Abstract
Bisphosphonates （BPs）, including minodronate hydrate, are commonly prescribed for the treatment of osteoporosis. Although BP-induced osteonecrosis of the jaw is a serious adverse effect in the maxillofacial region, reports of its widespread occurrence are rare. Here, we report a case of widespread oral, pharyngeal, and laryngeal mucositis in a patient with osteoporosis, which was thought to be caused by minodronate hydrate.
A 76-year-old woman with a history of multiple surgical interventions and reconstructions for oral cancer presented with morphological changes on the right side of the tongue, floor of the mouth, and right mandibular alveolar ridge, predisposing her to drug retention. She sought treatment for osteoporosis at her local orthopedic clinic, where she underwent a bone mineral density assessment. Because the young adult mean value of the femoral neck was 70％, oral minodronate hydrate was prescribed. The day after initiating oral minodronate hydrate, the patient returned to the clinic, reporting spontaneous pain in the oral mucosa immediately after taking the medication. Consequently, she was referred to our department for further evaluation of the oral mucosal lesions.
Upon initial examination in our department, the patient presented with oral mucositis with redness, erosion, and contact pain affecting the bilateral maxillary and mandibular gingiva, tongue, corner of the mouth, floor of the mouth, and surrounding buccal mucosa. Additionally, she reported a sore throat and was referred to the otorhinolaryngology department at a nearby general hospital for a comprehensive evaluation of the laryngopharyngeal lesion. Endoscopic examination revealed widespread mucositis extending from the right side of the tongue and buccal mucosa to the larynx. Based on the patient’s medical history, a diagnosis of extensive mucositis affecting the oral cavity, pharynx, and larynx, likely induced by minodronate hydrate, was established, and the drug was discontinued. In addition, treatment with hangeshashinto gargle was initiated, and her symptoms showed a tendency to improve. Four weeks after discontinuation of minodronate hydrate, the mucositis in all oral regions was improved, except for the erosion of the right side of the tongue. Six weeks after discontinuation, a comprehensive examination by the otolaryngology department at the general hospital revealed complete resolution of laryngopharyngeal symptoms. Minodronate hydrate administration was subsequently terminated, and no recurrence of symptoms has been observed to date.
