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JOURNAL ARTICLE

THU446 A Case Of Isolated Osteonecrosis

Of Torus Palatinus In A Patient On
Alendronate 
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Journal of the Endocrine Society, Volume 7, Issue Supplement_1,

October-November 2023, bvad114.407,
https://doi.org/10.1210/jendso/bvad114.407
Published: 05 October 2023

Abstract
Disclosure: A.A. Noor: None. A. Zia: None. B. Hoard: None. K.
Romo: None. S. Bhamre: None. M. Gabriel: None. S. Shu: None.
R. Ozolins: None. T. Pulisetty: None. G.I. Uwaifo: None.

Introduction: Osteonecrosis of the jaw (OJN) is a rare

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complication of bisphosphonate and RANKL inhibitor use. Most
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cases have been described in cancer or immunocompromised
patients using high dose parenteral therapy, but have even more
rarely been described with oral bisphosphonate (OBP) use. The
estimated risk is 1 in 10,000 to 1 in 100,000 patient-years in
patients taking OBP for osteoporosis. We describe a case isolated
osteonecrosis of torus palatinus (OTP) in a patient with long-
term use of OBP (alendronate) for postmenopausal osteoporosis.
Case Report: 75-year-old female with a history of torus
palatinus (TP), osteoporosis, fibromyalgia, echondromas of
humerus, degenerative disc disease, and spinal stenosis initially
presented at a primary care clinic with three weeks of inflamed,
painful, red, and swollen oral ulcer; associated with exudative
tonsillitis. She finished an antimicrobial course which improved
tonsillitis, but the oral ulcer persisted. She was on alendronate
70 mg weekly for ∼ three years prior to symptom onset.
Examination showed a nearly 1 cm shallow ulcer on the left
aspect of her large TP with associated erythema and tenderness
to palpation. The rest of the oral cavity was normal. She was
given triamcinolone paste for two weeks. Follow-up 1 month

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later showed progression of ulcer down to bone underlying the

TP. The mucosa of the TP was erythematous, thickened, and
tender. Given the lack of resolution after antimicrobials and
topical steroids, a biopsy was done which showed squamous
mucosa with reactive changes, hyperkeratosis, and chronic
inflammation, but negative for dysplasia or malignancy.
Maxillofacial CT showed, “a lobulated bony mass in the roof of
the mouth consistent with TP with left-central heterogeneous
density and cortical bone thinning without soft tissue mass or
extension. Due to suspicion for osteomyelitis and possible
underlying malignancy, lesion excision, and debridement was
done. Alendronate was stopped at this point. Excisional biopsy
showed necrotic bone consistent with OTP with associated acute
and chronic osteomyelitis. She was treated with four weeks of
metronidazole and two weeks of fluconazole. The postoperative
course was uneventful, with appropriate healing. Conclusion:
While OJN is uncommon in setting of OBP use, among patients
with TP and other bone overgrowth states high index of
suspicion is needed for bony lesions developing in such patients.
The possibility of OTP development should be considered with
appropriate oral complaints among OBP users with TP. Further
retrospective analyses to ascertain how prevalent this
uncommon condition is would provide much needed clinical
information.

Presentation: Thursday, June 15, 2023

Issue Section: Bone and Mineral Metabolism

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© The Author(s) 2023. Published by Oxford University Press on behalf of the

Endocrine Society.

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