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Bisphosphonate-related osteonecrosis risk — NDEB AFK MCQ

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ModerateBiomedical SciencesBisphosphonate-related osteonecrosis riskNDEB AFK

A 69-year-old with metastatic breast cancer receives monthly intravenous zoledronic acid and needs extraction of a fractured tooth 3.7. She has exposed mandibular bone from a previous extraction that persisted for 10 weeks. What is the most likely cause/mechanism?

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Correct answer: A — Medication-related osteonecrosis from antiresorptive therapy

Persistent exposed bone after extraction in a patient receiving high-dose intravenous zoledronic acid is most consistent with medication-related osteonecrosis of the jaw. Acute osteomyelitis can cause pain and sequestration, but the antiresorptive exposure and chronic non-healing bone are decisive. The pearl is that cancer-dose intravenous antiresorptives carry substantially higher dental surgical risk than osteoporosis dosing.

Reference: Canadian oral surgery/oral medicine reference texts; NDEB KSAs 2024