Anti-resorptive related osteonecrosis of the jaw in a patient with hemodialysis: Rapid progression and pathologic fracture in a short phase

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.