Strontium ranelate treatment in a postmenopausal woman with osteonecrosis of the jaw after long-term oral bisphosphonate administration: a case report

Abstract

Bisphosphonates (BPs) suppress bone resorption and increase bone strength, thus reducing the risk of fracture. Oral BPs are widely used for the prevention and treatment of osteoporosis and osteopenia. Here, we describe the case of a postmenopausal woman who took oral alendronate for >3 years for osteoporosis. The patient presented at the clinic with sharp jaw pain and swelling on the left mandible 4 months after extraction of the third molar. Clinical examinations identified an inflamed mucosal opening with pus over an area of necrotic bone. Initial images of cone beam computed tomography revealed a sequestrum at the extracted socket. The condition did not improve after 1 week of antibiotic treatment; therefore, the alendronate treatment was terminated and the patient was prescribed strontium ranelate instead. The patient gradually recovered and, at the 2-year follow-up, the site of BP-related osteonecrosis of the jaw healed completely as determined by both clinical and cone beam computed tomography measures. The bone mineral densities in the femoral neck and lumbar spine improved after 1 year, and were maintained at the 3-year follow-up. The serum C-terminal cross-linking telopeptide values also gradually increased from the initial 130 pg/mL to 320 pg/mL at the 3-year follow-up. Taken together, this case supports the use of strontium ranelate as an alternative treatment for postmenopausal women who receive long-term oral BP treatments and are at risk for serious complications of BP-related osteonecrosis of the jaw.

Determining elemental strontium distribution in rat bones treated with strontium ranelate and strontium citrate using 2D micro‐XRF and 3D dual energy K‐edge subtraction synchrotron imaging

“…Strontium ranelate has been used as an effective therapeutic treatment in battling osteoporosis in women (postmenopausal) and men . It has been shown that strontium ranelate is capable of improving intrinsic bone tissue quality of osteoporotic bone and reducing the risk of fractures associated with the disease in various animal models as well as in humans .…”

Effects of oncological therapy on bone disorders

“…Zmniejsza aktywność osteoklastów, powoduje wzrost syntezy kolagenu przez osteoblasty oraz zmniejsza rozpuszczalność kryształów hydroksyapatytu. Dowiedziono, że ranelinian strontu ogranicza ryzyko złamań kręgów u kobiet z osteopenią i osteoporozą po roku terapii o 49%, a w grupie z zaawansowaną osteoporozą po 3 latach zaobserwowano redukcję ryzyka złamań odcinka bliższego kości udowej o 36% [38,39].…”

Diagnóstico, tratamento e prevenção da osteonecrose maxilar relacionada a medicamentos

“…Além disso, em pacientes oncológicos frequentemente há associação destas drogas à quimioterápicos e corticosteroides, que aumentam o risco da MRONJ (RUGGIERO et al, 2014;ZHANG et al, 2016;OTTO et al, 2018). Já entre pacientes portadores de osteoporose ou outras condições benignas em que esses medicamentos são empregados, frequentemente se administram drogas com menor potência e cujas doses medicamentosas são menores, o que determina menor risco de ocorrência da MRONJ (KHAN et al, 2015;PAN et al, 2017;IVANOVSKI, 2018).…”