Osteonecrosis of jaw — SCE Rheumatology MCQ

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ModerateMetabolic Bone DiseaseOsteonecrosis of jawSCE Rheumatology

A 73-year-old woman receives intravenous zoledronic acid for osteoporosis after vertebral fractures. She now has exposed mandibular bone persisting 10 weeks after a dental extraction. There is local discomfort but no metastatic cancer history. What is the most important complication to screen for?

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Correct answer: B — Medication-related osteonecrosis of the jaw

Explanation lettering: B = shown as A · C = shown as B · E = shown as C · A = shown as E

Medication-related osteonecrosis of the jaw is best because exposed jaw bone persisting after dental extraction in a patient receiving potent bisphosphonate therapy suggests medication-related osteonecrosis of the jaw. A is less suitable because gouty tophus is urate deposition, usually periarticular or auricular; B is less suitable because Sjögren parotitis causes gland swelling and sicca; D is less suitable because Paget skull disease causes bone expansion and high ALP rather than exposed jaw bone; E is less suitable because temporal arteritis causes cranial ischaemic symptoms. Clinical pearl: dental assessment before potent antiresorptives reduces but does not eliminate risk.

Reference: NOGG osteoporosis guideline; BNF