Journal List > J Korean Endocr Soc > v.23(3) > 1003438

Lee, Ann, Kim, Park, Chung, Park, Song, Lee, and Joo: A Case of Intravenous Pamidronate-Related Osteonecrosis of the Jaw in a Patient with Waldenstrom's Macroglobulinemia


Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a rare, but serious, side effect of bisphosphonate therapy that produces significant morbidity in affected patients. It is characterized by poor wound healing and spontaneous intra-oral soft tissue breakdown, which lead to exposure of necrotic maxillary and mandibular bone.
We report a case of BRONJ in 56-year-old man who visited Ajou University Hospital Dental Clinic in March 2007. He had been diagnosed with Waldenstrom's macroglobulinemia in 2005 and had been treated with chemotherapeutic agents, along with concomitant pamidronate injections (45 mg monthly). The patient had clinical features of bisphosphonate-related osteonecrosis of the mandible precipitated by tooth extraction. The patient had multiple systemic risk factors, including extended duration of intravenous pamidronate therapy, chemotherapy, and glucocorticoid therapy for his malignancy. In the 6 months prior to presentation, curettage and debridement were performed repeatedly, but there was no improvement in the mandibular lesion. The patient was referred to the Endocrinology Clinic and was diagnosed with BRONJ. We discontinued pamidronate and started conservative care. BRONJ should be considered in the differential diagnosis when patients complain of poor oral wound healing or have recurrent exposure of necrotic maxillary and mandibular bone.

Figures and Tables

Fig. 1
A dental panoramic view demonstrated osseous sclerosis of alveolar bone in both sides of mandible. Mandibular canals were accentuated by surrounding osseous sclerosis.
Fig. 2
A whole body bone scan showed focal increased uptake in left mandible suggesting dental problem. Diffuse increased uptake in both patella and both shoulder joints suggesting probably arthritic change.
Fig. 3
Sections of bone showed chronic osteomyelitis associated with dead bone with empty lacunae, bone resorption, and fat necrosis in the marrow space (H&E stain, ×100).


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