Pentoxifylline and Tocopherol in the Treatment of Yearly Zoledronic Acid–Related Osteonecrosis of the Jaw in a Corticosteroid-Induced Osteoporosis

Osteonecrosis of the jaw (ONJ) is a well-known side effect of bisphosphonate (BP) therapy. ONJ is specifically related to the intravenous form of BPs and is usually seen in combination with other risk factors, such as dental surgery, concurrent corticosteroids, chemotherapy, and tobacco use. The risk of developing ONJ in patients treated with oral BPs for osteoporosis is lower than that in patients with cancer but is still significant. Zoledronic acid is a third-generation nitrogen-containing BP. It was first used in the treatment of malignancy as a monthly infusion and then approved for the treatment of osteoporosis as a yearly infusion and is an attractive option that is more reliable than the oral form. ONJ related to the use of yearly zoledronic acid is rarely reported in the literature and is most likely underestimated. Pentoxifylline and tocopherol have been used in the treatment of osteoradionecrosis for many years, with observed lesion improvement. The authors present a case of ONJ development after 3 yearly zoledronic acid infusions for corticosteroid-induced osteoporosis. The patient was successfully managed using conservative treatment with pentoxifylline and tocopherol.