Novel Application of Zoledronic Acid in Sclerosing Osteomyelitis

Dentist analyzing x-ray scan
Researchers investigated the case of a patient with sclerosing osteomyelitis who was successfully treated with zoledronic acid.

A 63-year-old woman with sclerosing osteomyelitis of the mandible was successfully treated with zoledronic acid, according to results presented at the American Society for Bone and Mineral Research 2019 Annual Meeting, held September 20 to 23, 2019, in Orlando, Florida. 

After extractions of the lower wisdom tooth and lower molar in 2010, the woman experienced episodes of “intense mandibular pain and swelling” every 3 to 5 months. This swelling responded to courses of amoxicillin until 2014, when several courses of prednisone were required.

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In 2017, magnetic resonance imaging results were concerning as the patient was suspected to have chronic osteomyelitis; about 6 weeks of intravenous antibiotic treatment followed. Flares occurred every 2 months, but they were treated with steroid tapers.

In August 2018, the patient was evaluated by an oral and maxillofacial surgeon. Panorex radiography showed sclerosis of the right ramus. Bone biopsy results showed fibromembranous tissue without neutrophilic infiltrates. The patient was diagnosed with aseptic chronic sclerosis osteomyelitis.

In October 2018, the patient underwent a facial computed tomography scan at the investigators’ metabolic bone clinic. Scan results indicated both sclerosis and thickening of the majority of the right mandible with lytic areas. Additional laboratory evaluations found C-telopeptide levels of 1205 pg/mL (range, 104-1008 pg/mL), vitamin D-25 levels of 36 ng/mL (range, 30-100 ng/mL), and glomerular filtration rate >60 mL/min/1.73 m² (reference, >60 mL/min/1.73 m2). After this evaluation, the patient received an infusion of 5 mg intravenous zoledronic acid in December 2018.

Within 3 weeks, the patient’s mandibular pain began improving, with “near complete resolution within 3 weeks.”

The researchers concluded, “Although larger, long-term studies are needed, our case suggests zoledronic acid is a promising treatment for patients with sclerosing osteomyelitis refractory to conventional treatment.”


Marcano I, Whitlatch H. Use of zoledronic acid for management of sclerosing osteomyelitis of the mandible. Presented at: American Society for Bone and Mineral Research Annual Meeting 2019; September 20-23, 2019; Orlando, FL. Abstract 213.