Ulceraciones orales por alendronato

The effect of antiresorptive therapy on the prevalence and severity of oral lichen planus: a retrospective study

BACKGROUND

Antiresorptive therapy (AR) disrupts osseous homeostasis and can induce direct irritation over the gastrointestinal mucosa; however, its possible erosive effects on the oral epithelium have not been totally described. Among the most frequent oral erosive lesions, oral lichen planus (OLP) frequently presents as painful mucosal ulcerations, arising from basal membrane inflammatory damage. Thus, the aim of this retrospective study was to describe the association between AR and the incidence of OLP.

METHODS

This case-control study included data from 148 patients (17 patients undergoing AR therapy (AR group) / 131 without AR therapy (Control group)). Each patient record was systematically processed and the association between AR drugs and OLP clinical characteristics within both groups was assessed.

RESULTS

The erosive form of OLP was significantly more frequent in the AR group than in the Control group (p = 0.029). Indeed, the AR treatment using alendronic acid (41.2%) was the most frequently reported. Additionally, the erosive form of OLP showed the strongest association with pain and burning sensation among the OLP types (p < 0.050). However, disease worsening and AR consumption were not significantly associated (p = 0.150).

CONCLUSIONS

Patients under AR therapy show more clinical symptoms associated to the erosive type of OLP. Regardless of the AR therapy, the erosive type of OLP is associated with more severe symptoms.

Bisphosphonate-Mediated Oral Ulcers: A Rare Differential Diagnosis of Erosive Oral Lesions

Oral bisphosphonates are widely used drugs for the treatment of various indications such as postmenopausal osteoporosis. Ulcerations of the upper gastrointestinal tract, predominantly reported for alendronate, are common side effects. The occurrence of ulcerations within the oral cavity is less well known and probably underreported. Especially in cases of incorrect mode of intake, oral bisphosphonates are prone to induce oral ulcerations by as yet incompletely delineated mechanisms. We herein report on 2 elderly female patients suffering from oral ulcerations, which could be attributed to inadequate ingestion of alendronate. Possible ways to cause damage to the oral mucosa include non-specific toxic and pro-apoptotic effects, partly via bisphosphonate-mediated interference with intracellular signalling such as the mevalonate downstream pathway. Adequate patient advice in terms of correct use of oral bisphosphonates is crucial in order to prevent mucosal damage. Otherwise, prompt treatment cessation or a switch to an intravenously administered bisphosphonate is likely to achieve complete healing.

Lip ulceration associated with intravenous administration of zoledronic acid: report of a case

Although osteonecrosis of the jaw is a well-known adverse reaction of bisphosphonates (BPs), random cases of oral mucosal ulceration after per os administration of BP-aledronate have been attributed to prolonged mucosal irritation. This report, for the first time, describes the mucosal ulceration related to intravenous use of zoledronic acid (ZA). A 52-year-old female patient presented with painful ulcers on both cutaneous/mucosal surfaces of the lower lip and a 2-month history of osteonecrosis of the mandible beside the right lower canine. Her medical record included intravenous administration of ZA for 10 months for primary breast cancer metastatic to bone. Examination of the peripheral blood showed severe anemia and a slightly increased white blood cell count, due to urinary tract infection by E. coli, but no evidence of a viral infection. The treatment of anemia and E. coli infection did not improve the labial ulcers. Biopsy from the mucosal lesion revealed a non-specific ulceration with moderate inflammatory infiltration. There was no evidence of infection or malignancy. ZA administration was discontinued and within 3 months the lesions were resolved after treatment with systemic antibiotics (amoxicillin), vitamins A and E, chlorexidine and H(2)O(2) (hydrogen peroxide) solutions and local pantothenic acid/vitamin A creams. Recurrence was detected a month after ZA re-administration. Nevertheless, after new treatment, the patient was free of oral/skin lesions 18 months later. This case, which is the first report of ulceration associated with intravenous administration of bisphosphonates, suggests that systemic mechanisms may be implicated in BP-induced oral mucosal ulceration. Furthermore, ZA appears to cause the same oral mucosal manifestations as alendronate. This emphasizes the need for oral examination in all cases of BP therapy, whether per os or intravenously administrated.

Oral ulcers, a little known adverse effect of alendronate: review of the literature

PURPOSE

To review the published data on a hitherto not widely known adverse effect of alendronate manifesting as mucosal ulcers in the oral cavity.

MATERIALS AND METHODS

The electronic database PubMed was searched for reports of this adverse effect. Publications published up to August 2010 were included. This electronic search was combined with a manual search of the reference lists of the selected publications.

RESULTS

A total of 47 publications were retrieved from the electronic and manual searches. Of these, 12 were selected for the review. Mostly, the ulcers were preceded by misuse of alendronate, but they also appeared after correct administration. The appearance of the ulcers varied from a few days to several months after the start of alendronate use. Effective treatment was withdrawal of the drug or revision of the dosing and administration instructions.

CONCLUSIONS

Alendronate can cause mucosal ulcerations in the oral cavity, affecting patients with intense pain and causing severe morbidity. Successful treatment of this oral pathosis is achieved by aborting the use of alendronate. This adverse effect of alendronate is a rare entity in published reports but careful monitoring of patients at risk is recommended.

Oral ulcer associated with alendronate: a case report

Irritation of the mucosa of the aerodigestive tract is a well-known adverse effect of alendronate, whereas oral ulceration has been reported in only 14 articles in both the English and non-English literature. All of these have been associated with misuse of the drug. We here present the first case of severe oral ulceration attributable to use of alendronate without inappropriate therapeutic administration of the medication.