Abstract
For patients undergoing treatment for bone metastases by the administration of drugs such as bisphosphonates (BP), osteonecrosis of the jaw is a serious side effect. In recent years, it has been reported that some drugs other than BP also cause osteonecrosis of the jaw. The American Association of Oral and Maxillofacial Surgeons (AAOMS) has designated such osteonecrosis as MRONJ (medication-related osteonecrosis of the jaw), and has published its position paper. We herein report a case of osteonecrosis of the jaw in a patient being treated with three drugs (denosumab, bevacizumab, and zoledronate).
A 68-year-old patient who was being treated with the administration of the three drugs for lung cancer and bone metastases was referred to our department with pain and exposed bone in the posterior mandible. Under a clinical diagnosis of osteonecrosis of the jaw, routine observation with antibiotic administration and irrigation of the exposed bone were performed after stopping administration of the drugs. However, the patient's general symptoms worsened, and six months after the first visit he died of multiple organ failure.
The present case indicates that the use of denosumab may be associated with osteonecrosis of the jaw because denosumab was used more frequently than BP. Reports on necrosis of the jaw caused by denosumab or angiogenesis inhibitors may increase in the future, therefore it is necessary to understand the condition of underlying diseases and to diagnose the adaptation of invasive dental treatment for patients treated with those drugs as well as BP.
