Pathological Fractures in Patients Caused by Bisphosphonate-Related Osteonecrosis of the Jaws: Report of 3 Cases

Abstract

For several decades, bisphosphonates have been successfully prescribed for the treatment of patients with metastatic disease to the bone and in the treatment of osteoporosis. 1 The main benefit of bisphosphonates is a reduction in bone resorption (mediated by a decreased function of osteoclast) and turnover. Bisphosphonates are administered either orally or intravenously, depending on the clinical disease. 2 In recent years, bisphosphonate-related osteonecrosis of the jaws (BRONJ) was reported in a wide number of patients receiving bisphosphonates. The first report of BRONJ was described by Mark in 2003. 3 Since then, several more cases have been described, but the treatment of BRONJ is still difficult. The current focus is on prevention and conservative symptomatic treatment. 4,5 However, treatment with a minor invasive modality is not always successful. A number of patients present with, or progress to, an advanced state in need of more complex management. At advanced stages, the presence of an extraoral fistula and osteolysis extending to the inferior border or a pathologic fracture may be evident. 4,5 Most of the pathological fractures described in the literature were associated with osteoradionecrosis. 6 The diagnosis of pathological fractures itself is not difficult, based on physical and radiological examination. Most cases involve the mandible. The determination of underlying pathology has considerable implication for treatment. 7 The consensual management of advanced cases of patients with pathological fractures caused by BRONJ has seldom been reported. We report on 3 cases of BRONJ that progressed to pathological fractures, as treated at our department in the last 2 years.