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Osteonecrosis of the jaw in a patient on raloxifene: a case report
Abstract:
Osteonecrosis of jaws (ONJ) is a chronic disease characterized by necrotic bone from any number of causes. ONJ can also occur due to several systemic and local factors which compromise blood flow within the bone. Among anti-resorptive medications, a very low risk of ONJ development is associated with oral bisphosphonates used for the management of osteopenia, osteoporosis, and Paget's disease. Raloxifene is a nonsteroidal benzothiophene which is classified as a selective estrogen receptor modulator (SERM). It is commonly used for the prevention and the treatment of osteoporosis in postmenopausal women and was recently approved to reduce the risk of breast cancer. Raloxifene is regarded as a safe alternative in the management of osteoporosis in terms of ONJ development. This report presents a case of ONJ in a patient receiving raloxifene, who presented with existing comorbidities and a history of discontinued oral bisphosphonates use. The clinical report is followed by a discussion aimed to clarify how the general practitioner should consider similar cases.
Insights
Osteonecrosis of the jaws (ONJ) is a rare complication of raloxifene, a selective estrogen receptor modulator (SERM). This case highlights the importance of considering ONJ in patients with comorbidities and prior bisphosphonate use.
Area of Science:
- Oral and Maxillofacial Surgery
- Pharmacology
- Endocrinology
Background:
- Osteonecrosis of the jaws (ONJ) is characterized by necrotic bone, often linked to factors compromising bone blood flow.
- Oral bisphosphonates, used for osteoporosis, have a very low risk of ONJ.
- Raloxifene, a SERM, is considered a safe alternative for osteoporosis management regarding ONJ risk.
Observation:
- This report details a case of ONJ in a patient undergoing raloxifene therapy.
- The patient had pre-existing comorbidities.
- A history of discontinued oral bisphosphonate use was noted.
Findings:
- The case presents a rare occurrence of ONJ associated with raloxifene.
- This challenges the perception of raloxifene as entirely safe concerning ONJ development.
Implications:
- General practitioners should maintain a high index of suspicion for ONJ in patients on raloxifene, especially those with comorbidities or a history of bisphosphonate use.
- Further research may be needed to fully elucidate the ONJ risk associated with raloxifene.
- Clinical vigilance is crucial for early diagnosis and management of ONJ.
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