Endocrine Abstracts

Introduction: Bisphosphonates (BP) have been employed for many years and have demonstrated an excellent safety profile. Nevertheless, severe osteonecrosis of the jaw (ONJ) have been described in patients with bone metastases that were treated with BP for many years.

Case: A 72 year old female with breast cancer and bone metastases treated with quadrantectomy, axillary lymph node dissection, radiotherapy, tamoxifen and pamidronate 90 mg/month. Two years later, the patient suffered from pain in the right body of the jaw one month after the extraction of low dental pieces. She had an extended intraoral ulcer, which leaved exposed part of the body of the jaw and loss of dental pieces. The patient had not received radiotherapy in the jaw. X ray revealed osteolysis and CT scan showed lesions in bone and soft parts of the jaw. Biopsy confirmed necrosis. Irrigation with chlorhexidine gluconate 0,12% and extraction of dental pieces were performed. In spite of the conservative treatment, she presented severe pain and suppuration. The right side of the jaw was removed. Pamidronate treatment was discontinued. The patient had cancer progression and died some months later.

Conclusion: The aim of this presentation is to emphasize the importance of taking into account the risk factors of ONJ at the moment of performing an invasive procedure. The estimated incidence of ONJ in patients with malignancy who receive BP seems to range between 1 and 10%. The risk factors of ONJ are related to BP, local, systemic and demographic factors. The use of less traumatic techniques available and adequate antibiotic treatment is mandatory in the presence of risk factors of ONJ. BP treatment should be interrupted after surgery until the wound is fully healed.