Reactions Weekly

, Volume 1777, Issue 1, pp 17–17 | Cite as


Osteonecrosis of the jaw: 3 case reports
Case report
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An event is serious (based on the ICH definition) when the patient outcome is:

  • * death

  • * life-threatening

  • * hospitalisation

  • * disability

  • * congenital anomaly

  • * other medically important event

  • * drug interaction

In a case series, three women aged 50−70 years were described, who developed osteonecrosis of jaw (ONJ) following concomitant administration of methotrexate and alendronic acid [alendronate; routes not stated; not all dosages stated].

Case 1: A 70-year-old woman had been receiving low dose methotrexate for rheumatoid arthritis and alendronic acid 70mg/week for osteoporosis. She had undergone dental extraction and was prescribed chlorhexidine mouth wash with unspecified antibiotics. However, after 5 months of dental extraction surgery, she presented with oral symptoms. An extra-oral examination showed tenderness on palpation and an intra-oral examination demonstrated a non-healing exposed bone at the extraction. On palpation, slight pus discharge was noted...


  1. Mathai PC, et al. Low-dose methotrexate in rheumatoid arthritis: a potential risk factor for bisphosphonate-induced osteonecrosis of the jaw. Oral and Maxillofacial Surgery 22: 235-240, No. 2, Jun 2018. Available from: URL: - IndiaCrossRefGoogle Scholar

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