our clinical diagnosis. The necrotic bone was removed with caution. The PRF was then inserted, and the flap was sutured without any tension. No complications were observed on following-up, and all symptoms were discontinued. There was a correlation between the administration of high-dose simvastatin and MRONJ. Moreover, more clinical investigation with larger sample sizes is suggested.

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“…Non-surgical treatment options include good oral hygiene, local and systemic antibiotic therapy [using drugs such as penicillin, clindamycin, or metronidazole that penetrate the bone] per organization-specific guidelines. Discontinuation of therapy with drugs such as Tyrosine kinase inhibitors 7,34 Sunitinib Erlotinib Imatinib Axitinib Sorafenib Cabozanitib Pazopanib Anti TNF alpha 35 Infliximab Adalimumab Anti CD 20 36 Rituximab Cytotoxic agent 37…”

“…The condition was reported for the first time in 2003 in a cohort of 36 patients who were treated with pamidronate or zoledronic acid and presented with a painful bony exposure of the maxilla, mandible, or both and that was not amenable to medical or surgical management 6 . Subsequent to this, several case reports of MRONJ due to diverse medications, 7,8 case series, 9 and cohort studies 10 have this association. The prevalence following bisphosphonate therapy in patients with osteoporosis ranges from 0.001% to 0.01%.…”

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“…Recently, the association of this pathology with other drugs such as simvastatin has been reported [6].…”