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Case Report
Anti-resorptive related osteonecrosis of the jaw in a patient with hemodialysis: Rapid progression and pathologic fracture in a short phase
1 Assistant professor, DDS, PhD, Department of Oral and Maxillofacial Surgery, Fukushima Medical University Hospital, Fukushima, Japan
2 Research assistant, DDS, Department of Oral and Maxillofacial Surgery, Fukushima Medical University Hospital, Fukushima, Japan
3 Research assistant, Department of Oral and Maxillofacial Surgery, Fukushima Medical University Hospital, Fukushima, Japan
4 Lecturer, Department of Oral and Maxillofacial Surgery, Fukushima Medical University Hospital, Fukushima, Japan
Address correspondence to:
Chihiro Kanno
1 Hikarigaoka, Fukushima City, Fukushima,
Japan
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Article ID: 100041Z07CK2022
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Kanno CK, Kitabatake T, Kojima M, Yamazaki M, Kaneko T. Anti-resorptive related osteonecrosis of the jaw in a patient with hemodialysis: Rapid progression and pathologic fracture in a short phase. J Case Rep Images Dent 2022;8(1):5–9.ABSTRACT
Introduction: Anti-resorptive agent-related osteonecrosis of the jaw (ARONJ) is a slowly progressive disease occurring due to the chronic use of antiresorptive agents (e.g., bisphosphonates) and rarely presents with pathologic fractures. The frequency of pathologic fractures is rare, especially in patients with osteoporosis who are prescribed, low-dose bone-modifying agents. Herein, we report a case of rapidly progressive ARONJ with a pathologic fracture in a patient with hemodialysis.
Case Report: A 64-year-old woman with hemodialysis due to the microscopic polyangiitis who was treated with corticosteroids, immunosuppressants, and ibandronate presented with tooth pain of left mandibular second premolar and second molar, necessitating extraction. After extraction, ARONJ developed in the left mandibular. Anti-resorptive agent-related osteonecrosis of the jaw progressed rapidly during the follow-up at the 12th and 15th months, furthermore, ARONJ also developed in the right mandibular second premolar and second molar lesion, requiring extensive surgery. We performed curative segmental and marginal mandibulectomy in the left and right hemimandible, respectively. The postoperative course was uneventful.
Conclusion: We report a rare case of rapidly progressive ARONJ with pathologic fracture in a patient with hemodialysis. This report suggests a potential role of hemodialysis as a risk factor for disease progression and pathologic fracture development. Further studies regarding factors that inhibit the healing of ARONJ are still needed.
Keywords: ARONJ, Hemodialysis, Low dose BMA, Pathologic fracture, Rapid progression
SUPPORTING INFORMATION
Author Contributions:
Chihiro Kanno - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Revising it critically for important intellectual content, Final approval of the version to be published
Takehiro Kitabatake - Interpretation of data, Drafting the article, Final approval of the version to be published
Momoyo Kojima - Acquisition of data, Drafting the article, Final approval of the version to be published
Morio Yamazaki - Acquisition of data, Drafting the article, Final approval of the version to be published
Tetsuharu Kaneko - Acquisition of data, Drafting the article, Final approval of the version to be published
AcknowledgmentsWe thank Editage (www.editage.co.jp) for English editing service.
Guaranter of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2022 Chihiro Kanno et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
