Bisphosphonate Related Osteonecrosis of the Jaws, Simulating Garre`s Osteomyelitis. A Case Report

Bisphosphonate-related osteonecrosis of the jaw (BRONJ), first described in 2003, is attributed to the inhibition of osteoclastic function via bisphosphonate disruption of the mevalonate pathway, adversely affecting the remodeling process. This report describes a patient with stage 3 bisphosphonate-related necrosis of the jaw. Intra-oral evaluation revealed an absence of mucosal covering on most of the mandible with exposure of dentoalveolar necrotic bone, and a purulent discharge on the right side. Computed tomography scan revealed subperiosteal bone formation, a rare finding in this setting, with a similar clinical and radiological appearance to Garre’s osteomyelitis. Clinicians should be alert to the possibility that bisphosphonate treatment may affect not only bone resorption but also bone apposition. The underlying mechanism is unclear