The treatment of diffuse sclerosing osteomyelitis with oral bisphosphonates

Abstract

Diffuse sclerosing osteomyelitis (DSO) is a rare inflammatory disease of bone. The underlying cause is poorly understood and traditional management techniques have struggled to provide patients with adequate relief. A number of reports in the literature have described the use of bisphosphonates to manage DSO; however, these have predominantly been associated with the intravenous formulation. Understandably, there is an element of angst due to its underlying and well-recognised risk of osteonecrosis of the jaw. In this article, we review the literature for the management of DSO including the novel approach of using bisphosphonates. As an example, we present a case of a 56-year-old female with DSO where conventional therapies failed to manage her symptoms; however, treatment with oral alendronic acid led to complete and sustained resolution. This case in conjunction with additional reported cases provides further evidence of the value of bisphosphonates in DSO and highlights that the use of oral bisphosphonates can be successful and could be a viable consideration prior to the use of intravenous versions.

Diffuse sclerosing osteomyelitis of the mandible: A case‐report following the treatment over a 12‐year period

“…As a result of the wide availability of antibiotics, acute osteomyelitis of the jaws is rare. If symptoms last longer than four weeks, this is known as secondary chronic osteomyelitis 3 …”

“…Unfortunately, it was found to increase the risk of cancer when used long term and was discontinued for the treatment of DSO in 2012 21 . There is lack of evidence for the use of hyperbaric oxygen therapy and it has not been routinely used in the treatment of DSO 3 …”

“…Further disadvantages of intravenous bisphosphonates include the increased cost to the National Health Service (approximately £202/annum compared to oral bisphosphonates) and the requirement to attend the hospital for intravenous infusions 3 . Overall, oral bisphosphonates appear to be the safer, more effective first‐line treatment to manage chronic DSO.…”

“…21 There is lack of evidence for the use of hyperbaric oxygen therapy and it has not been routinely used in the treatment of DSO. 3 Mandibular reconstruction has also been performed, where non-surgical therapy has been unsuccessful. One case resulted in total resection and reconstruction of the mandible and both temporomandibular joints.…”

Pediatric Gnathic Bony and Mesenchymal Tumors

“…Rarely, osteomyelitis can occur unrelated to infection (non-suppurative osteomyelitis) and will lack purulence, sequestra, or fistula. 115 Chronic non-suppurative osteomyelitis can include Garré's osteomyelitis and diffuse sclerosing osteomyelitis. The term Garré's osteomyelitis is used in cases where the main finding is a periosteal reaction (sclerosis and bone deposition), radiographically and histologically.…”