Use of recombinant parathyroid hormone in treatment of bisphosphonate related osteonecrosis leading to spontaneous healing (2019)

Type of publication:
Conference abstract

Author(s):
*Chundoo S.; *Pilkington R.; *Bhatia S.; *Garton M.

Citation:
British Journal of Oral and Maxillofacial Surgery; Dec 2019; vol. 57 (no. 10)

Abstract:
Introduction: Case presentation of 61 year old female patient who developed BRONJ (bisphosphonate related osteonecrosis of the jaw) and a pathological triple fracture of the anterior mandible. She had underlying vitamin D deficiency and secondary hypoparathyroidism. She also suffers from anca positive rheumatoid arthritis and is under the active care of rheumatology.
Method(s): Patient was treated with conservative measures which failed to give a good quality of life outcome. Under special license, with involvement from rheumatology, the patient was started on monthly injections of recombinant parathyroid hormone (teriparatide).
Result(s): Over 12-18 months, the serial radiographs reveal bony union of all fracture sites. Patient now has
good quality of life and patient is back on disease modifying drugs to control their active rheumatoid arthritis.
Conclusions/Clinical Relevance: Novel approach to using teriparatide for patients with end-stage BRONJ.
License of the drug as well as current NICE guidelines for its use and patient specific requirements such as
fragility fracture risks age and DEXA scores are also discussed. The action of the drug on osteoblastic formation and bone turnover is discussed. This will help practitioners have another agent to add to their treatment options in treating the effects of BRONJ.

A rare mandibular presentation in multiple myeloma (2017)

Type of publication:
Conference abstract

Author(s):
*Mihalache G.; *MacBean A.; *Bhatia S.

Citation:
British Journal of Oral and Maxillofacial Surgery; Dec 2017; vol. 55 (no. 10)

Abstract:
Introduction: Multiple myeloma(MM)is a relatively rare malignant haematological disease, a monoclonal malignant proliferation of plasma cells that causes osteolytic lesions in the vertebrae, ribs, pelvic bone, skull and jaw. This rare disease develops mainly in men aged 50 to 80 years (mean age, 60 years). Materials: We report on a clinical case of a 45-year-old female patient who presented with spinal and long bones pain to the hospital and she was diagnosed with multiple myeloma. In order to start her treatment (radiotherapy/ chemotherapy/ bisphosphonates) conform our hospital protocol, she came for a full oral and dental assessment. No intraorally abnormalities were seen. However the orthopantomogram showed multiple rounded lesions of various sizes which have little, if any, circumferential osteosclerotic bone reaction. Results: Patient was diagnosed with multiple myeloma with mandibular involvement. She will be followed up by our team and her dentist for monitoring the oral health. Conclusions: The clear and rare multilocular image of myeloma on the orthopantomogram makes our case unique. Knowledge about the maxillofacial manifestations of multiple myeloma is important for the diagnosis of the disease and treatment, also the follow up of these patients regarding their oral manifestations. In the clinical case presented here, we highlight the interdisciplinarity needed to obtain a diagnosis and treatment of multiple myeloma.