Shafiepour ,mohsen MD.Kerman university of medical sciences

A 70-year-old woman reported oral malodor and left mandibular pain accompanied by numbness on the left side of the lower lip. She had been receiving alendronate therapy for more than 2 years.

D.DX:Osteomyelitisinfarction (of the type that can occur in sickle cell disease)bone disordersOsteonecrosis

Pathological examination of a surgicalspecimen confirmed necrotic bone.

Osteonecrosisof the jaw has been described in association with bisphosphonate therapy or herpes zoster and is seen especially in patients undergoing cancer therapy.

Osteonecrosis of the jaw

Osteonecrosis of the jaw (ONJ, avascular necrosis of the jaw), often associated with pain, swelling, exposed bone, local infection, and pathologic fracture of the jaw, has been described in patients receiving chronic bisphosphonate therapy .

Risk factors for developing ONJ include

intravenous bisphosphonates, cancer and anti-cancer therapy, duration of exposure, dental extractions, dental implants, poorly fitting dentures, glucocorticoids, smoking, preexisting dental disease

However, if a patient has been treated for more than three years, they recommend discontinuing oral bisphosphonates for three months prior to performing the dental surgery and restarting when the bone has healed

Bisphosphonate use in malignant disease

Use of bisphosphonates in patients with malignant diseases such as multiple myeloma and metastatic breast cancer has been suggested as a risk factor for development of osteonecrosis of the jaw.

Treatment with a combination of antimicrobial agents and surgicaldébridement was eventually successful.

TREATMENT The treatment of osteonecrosis remains one of the most controversial subjects in the orthopedic literature. The goal of therapy is to preserve the native joint for as long as possible. There are three main therapeutic options:Conservative managementJoint preserving proceduresJoint replacement