Breast Cancer

, Volume 16, Issue 2, pp 147–150

A case of osteonecrosis of the jaw in a breast cancer patient with bone metastases receiving long-term treatment with bisphosphonates

  • Yukako Mouri
  • Miwa Yoshida
  • Shogo Nakano
  • Kyoko Yorozuya
  • Kimihito Fujii
  • Takashi Fukutomi
  • Toshiaki Nakaoka
  • Shiro Yamada
  • Kazuo Hara
Case Report

Abstract

Bisphosphonates (BPs) are often used for the treatment of several diseases such as osteoporosis, cancer-associated hypercalcemia, and osteolytic bone metastasis. Recently, there have been reports of osteonecrosis of the jaw (ONJ) in cancer patients whose treatment regimens include BPs. In this case report, we describe complications and treatment of ONJ in a breast cancer patient with bone metastases who received long-term treatment with BPs. A 70-year-old woman underwent modified radical mastectomy on her left breast cancer and received oral 5-fluorouracil derivatives for 2 years in another hospital. Eleven years after the surgery, she came to our hospital complaining of spinalgia and was diagnosed with recurrent breast cancer with multiple metastases to the stomach, liver, multiple lymph nodes, and spine. After surgery for spine metastases, she was given a combination therapy of trastuzumab (initial bolus: 170 mg/body, followed by two or more cycles of 85 mg/body) every week, docetaxel (100 mg/body) every 3 weeks, and BPs (90 mg/body) every 4 weeks. About 1 year and 4 months later, she complained of pain in her right maxilla; biopsy revealed ONJ. Medical oncologists need to recognize ONJ as a serious side effect of BP treatment; dentists and oral and maxillofacial surgeons need to thoroughly consult patients regarding the administration of BPs and have them make an informed consent.

Keywords

Breast cancer Osteonecrosis Bisphosphonate 

References

  1. 1.
    Ruggiero SL, Mehrotra B, Rosenberg TJ, Engroff SL. Osteonecrosis of the jaws associated the use of bisphosphonates. A review of 63 cases. J Oral Maxillofac Surg. 2004;62:527–34.PubMedCrossRefGoogle Scholar
  2. 2.
    Marx RE. Pamidronate (Aredia) and zoledronate (Zometa) induced avascular necrosis of the jaws. A growing epidemic. J Oral Maxillofac Surg. 2003;61:1115–8.PubMedCrossRefGoogle Scholar
  3. 3.
    Migliorati CA. Bisphosphonates and oral cavity avascular bone necrosis. J Clin Oncol. 2003;21:4253–4.PubMedCrossRefGoogle Scholar
  4. 4.
    Wang J, Goodger NM, Pogrel MA. Osteonecrosis of the jaws associated with cancer chemotherapy. J Oral Maxillofac Surg. 2003;61:1104–7.PubMedCrossRefGoogle Scholar
  5. 5.
    Pogrel MA. Bisphosphonates and bone necrosis. J Oral Maxillofac Surg. 2004;62:391–2.PubMedCrossRefGoogle Scholar
  6. 6.
    Schwartz CH. Osteonecrosis and bisphosphonates; correlation versus caution. J Oral Maxillofac Surg. 2004;62:763–4.PubMedCrossRefGoogle Scholar
  7. 7.
    Greenberg MS. Intravenous bisphosphonates and osteonecrosis. Oral Surg. 2004;98:259–60.Google Scholar
  8. 8.
    Bagan JV, Murillo J, Jimenez Y, Poveda R, Milian MA, Sanchis JM, et al. Avascular jaw osteonecrosis in association with cancer chemotherapy: series of 10 cases. J Oral Pathol Med. 2005;34:120–3.PubMedCrossRefGoogle Scholar
  9. 9.
    Bamias A, Kastritis E, Bamia C, Moulopoulos LA, Melakopoulos I, Bozas G, et al. Osteonecrosis of the jaw in cancer after treatment with bisphosphonates: incidence and risk factors. J Clin Oncol. 2005;23:8580–7.PubMedCrossRefGoogle Scholar
  10. 10.
    Wutzl A, Eisenmenger G, Hoffmann M, Czerny C, Moser D, Pietschmann P, et al. Osteonecrosis of the jaws and bisphosphonate treatment in cancer patients. Wien Klin Wochenschr. 2006;118:473–8.PubMedCrossRefGoogle Scholar
  11. 11.
    Cavanna L, Berte R, Arcari A, Mordenti P, Pagani R, Vallisa D. Osteonecrosis of the jaw. A newly emerging site-specific osseous pathology in patients with cancer treated with bisphosphonates. Report of five cases and review of the literature. Eur J Intern Med. 2007;18:417–22.PubMedCrossRefGoogle Scholar
  12. 12.
    Ibrahim T, Barbanti F, Giorgio-Marrano G, Mercatalli L, Ronconi S, Vicini C, et al. Osteonecrosis of the jaw in patients with bone metastases treated with bisphosphonates: a retrospective study. Oncologist. 2008;13:330–6.PubMedCrossRefGoogle Scholar
  13. 13.
    MD Anderson Cancer Center. Updated recommendations for the prevention, diagnosis, and treatment of osteonecrosis of the jaw in cancer patients: May 2006. ASCO 2006.Google Scholar
  14. 14.
    Goldman ML, Denduluri N, Berman AW, Sausville R, Guadagnini JP, Kleiner DE, et al. A novel case of bisphosphonate-related osteonecrosis of the torus palatinus in a patient with metastatic breast cancer. Oncology. 2006;71:306–8.PubMedCrossRefGoogle Scholar
  15. 15.
    Purcell PM, Boyd IW. Bisphosphonates and osteonecrosis of the jaw. Med J Aust. 2005;182:417–8.PubMedGoogle Scholar
  16. 16.
    Ficarra G, Beninati F, Rubino I, Vannucchi A, Longo G, Tonelli P, et al. Osteonecrosis of the jaws in periodontal patients with a history of bisphosphonates treatment. J Clin Periodontal. 2005;132:1123–8.CrossRefGoogle Scholar
  17. 17.
    Iizuka T, Miller SC, Marcs SC Jr. Alveolar bone remodeling after tooth extraction in normal and osteopetrotic (ia) rats. J Oral Pathol Med. 1992;21:150–5.PubMedCrossRefGoogle Scholar
  18. 18.
    Bennet NT, Schultz GS. Growth factors and wound healing: biochemical properties of growth factors and their receptors. Am J Surg. 1993;165:728–37.CrossRefGoogle Scholar
  19. 19.
    Fournier P, Boissier S, Filleur S, Guglielmi J, Cabon F, Colombel M, et al. Bisphosphonates inhibit angiogenesis in vitro and testosterone-stimulated vascular regrowth in the ventral prostate in castrated rats. Cancer Res. 2002;62:6538–44.PubMedGoogle Scholar
  20. 20.
    Lenz JH, Steiner-Krammer B, Schmidt W, Fietkau R, Mueller PC, Gundlach KK. Does avascular necrosis of the jaws in cancer patients only occur following treatment with bisphosphonates? J Craniomaxillofac Surg. 2005;33:395–403.PubMedGoogle Scholar
  21. 21.
    Migliorati CA, Schubert MM, Peterson DE, Seneda LM. Bisphosphonate-associated osteonecrosis of mandibular and maxillary bone. Cancer. 2005;104:83–93.PubMedCrossRefGoogle Scholar
  22. 22.
    Wessel JH, Dodson TB, Zavras AI. Zoledronate, smoking, and obesity are strong risk factors for oseonecrosis of the jaw: a case-control study. J Oral Maxillofac Surg. 2008;66:625–31.PubMedCrossRefGoogle Scholar
  23. 23.
    Durie BG, Katz M, Crowley J. Osteonecrosis of the jaw and bisphosphonates. N Engl J Med. 2005;353:99–100.PubMedCrossRefGoogle Scholar
  24. 24.
    Melo MD, Obeid G. Osteonecrosis of the maxilla in a patient with a history of bisphosphonate therapy. J Can Dent Assoc. 2005;71:111–3.PubMedGoogle Scholar
  25. 25.
    Marx RE, Sawatari Y, Fortin M, Broumand V. Bisphosphonate-induced exposed bone (osteonecrosis/osteopetrosis) of the jaws: risk factors, recognition, prevention, and treatment. J Oral Maxillofac Surg. 2005;63:1567–75.PubMedCrossRefGoogle Scholar

Copyright information

© The Japanese Breast Cancer Society 2008

Authors and Affiliations

  • Yukako Mouri
    • 1
  • Miwa Yoshida
    • 1
  • Shogo Nakano
    • 1
  • Kyoko Yorozuya
    • 1
  • Kimihito Fujii
    • 1
  • Takashi Fukutomi
    • 1
  • Toshiaki Nakaoka
    • 2
  • Shiro Yamada
    • 2
  • Kazuo Hara
    • 3
  1. 1.Department of Surgery, Division of Breast and Endocrine SurgeryAichi Medical UniversityAichiJapan
  2. 2.Department of Oral and Maxillofacial SurgeryAichi Medical UniversityAichiJapan
  3. 3.Division of PathologyAichi Medical UniversityAichiJapan

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