Oral Bisphosphonate Induced Recurrent Osteonecrosis of Jaw with Atypical Femoral Fracture and Subsequent Mandible Fracture in the Same Patient: A Case Report

INTRODUCTION: Oral bisphosphonates are commonly prescribed for osteoporosis to arrest bone loss and preserve bone density. Complications such as atypical femoral fractures (AFF) and osteonecrosis of jaw (ONJ) are rare. CASE REPORT: We describe a case of a 60-year-old patient who was on oral bisphosphonate therapy for osteoporosis and developed ONJ, AFF, recurrent ONJ, and subsequent mandible fracture with delayed AFF union - this is a very unique and extremely rare case. For the same, she underwent multiple surgeries - sequestrectomy in the mandible, proximal femoral nailing for femur fracture and plate fixation for her jaw. The delayed union needed teriparatide administration. At 1 year follow-up, the patient had a complete radiological union for AFF and on recent follow-up the patient is asymptomatic as regards the femur as well as the jaw. This unique sequence of events has not been described previously. CONCLUSION: This case report shows the possibility of extremely rare adverse effects happening sequentially in the same patient with long-term oral bisphosphonate therapy. Patients need to be informed and monitored regularly for symptoms such as jaw pain and thigh pain and if these occur, the drug must be stopped immediately, and other alternative medical treatment for the osteoporosis should be started.