Unusual case of a conservatively treated pathological fracture after sequestrectomy in a patient with long-term oral bisphosphonate use

作者：Kuijpers Sophie C C; van Roessel Erik W; van Merkesteyn J P Richard^*

来源：Journal of Cranio-Maxillofacial Surgery, 2011, 39(1): 69-72.

DOI：10.1016/j.jcms.2010.03.022

• Bisphosphonates
• Mandible
• Osteonecrosis
• Polymyalgia rheumatica
• Alendronate
• Osteomyelitis
• Pathological fracture

Bisphosphonates are used in the management of metastatic bone disease, Paget's disease of bone and osteoporosis. A long-term complication of these drugs is bisphosphonate-related osteonecrosis of the jaws (BRONJ). Treatment of BRONJ can be quite challenging, and remains a topic of debate.
We report the case of a 74-year-old woman who had used Fosamax (R) (alendronate sodium) orally for four years. After 3 1/2 years she developed pain, swelling, and a fistula in the left mandible. After exploration and sequestrectomy in combination with antibiotic treatment, osteolysis with a pathological fracture developed. Given the extent of the disorder and a decrease in complaints after the surgery, a non-surgical approach was chosen with continuation of the antibiotic treatment for 10 weeks, a soft diet and not wearing of dentures. During follow-up complaints subsided, the intra-oral fistula disappeared and the fracture healed.
This is the first report of healing of a BRONJ patient stage III with pathological fracture. It illustrates the remaining healing potential of the bisphosphonate-treated bone.

• 出版日期2011-1