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References

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Luckman SP, Hughes DE, Coxon FP, Graham R, Russell G, Rogers MJ. Nitrogen-containing bisphosphonates inhibit the mevalonate pathway and prevent post-translation prenylation of GTP-binding proteins, including Ras. J Bone Miner Res. 1998; 13:581-589 https://doi.org/10.1359/jbmr.1998.13.4.581
Health & Social Care Information Centre (HSCIC). http://digital.nhs.uk/catalogue/PUB20200/pres-cost-anal-eng-2015-rep.pdf (Accessed 17 June 2016)
Medicines and Healthcare Products Regulatory Agency. https://yellowcard.mhra.gov.uk (Accessed 27 March 2016)
The electronic Medicines Compendium (eMC). http://www.medicines.org.uk/emc/medicine/4115 (Accessed 3 August 2016)
Alendronic Acid 70mg Tablets PL 16002/005.
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Oral erosive mucositis associated with improper administration of a drug. 2010. http://www.jcda.ca/article/a156 (Accessed 20 March 2016)
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Demerjian N, Bolla G, Spreux A. Severe oral ulcerations induced by alendronate. Clin Rheumatol. 1999; 18:349-350 https://doi.org/10.1007/s100670050116
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Oral Mucosal Ulceration Induced by Alendronic Acid: A Case Series

From Volume 45, Issue 1, January 2018 | Pages 38-42

Authors

Daniel Finn

BDS(Hons), MFDS RCS(Ed), PGCert

Specialty Dentist in Oral Medicine, Liverpool University Dental Hospital, Liverpool, UK

Articles by Daniel Finn

Anne Field

Senior Lecturer/Consultant in Oral Medicine, Liverpool University Dental Hospital and School, Pembroke Place, L3 5PS

Articles by Anne Field

Bijaya Rajlawat

Consultant in Oral Medicine, Liverpool University Dental Hospital, Liverpool, UK

Articles by Bijaya Rajlawat

Christine Randall

BPharm MRPharmS

Senior Medicines Information Pharmacist, North West Regional Medicines Information Centre, 70 Pembroke Place, Liverpool L69 3GF

Articles by Christine Randall

Abstract

A number of medications may cause oral ulceration by either systemic or local mechanisms. Alendronic acid tablets, when in prolonged contact with the oral mucosa, are one such medication. When prescribing alendronic acid tablets, it is important to ensure that the patient is able to take them correctly and, if this is not the case, that alternative methods of bone protection are considered. When patients present with oral ulceration, it is important to consider whether a medicine could be causing a localized tissue reaction. This case series highlights three cases of alendronic acid-induced oral ulceration.

CPD/Clinical Relevance: Practitioners should be aware of the potential oral unwanted effects of medications, including oral ulceration induced by prolonged mucosal contact with alendronic acid.

Article

Bisphosphonates are used to manage a number of conditions including; the treatment and prevention of osteoporosis, bone metastases, multiple myeloma and Paget's disease of the bone.1 Oral alendronic acid, the most commonly prescribed bisphosphonate used for the treatment and prevention of osteoporosis, acts to reduce bone resorption by inhibiting osteoclasts.2 Well recognized adverse effects of bisphosphonates include; osteonecrosis of the jaw and external auditory canal, as well as atypical femoral fractures.3 Alendronic acid is a frequently prescribed medication, with 8,758,501 prescriptions dispensed in the UK in 2015.4 Dental practitioners therefore need to be aware of the potential oral and dental adverse effects of this medication, including oral ulceration. The following three cases describe oral ulceration caused by alendronic acid when left in contact with the oral mucosa for a prolonged period of time.

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