FDG-PET may predict the effectiveness of hyperbaric oxygen therapy in a patient with bisphosphonate-related osteonecrosis of the jaw: report of a case

• Published in: Odontology Vol. 103; no. 1; pp. 105 - 108
• Main Authors: Fatema, Chowdhury Nusrat, Sato, Jun, Yamazaki, Yutaka, Hata, Hironobu, Hattori, Naoya, Shiga, Tohru, Tamaki, Nagara, Kitagawa, Yoshimasa
• Format: Journal Article
• Language: English
• Published: Tokyo Springer Japan 01.01.2015; Springer Nature B.V
• Subjects: Aged, 80 and over; Bisphosphonate-Associated Osteonecrosis of the Jaw - diagnostic imaging; Bisphosphonate-Associated Osteonecrosis of the Jaw - therapy; Bone density; Case Report; Dentistry; Drug therapy; Female; Fluorodeoxyglucose F18; Humans; Hyperbaric Oxygenation; Medical imaging; Medicine; Mouth; Oral and Maxillofacial Surgery; Positron-Emission Tomography - methods; Predictive Value of Tests; Radiopharmaceuticals; Side effects; FDG-PET; Hyperbaric oxygen therapy; Bisphosphonate; BRONJ
• ISSN: 1618-1247; 1618-1255; 1618-1255
• DOI: 10.1007/s10266-013-0129-y

We report an advanced case of bisphosphonate-related osteonecrosis of the jaw (BRONJ) in an osteoporotic patient treated with oral risedronate sodium for 2 years. An 80-year-old woman presented to our hospital complaining of pain, swelling and pus discharge in the lower alveolar ridge. Fluorine-18 labeled fluorodeoxyglucose positron emission tomography (FDG-PET) and bone scintigraphy showed definite uptake in the mandible. Under clinical diagnosis of BRONJ, we applied systematic treatments including antibiotic therapy, irrigation, cessation of bisphosphonate, hyperbaric oxygen (HBO) therapy, and debridement of necrotic bone. After pre-operative 20 sessions of HBO therapy, her clinical symptoms disappeared. SUV max of FDG-PET decreased definitely from 4.5 to 2.5, although magnetic resonance image and bone scintigraphy did not show remarkable changes. After minor surgery with debridement of necrotic bone, she received another ten sessions of HBO therapy. After the treatment, her clinical course was excellent. In conclusion, this report demonstrates FDG-PET may predict the effect of HBO therapy in BRONJ.