Clinical case Avascular necrosis of the proximal carpal row of the wrist. A possible complication of bisphosphonate administration Ostéonécrose de la première rangée du carpe. Complication probable d’administration de bisphosphonates K. Didden a , L. De Smet a , L. Vandenberghe a , R. Sciot b , I. Degreef a, * a Department of Orthopaedic Surgery, Upper Limb Surgery, University Hospitals of Leuven, Pellenberg Campus, Weligerveld 1, B-3212 Pellenberg, Belgium b Pathology, University Hospitals of Leuven, Sint Rafael Campus, Leuven, Belgium Received 16 April 2012; received in revised form 23 July 2012; accepted 11 October 2012 Abstract Reports of coexisting osteonecrosis of more than one carpal bone are rare. We report an osteonecrosis of the entire proximal carpal row of the wrist, started briefly after intravenous bisphosphonate administration. The use of bisphosphonates for the treatment of osteoporosis is increasing. Osteonecrosis of the jaw (ONJ) is one of the known adverse effects during chronic treatment with bisphosphonates. This case is reported to make clinicians aware of a possible causative link between bisphosphonate use and osteonecrosis of other bones. # 2012 Elsevier Masson SAS. All rights reserved. Keywords: Avascular necrosis; Bisphosphonate; Proximal carpal row; Zoledronic acid Résumé L’ostéonécrose de plus d’un os carpien est rare. Nous rapportons un cas d’ostéonécrose de la première rangée du carpe, qui a débuté après l’administration de bisphosphonates. L’administration de bisphosphonates dans le traitement de l’ostéoporose a augmenté ces dernières années. L’ostéonécrose de la mâchoire est une complication connue pendant le traitement par bisphosphonates. Nous présentons ce cas clinique pour attirer l’attention sur la probable relation entre les bisphosphonates et l’ostéonécrose. # 2012 Elsevier Masson SAS. Tous droits réservés. Mots clés : Ostéonécrose ; La première rangée carpien ; Bisphosphonate ; Acide zolédronique 1. Introduction Non-traumatic osteonecrosis of one of the carpal bones is a well-known entity. The most common are osteonecrosis of the os lunatum as described by Kienböck [1]. Other common forms are Preiser disease of the scaphoid and Johnson disease of the capitate. Reports of simultaneous non-traumatic osteonecrosis of more than one carpal bone does exist but are rare [2]. Most of these previous described case reports had a history of corticosteroid use or a systemic disease [2]. We report a case of osteonecrosis of the entire proximal carpal row in a 54-year-old woman without any previous determined risk factors of osteonecrosis, except smoking. This patient had a history of osteoporosis, which was treated with yearly repeated infusion of long-acting bisphosphonates. (zoledronic acid infusions [aclasta]). Bisphosphonates are widely used, with yearly 200 million prescriptions worldwide [3]. Abrahamsen reviewed the latest findings on bisphosphonate safety from healthcare databases [4]. Osteonecrosis of the jaw (ONJ) is one of the known adverse effects of the use of bisphosphonates. The incidence of ONJ is 0.09–0.34% in patients receiving oral and 6,6–9% in patients receiving intravenous bisphosphonates [5]. Intravenous but not oral bisphosphonates increased the risk of adverse jaw Available online at www.sciencedirect.com Chirurgie de la main 31 (2012) 355–357 * Corresponding author. E-mail address: Ilse.degreef@uz.kuleuven.ac.be (I. Degreef). 1297-3203/$ – see front matter # 2012 Elsevier Masson SAS. All rights reserved. http://dx.doi.org/10.1016/j.main.2012.10.168