Revista nº 798

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115 CASO CLÍNICO
Actualidad
Médica
A C T U A L I D A D
M É D I C A
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Actual. Med.
2016; 101: (798): 115-116
Bilateral jaw fracture after long term treatment
with bisphosphonates. A case report.
Abstract
Bisphosphonates represent type of medication used for treating numerous pathologies. In fact, more and more
clinicians utilize bisphosphonates for dealing oncological diseases, rheumatic pathologies and severe osteoporosis.
Despite its benefits, various undesirable side effects have also been associated with the use of these drugs. For
instance, patients who receive bisphosphonates present a greater risk of suffering osteonecrosis of jaw. Indeed,
the possibility of experiencing this complication is around 0,812% when bisphosphonates are administered
intravenously. In contrast, the risk is about 0,01% with oral administration. However, when a tooth extraction is
carried out the risk rises to 0,34%. This report presents the case of a 66 years old woman who suffered a bilateral
jaw fracture after prolonged treatment with bisphosphonates. Interestingly, no invasive dental procedures were
referred by patient. The main aim of this paper is to focus the attention on the serious complications that this
treatment may show in the long term.
Resumen
Los bifosfonatos son fármacos ampliamente utilizados en el tratamiento de numerosas enfermedades. Diferentes
profesionales utilizan los bifosfonatos para tratar complicaciones de patologías oncológicas, osteoporosis y pato-
logías reumatológicas. Sin embargo, a pesar de los efectos benéficos, existen efectos secundarios consecuente al
utilizo de este tipo de medicamento. Por ejemplo, la osteonecrosis maxilar es más frecuente en pacientes trata-
dos con bifosfonatos. En este sentido, la posibilidad de desarrollar osteonecrosis maxilar es del 0,812% cuando la
medicación es administrada por vía intravenosa y del 0,01% en caso de administración oral. Además, cuando se
realiza una extracción dental el riesgo incrementa de un 0,34%. Este artículo presenta el caso de una paciente de
66 años que sufrió una fractura bilateral y espontanea de la mandíbula tras el utilizo de bifosfonatos durante un
largo periodo de tiempo. Es importante enfatizar que, en este caso, el paciente no había sido sometido a inter-
venciones de cirugía oral en los meses previos. El principal objetivo de este estudio es focalizar la atención sobre
las posibles complicaciones provocadas por este medicamento.
Paolo Cariati1, Dario Sanchez Lopez2, Miguel Perez de Perceval1, Alfredo Valencia 2,
Blas Gracia Medina2
1Residente de Cirugía Oral y Maxilofacial. Complejo Hospitalario Granada.
2FEA Cirugía Oral y Maxilofacial. Complejo Hospitalario Granada.
Paolo Cariati
ComplejoHospitalariodeGranada
Email:
Palabras clave: Fractura
de mandibula bilateral,
bifosfonatos, hueso
mandibular, osteonecrosis
maxilar
Keywords: Bilateral jaw
fracture, bisphosphonates, jaw
bone, ONJ
Fractura bilateral demandibular tras un tratamiento a largoplazo
conbifosfonatos
INTRODUCTION:
Several studies demonstrated that Bisphosphonates are an
important and well-established drug in the treatment of several
diseases (1). Its represent the first-line treatment for malignant hy-
percalcemia and bone metastasis (2). Moreover, bisphosphonates
are also used for treatment of paget’s disease, osteoporosis, and
multiple myeloma (3). When administered, bisphosphonates are
deposited into the bones, due to high affinity for hydroxyapatite,
and are accumulated through time (4). It is common knowledge
that patients who receive these medicines have an increased risk
of suffering ONJ (5) (6). This risk is around 0,812% if bisphosphona-
tes are administered intravenously. Whereas, is less for oral admi-
nistration (0,01%). Notwithstanding, the risk rises to 0,34% when
invasive dental procedures are performed in patients treated with
this drugs (4).In this sense, professionals who prescribe bisphos-
phonates must strongly advise about this complication and dental
extractions should be avoided in these case (7) (8) (9).
CASE REPORTS:
We describe the case of a 66-year-old woman who came to
the emergency service of our Hospital with mouth pain, active oral
suppuration, fever and bad general condition. Once in the hospital,
Enviado:23-05-2016
Revisado: 13-06-2016
Aceptado: 18-08-2016