Severe Osteomyelitis of the Mandible Associated With the Use of Non–Nitrogen-Containing Bisphosphonate (Disodium Clodronate): Report of a Case

Abstract

Bisphosphonate-associated osteonecrosis of the jaws (ONJ) is a very topical subject. Painful exposure of bone in the mandible and maxilla of patients receiving bisphosphonates was first reported by Marx in 2003. Subsequently, many dental professionals, especially oral and maxillofacial surgeons, have identified numerous cases, and several authors have reported additional cases. Bisphosphonates have been the standard of care for managing the osteoporosis associated with malignancy. There are 2 classes of bisphosphonates: nitrogen-containing and non–nitrogen-containing. Non–nitrogen-containing bisphosphonates are metabolized rapidly, whereas nitrogen-containing bisphosphonates are much more potent and are not metabolized. This previously unrecognized complication is seen predominantly with the nitrogen-containing bisphosphonates, such as pamidronate (Aredia; Novartis Pharmaceuticals, East Hanover, NJ), alendronate (Fosamax; Merck, West Point, PA), and zoledronate (Zometa; Novartis Pharmaceuticals); it has not been reported in patients taking non–nitrogencontaining bisphosphonates, such as etidronate (Didronel; Procter and Gamble, Cincinnati, OH) and disodium clodronate (Bonefos; Anthra Pharmaceuticals; Princeton, NJ), and tiludronate (Skelid; Sanofi Aventis, Bridgewater, NJ). This report presents a case of osteomyelitis in the jaw of a patient who had received chronic non– nitrogen-containing bisphosphonate (disodium clodronate) therapy for prevention of bone disease due to multiple myeloma.