The use of oral bisphosphonates in the management of antibiotic refractory secondary chronic osteomyelitis.

OBJECTIVE

Secondary chronic osteomyelitis (SCO) is a complex condition and often requires the use of long-term antimicrobial treatment, surgical input, or, in severe cases, a combined aggressive approach. The current clinical outcome review examines the use of oral bisphosphonates in the management of antimicrobial refractory SCO.

STUDY

DESIGN

The current case series retrospectively reviews refractory SCO cases which have failed to achieve control and healing via antimicrobial treatment using both broad spectrum and long-term antimicrobials leaving radical surgery as the only viable option. As an alternative to surgery, the patients were prescribed oral bisphosphonates alongside their antimicrobial treatment.

RESULTS

A total of 6 patients with refractory SCO were included with 5 patients (83%) showing complete resolution of their symptoms. Overall, all cases showed positive clinical and radiographic response to oral bisphosphonates. Resolved cases showed no clinical or radiographic evidence of recurrence of SCO upon cessation of the oral bisphosphonates. All but 1 patient required oral bisphosphonates for less than 12 months.

CONCLUSIONS

The success of treating refractory SCO in the current series of patients using oral bone-modifying agents suggests a promising alternative treatment strategy to consider when conventional methods have been exhausted. (Oral Surg Oral Med Oral Pathol Oral Radiol YEAR;VOL:page range).