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. 2024 Feb;114(2):129-136.
doi: 10.1007/s00223-023-01154-4. Epub 2023 Nov 22.

Treatment Effect of Zoledronic Acid in Chronic Non-bacterial Osteomyelitis of the Jaw: A Case Series

Rasmus Bo Jansen  1 , Johanna Nilsson  2 , Kristian Buch-Larsen  3 , Thomas Kofod  2 , Peter Schwarz  3
Affiliations

Treatment Effect of Zoledronic Acid in Chronic Non-bacterial Osteomyelitis of the Jaw: A Case Series

Rasmus Bo Jansen et al. Calcif Tissue Int. 2024 Feb.

Abstract

Chronic non-bacterial osteomyelitis (CNO) is an autoinflammatory, osteolytic bone disorder sometimes localized to a unifocal site in the jaw, causing long-term pain and reduced function. The aim of this study was to describe the patients with CNO of the jaw, focusing on treatment with zoledronic acid for pain relief. An analysis of medical records of 24 patients with CNO of the jaw, including treatment with zoledronic acid and effects on pain relief. Descriptive statistics and nonparametric tests were used to describe the population and compare treatment effects, respectively. The average treatment period was 33.4 months (median 23; Q1 11.5; Q3 42.0) with an average of 4.1 infusions (median 3; Q1 2; Q3 5) of zoledronic acid. The average pain VAS score (visual analogue scale) was significantly reduced from 7.7 (median 8; Q1 6.5; Q3 8.5) to 2.5 points (median 2; Q1 0.5; Q3 4.5) (p < 0.001). At final visit, 46% of patients reported no pain and 38% reported a reduction of pain. At least 67% of patients had at least one episode of pain recurrence, and most patients experienced the first recurrence within a year of initial treatment. Four patients (16%) had no pain relief from the treatment. In this group of patients with CNO of the jaw, there was a positive response to treatment with zoledronic acid on pain relief, averaging 5.2 points on a pain VAS score, with 84% of patients treated experiencing either a partial or a total reduction in pain after about 2.5 years.

Keywords: Bone remodelling; Chronic non-bacterial osteomyelitis of the jaw; Jaw pain; Osteomyelitis; Zoledronic acid.

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Conflict of interest statement

Rasmus Bo Jansen, Johanna Nilsson, Kristian Buch-Larsen, Thomas Kofod, and Peter Schwarz declare that they have no conflict of interest regarding this study or any aspect thereof, including its funding and/or publication.

Figures

Fig. 1
Fig. 1
Flowchart of treatment regime with zoledronic acid for pain related to CNO of the jaw
Fig. 2
Fig. 2
Flowchart of patient inclusion in the study
Fig. 3
Fig. 3
Summary of the diagnostic tests used to confirm the diagnosis of CNO prior to referral
Fig. 4
Fig. 4
Number of doses of zoledronic acid given within the first 12 months, including initial dose
Fig. 5
Fig. 5
Overview of patients’ 1st recurrence of CNO-related pain. N/A denotes insufficient records data to conclude whether a recurrence had occurred. This was mainly due to insufficient follow-up time (less than 12 months of follow-up)
Fig. 6
Fig. 6
Pain relief after treatment with zoledronic acid
See this image and copyright information in PMC

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