WBR0767

Author	[[PageAuthor::Rim Halaby, M.D. [1]]]
Exam Type	ExamType::USMLE Step 1
Main Category	MainCategory::Pharmacology
Sub Category	SubCategory::Musculoskeletal/Rheumatology
Prompt	[[Prompt::A 58 year old female patient presents to the physician's office for a mandibular lesion. Her past medical history is significant for breast cancer. She is currently receiving zoledronic acid for her osteoporosis. The physician suspects the patient is having bisphosphonate-related osteonecrosis of the jaw. What additional predisposing factor is most likely to be present that led to this patient's condition?]]
Answer A	AnswerA::Personal history of dental problems
Answer A Explanation	AnswerAExp::History of dental problems, such as dental extractions or tooth infections, is the main risk factor for BRONJ.
Answer B	AnswerB::High-grade breast cancer on pathological analysis
Answer B Explanation	AnswerBExp::The patient's breast cancer does not predispose the patient to BRONJ.
Answer C	AnswerC::Personal history of corrosive esophagitis
Answer C Explanation	[[AnswerCExp::Corrosive esophagitis may be an adverse effect of bisphosphonates. To prevent corrosive esophagitis, patients are asked to take bisphosphonates in the morning in a standing position while drinking plenty of water. Patients are instructed to stay standing for several minutes before lying in a supine position.]]
Answer D	AnswerD::Personal history of heavy smoking
Answer D Explanation	AnswerDExp::Smoking is not a risk factor for developing BRONJ.
Answer E	AnswerE::Caucasian race
Answer E Explanation	AnswerEExp::Caucasian race is not a risk factor for developing BRONJ.
Right Answer	RightAnswer::A
Explanation	[[Explanation::Bisphosphonates are potent inhibitors of osteoclasts that are indicated for osteoporosis. Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a n adverse drug reaction during bisphosphonate use. The main risk factor for BRONJ is: History of pental procedures and poor dental hygiene, such as tooth infections or dental extractions especially among patients who have undergone surgery of the maxillofacial region. Other factors that also seem to be associated are corticosteroid therapy, radiotherapy, diabetes mellitus, and peripheral vascular disease. Educational Objective: Bisphosphonate-related osteonecrosis of the jaw is associated with a personal history of poor dental problems. Reference: Maerevoet M, Martin C, Duck L. Osteonecrosis of the jaw and bisphosphonates. N Engl J Med. 2005; 353(1):99-102. Educational Objective: References: ]]
Approved	Approved::No
Keyword	WBRKeyword::dental, WBRKeyword::procedures, WBRKeyword::extraction, WBRKeyword::extractions, WBRKeyword::procedure, WBRKeyword::tooth, WBRKeyword::infection, WBRKeyword::infections, WBRKeyword::teeth, WBRKeyword::ostenoecrosis, WBRKeyword::jaw, WBRKeyword::bisphosphonate, WBRKeyword::zoledronic, WBRKeyword::acid, WBRKeyword::breast, WBRKeyword::cancer, WBRKeyword::lesion, WBRKeyword::mandible, WBRKeyword::mandibular, WBRKeyword::risk, WBRKeyword::factor, WBRKeyword::predisposing
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