Multimodal Therapy for the Management of Drug-Induced Osteonecrosis: Case Report

Autores

DOI:

https://doi.org/10.17921/2447-8938.2024v26n2p79-84

Resumo

Abstract

Osteonecrosis of the jaws is a complex and debilitating condition, whose characteristic is the gradual destruction of the jaws in patients exposed to predisposing factors, such as tooth extraction. The clinical manifestations vary according to the severity of the lesion, which may culminate in the exposure of necrotic bone. The objective of this study is to discuss therapeutic options in the management of osteonecrosis associated with the use of cancer medication (MRONJ) through a case report, in addition to discourse the topic, discussing the importance of the role of Dentistry in the prevention and management of the condition. A 45-year-old female patient, melanoderma, with malignant left breast neoplasm associated with metastasis in the bone and peritoneum, and using the bisphosphonate Zometa®, was diagnosed with MRONJ after teeth 26 extraction’. Multimodal therapy through the use of topical antimicrobials, Antimicrobial Photodynamic Therapy, systemic antibiotic and ozone therapy were adopted to regression of the case. The patient was follow-up for 46 months. In order to update the information regarding MRONJ, cases in maxilla, their repercussions, challenges and therapeutic options, It was carried out aditional search in eletronic databases. MRONJ is a challenging condition that deserves to be discussed in order to contribute to a better understanding of the disease, prevention and management. That way, the positive result of adjuvant therapies demonstrated in this report may contribute to the structuring of effective protocols for the management of MRONJ, in addition to enabling the development of new questions and, therefore, new studies related to the condition.

Keywords: Osteonecrosis. Maxilla. Bisphosphonate. Bisphosphonates-Related Osteonecrosis of the Jaws. Bone Density.

Resumo

A osteonecrose dos maxilares é uma condição complexa e debilitante, que tem como característica a destruição gradativa dos maxilares em pacientes expostos a fatores predisponentes, como uma extração dentária. As manifestações clínicas variam de acordo com a gravidade da lesão, podendo culminar na exposição de osso necrótico. Este trabalho tem como objetivo discutir opções terapêuticas no manejo da osteonecrose associada ao uso de medicamento (OMAM) oncológico por meio de um relato de caso, além de discorrer acerca do tema, discutindo a importância da atuação da Odontologia na prevenção e manejo da condição. Paciente 45 anos, sexo feminino, melanoderma, portadora de neoplasia maligna em mama esquerda, com metástase em osso e peritônio e sob uso do bisfosfonato Zometa® foi diagnosticada com OMAM após exodontia de unidade 26. Terapia multimodal através do uso de antimicrobiano tópico, Terapia Fotodinâmica antimicrobiana, antibioticoterapia sistêmica e ozonioterapia foram adotadas com vistas à regressão do caso e a paciente foi acompanhada por 46 meses. No intuito de atualizar informações referentes à OMAM, sobretudo casos em maxila, suas repercussões, desafios e opções terapêuticas, foi realizada uma busca adicional em bases eletrônicas. A OMAM é uma condição desafiadora que merece ser discutida a fim de contribuir com um melhor conhecimento, prevenção e manejo. Dessa forma, o resultado positivo das terapias adjuvantes demonstrado no presente relato pode contribuir com a estruturação de protocolos efetivos para o manejo da OMAM, além de possibilitar a elaboração de novos questionamentos e, portanto, novos estudos relacionados à condição.

Palavras-chave: Osteonecrose. Maxila. Bisfosfonato. Osteonecrose Associada a Bisfosfonatos. Conservadores da Densidade Óssea.

Referências

Beth-Tasdogan NH, Mayer B, Hussein H, Zolk O, Peter JU. Interventions for managing medication-related osteonecrosis of the jaw. Cochrane database Syst Rev. 2022;7(7). Available from: https://pubmed.ncbi.nlm.nih.gov/35866376/

Ruggiero SL, Dodson TB, Aghaloo T, Carlson ER, Ward BB, Kademani D. American Association of Oral and Maxillofacial Surgeons’ Position Paper on Medication-Related Osteonecrosis of the Jaws-2022 Update. J Oral Maxillofac Surg. 2022;80(5):920–43. Available from: https://pubmed.ncbi.nlm.nih.gov/35300956/

Watts NB. Long-term risks of bisphosphonate therapy. Arq Bras Endocrinol Metabol. 2014;58(5):523–9. Available from: https://www.scielo.br/j/abem/a/VJgZxXPtPDrB8RFymjfWgvc/?lang=en

Bermúdez-Bejarano EB, Serrera-Figallo MÁ, Gutiérrez-Corrales A, Romero-Ruiz MM, Castillo-de-Oyagüe R, Gutiérrez-Pérez JL, et al. Analysis of different therapeutic protocols for osteonecrosis of the jaw associated with oral and intravenous bisphpsphonates. Med Oral Patol Oral Cir Bucal. 2017;22(1):e43. Available from: /pmc/articles/PMC5217496/

Ahdi HS, Wichelmann TA, Pandravada S, Ehrenpreis ED. Medication-induced osteonecrosis of the jaw: a review of cases from the Food and Drug Administration Adverse Event Reporting System (FAERS). BMC Pharmacol Toxicol. 2023;24(1). Available from: https://pubmed.ncbi.nlm.nih.gov/36879299/

Boyd BC. Update on Medication Related Osteonecrosis of the Jaws. Delaware J Public Heal. 2023;9(1):42. Available from: /pmc/articles/PMC10132365/

Yarom N, Shapiro CL, Peterson DE, Van Poznak CH, Bohlke K, Ruggiero SL, et al. Medication-Related Osteonecrosis of the Jaw: MASCC/ISOO/ASCO Clinical Practice Guideline. J Clin Oncol. 2019;37(25):2270–90. Available from: https://pubmed.ncbi.nlm.nih.gov/31329513/

Fliefel R, Tröltzsch M, Kühnisch J, Ehrenfeld M, Otto S. Treatment strategies and outcomes of bisphosphonate-related osteonecrosis of the jaw (BRONJ) with characterization of patients: a systematic review. Int J Oral Maxillofac Surg. 2015;44(5):568–85. Available from: https://pubmed.ncbi.nlm.nih.gov/25726090/

Hinson AM, Siegel ER, Stack BC. Temporal correlation between bisphosphonate termination and symptom resolution in osteonecrosis of the jaw: a pooled case report analysis. J Oral Maxillofac Surg. 2015;73(1):53–62. Available from: https://pubmed.ncbi.nlm.nih.gov/25511956/

Tetradis S, Allen MR, Ruggiero SL. Pathophysiology of Medication-Related Osteonecrosis of the Jaw-A Minireview. JBMR plus. 2023;7(8). Available from: https://pubmed.ncbi.nlm.nih.gov/37614299/

Zisis V, Andreadis D, Iliadis A, Angelopoulos C, Poulopoulos A. Oral Squamous Cell Carcinoma (OSCC) Imitates Denosumab-Induced Osteonecrosis of the Mandibular Alveolus: A Diagnostic Challenge. Cureus. 2023 Jul 28;15(7). Available from: /pmc/articles/PMC10410184/

Kinoshita S, Sato R, Kinoshita M. A Case of Anti-Resorptive Agents-Related Osteonecrosis of the Jaw and Extensive Loss of Maxillary Bone in a Patient of Breast Cancer. Gan To Kagaku Ryoho. 2023;829–31.

Sim IW, Borromeo GL, Tsao C, Hardiman R, Hofman MS, Hjelle CP, et al. Teriparatide Promotes Bone Healing in Medication-Related Osteonecrosis of the Jaw: A Placebo-Controlled, Randomized Trial. J Clin Oncol. 2020;38(26):2971–80. Available from: https://pubmed.ncbi.nlm.nih.gov/32614699/

Agrillo A, Ungari C, Filiaci F, Priore P, Iannetti G. Ozone therapy in the treatment of avascular bisphosphonate-related jaw osteonecrosis. J Craniofac Surg. 2007;18(5):1071–5.

Oliveira CCB, Dantas JB de L, Borges D de PO, Martins GB, Medrado ARAP, Reis JVNA, et al. Ozonotherapy for Treatment of Radiation Therapy-induced Jaw Osteonecrosis and Bisphosphonates: Case Report. Rev Bras Cancerol. 2021;67(2):e-02785. Available from: https://fi-admin.bvsalud.org/document/view/6zycv

Di Fede O, Canepa F, Panzarella V, Mauceri R, Del Gaizo C, Bedogni A, et al. The Treatment of Medication-Related Osteonecrosis of the Jaw (MRONJ): A Systematic Review with a Pooled Analysis of Only Surgery versus Combined Protocols. Int J Environ Res Public Health. 2021;18(16). Available from: /pmc/articles/PMC8392050/

Epstein JB, Arany PR, Yost SE, Yuan Y. Medication-Related Osteonecrosis of the Jaw: Successful Medical Management of Complex Maxillary Alveolus with Sinus Involvement. Case Rep Oncol. 2023;16(1):406–22. Available from: https://pubmed.ncbi.nlm.nih.gov/37384201/

Minamisako MC, Ribeiro GH, Lisboa ML, Mariela Rodríguez Cordeiro M, Grando LJ. Medication-Related Osteonecrosis of Jaws: A Low-Level Laser Therapy and Antimicrobial Photodynamic Therapy Case Approach. Case Rep Dent. 2016;2016. Available from: https://pubmed.ncbi.nlm.nih.gov/27668100/

Magalhães JMI, da Motta Silveira FM, Regueira LS, de Lima e Silva DF, de Andrade Veras SR, de Mello MJG. Pentoxifylline and tocopherol as prophylaxis for osteonecrosis of the jaw due to bone-modifying agents in patients with cancer submitted to tooth extraction: a case series. Support Care Cancer. 2023;31(8). Available from: https://pubmed.ncbi.nlm.nih.gov/37436539/

Owosho AA, Estilo CL, Huryn JM, Yom SHK. Pentoxifylline and tocopherol in the management of cancer patients with medication-related osteonecrosis of the jaw: an observational retrospective study of initial case series. Oral Surg Oral Med Oral Pathol Oral Radiol. 2016;122(4):455–9. Available from: https://pubmed.ncbi.nlm.nih.gov/27651287/

Varoni EM, Lombardi N, Villa G, Pispero A, Sardella A, Lodi G. Conservative Management of Medication-Related Osteonecrosis of the Jaws (MRONJ): A Retrospective Cohort Study. Antibiotics. 2021;10(2):1–16. Available from: /pmc/articles/PMC7922963/

Cavalcante RC, Tomasetti G. Pentoxifylline and tocopherol protocol to treat medication-related osteonecrosis of the jaw: A systematic literature review. J Craniomaxillofac Surg. 2020;48(11):1080–6. Available from: https://pubmed.ncbi.nlm.nih.gov/32998853/

Downloads

Publicado

2024-07-03

Como Citar

1.
Sueira MS, Santos ASG, Matos ML da S, Freire TFC, Dantas JB de L, Carrera M. Multimodal Therapy for the Management of Drug-Induced Osteonecrosis: Case Report. J. Health Sci. [Internet]. 3º de julho de 2024 [citado 14º de dezembro de 2024];26(2):79-84. Disponível em: https://journalhealthscience.pgsscogna.com.br/JHealthSci/article/view/12566

Edição

Seção

Artigos