doi: 10.5606/tjr.2011.054 Turk J Rheumatol 2011;26(4):333-337 Case Report Bisphosphonate-Related Osteonecrosis of the Jaw Bones in a Patient with Ankylosing Spondylitis Receiving Anti-Tumor Necrosis Factor Treatment Anti-Tümör Nekroz Faktör Tedavisi Alan Ankilozan Spondilitli Bir Olguda Gelişen Bifosfonatla İlişkili Çene Osteonekrozu Banu İŞLETEN, 1 Simin HEPGÜLER, 1 Selen BAYRAKTAROĞLU, 2 Gökhan KESER 3 1 Department of Physical Medicine and Rehabilitation, Medical Faculty of Ege University, İzmir, Turkey; 2 Department of Radiology, Medical Faculty of Ege University, İzmir, Turkey; 3 Department of Internal Diseases, Medical Faculty of Ege University, İzmir, Turkey Received: December 16, 2010 Accepted: April 13, 2011 Correspondence: Banu İ ̇şleten, M.D. Ege Üniversitesi Tıp Fakültesi, Fizik Tedavi ve Rehabilitasyon Anabilim Dalı, 35100 Bornova, İzmir, Turkey. Tel: +90 232 - 390 24 03 e-mail: banuisleten@gmail.com ©2011 Turkish League Against Rheumatism. All rights reserved. Bifosfonat ile ilişkili çene osteonekrozu nadir görülen ancak iyi bilinen bir durumdur ve özellikle kanser ile ilişkili hiperkalsemi veya iskelet metastazı için parenteral ve yüksek dozlu bifosfonat tedavisi alan olgularda meydana gelmektedir. Ancak, daha düşük bir oranda olmakla birlikte, bu komplikasyon osteoporoz tedavisi için oral bifosfonat kullanan hastalarda da meydana gelebilmektedir. Bu makalede osteoporoz nedeniyle uzun süreli oral alendronat tedavisi gördükten sonra çene osteonekrozu gelişen ankilozan spondilitli (AS) 58 yaşında bir kadın olgu sunuldu. Diş çekimi olasılıkla bu hastada çene osteonekrozu gelişimini tetiklemiştir. Bu hasta kullanılan anti-tümör nekroz faktör (anti-TNF) tedavisi ile de dikkat çekmektedir. Bildiğimiz kadarıyla, anti- TNF tedavisi almakta iken bifosfonat ile ilişkili çene osteonekrozu gelişen AS’li bir olgu henüz literatürde bildirilmemiştir. Anahtar sözcükler: Ankilozan spondilit; bifosfonat; çene osteo- nekrozu. Bisphosphonate-related osteonecrosis of the jaw bones is a rare, but well-recognized pathology, occurring mainly in patients receiving parenteral and high doses of bisphosphonates for the treatment of skeletal metastasis and/or hypercalcemia associated with cancer. However, to a lesser extent, this complication may also occur in patients receiving oral bisphosphonates for the treatment of osteoporosis. In this article, we present a 58-year- old female patient with ankylosing spondylitis (AS) who developed mandible osteonecrosis following long-term oral alendronate treatment for osteoporosis. Dental tooth extraction possibly triggered the occurrence of mandible osteonecrosis in this patient. This patient is notable for receiving concomitant anti-tumor necrosis factor (anti-TNF) treatment. To our knowledge, occurrence of bisphosphonate-related jaw osteonecrosis in a patient with AS receiving concomitant anti-TNF treatment has not been reported previously in the literature. Key words: Ankylosing spondylitis; bisphosphonate; jaw osteonecrosis. Bisphosphonates, the potent inhibitors of osteoclast- mediated bone resorption, are mainly used in the treatment of metabolic and oncological diseases involving the skeleton, including osteoporosis, Paget’s disease, and metastatic bone lesions. [1] They have a high affinity for hydroxyapatite bone mineral surfaces, especially in regions with high bone- remodeling. A subgroup of these agents known as aminobisphosphonates, which includes alendronate, also inhibits the osteoclastic enzyme known as farnesyl pyrophosphate (FPP) synthase, thereby maximizing their antiresorptive potential. [2]