SAT-780 From Bone Density to Bone Death: Osteonecrosis of the Jaw in a Patient with Minimal Risk Factors

Abstract Disclosure: A. Zaidi: None. W. Akhter: None. J.L. Gilden: Novartis Pharmaceuticals. A. Khan: None. Background: Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a rare but serious complication associated with the use of bisphosphonates (BP), which are commonly prescribed for treatment of osteoporosis (OP). BRONJ is defined as presence of exposed necrotic bone in the maxillofacial region that does not heal within 8 weeks. BRONJ occurs in 0.01%-0.06% of OP patients and up to 8% of cancer patients receiving higher and more frequent doses of antiresorptive medications or jaw radiation.Here we present a case of a 70-year-old female with a history of OP, who developed osteonecrosis of the jaw after 5 years of alendronate use with limited risk factors. The case highlights the importance of monitoring for oral complications in all patients receiving long-term BP therapy, regardless of whether there are minimal risks. Case Report A 70-year-old Caucasian female was referred to the Endocrinology clinic for management of OP (Calcium 10.2 mg/dl (8.7-10.40); Vit D 53 ng/ml (30-100); MG 2.12 mg/dl (1.6-2.6); PTH 47.9 pg/ml(18.4-80). Risk factors: 50 pack-yr. past smoking and marijuana; history of traumatic right wrist fractures at age 51, and at age 65. She is physically active, and exercises. She was diagnosed with OP at age 64 on screening Dexa scan with FRAX score of 4.5% for major OP fracture and 0.9% for a hip fracture, with T-score -2.9 in left forearm radius. She was then prescribed alendronate 70 mg weekly for 5 yrs. One year ago, she started having pain in her jaw and lower teeth which prompted dental evaluation. She was diagnosed with BRONJ, which led to discontinuation of the alendronate. Following this, she has undergone multiple dental extractions and debridement, and due to get Laser-assisted new attachment Procedure (LANAP) to help regeneration of dental tissue and will eventually get Bone grafts. She now has severe chronic pain, mental and emotional turmoil, with speech impairment, swallowing and breathing difficulty. A comprehensive management plan for osteoporosis was developed in conjunction with her dental team to prevent further complications (managing bone health with adequate calcium and vitamin D supplements, strengthening exercises and lifestyle modifications including fall precautions while undergoing management of BRONJ). Conclusion: This case illustrates the rare, but debilitating complication of using BP in patients with OP. It emphasizes the importance of careful monitoring during BP therapy, and also raises the concern about treatment options for managing worsening OP in patients with BRONJ. Non-BP therapies, such as denosumab or teriparatide, could be considered to prevent further bone loss and fractures, but also carries the risk of ONJ, although data is limited. Presentation: Saturday, July 12, 2025