Diffuse sclerosing osteomyelitis: a case series and literature review

Abstract

Diffuse sclerosing osteomyelitis (DSO) is a poorly understood chronic inflammatory disease, for which many etiologic theories and treatment modalities have been suggested. We retrospectively evaluated bisphosphonate treatment outcomes in patients with DSO and compared them with those of alternative treatment modalities and those reported in the current literature. This series was a retrospective analysis of patients diagnosed with DSO of the mandible. We identified a total of 11 DSO cases at Guys Dental Hospital from 1996 to 2017. Data on all treatment modalities attempted during this time were collected, with a focus on patients who underwent management with oral bisphosphonates. Eight of 11 patients who continued to have symptoms after failure of previous interventions were prescribed alendronic acid (70 mg once weekly) for an average of 16 months. All patients reported improvement or resolution of symptoms within 72 hours. Three patients ceased medication at 4 weeks because of medication side effects. The remaining 5 patients reported improved symptom control in comparison with prior treatment regimes. Oral bisphosphonates appear to provide prolonged symptom relief in patients with DSO compared with previously attempted treatment strategies; however, the exact regimen and length of use is still being debated. The positive impact of bisphosphonates may provide a potential insight into the pathophysiology of DSO.