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Case of the Week 599




What is the most likely diagnosis?

  • 61 year-old being treated for a bone malignancy



3D Reconstruction of CT of the Mandible

  1. Periapical cyst
  2. Fibrous dysplasia
  3. Bisphosphonate-related osteonecrosis
  4. Paget disease
  5. Ovarian metastases

Additional Image - Axial Images of the Mandible

 

Additional Images

 

Axial Images of the Mandible


Answer:

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3. Bisphosphonate-related osteonecrosis

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More (Click Discussion Tab)


 

Bisphosphonate-Related Osteonecrosis

 

General Considerations

  • Bisphosphonates are commonly prescribed for the treatment and prevention of
    • Osteoporosis (e.g. alendronate, risendronate, ibandronate)
    • Osteolytic lesions in metastatic bone tumors (e.g. breast, prostate, multiple myeloma) (e.g. zoledronate, pamidronate)
    • Hypercalcemia associated with malignancy
  • Bind and inhibit osteoclastic activity
  • There has been an association described between bisphosphonates, usually in higher doses in cancer patients, and avascular necrosis, especially of the mandible

MORE . . .


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