Raloxifene-induced osteonecrosis of the jaw (MRONJ) with no exposure to bisphosphonates: clinical and radiographic findings

Raloxifene is a selective estrogen receptor modulator (SERM) that is used to manage osteoporosis in women. Because of its tissue selectivity, raloxifene has fewer side effects than estrogen therapy; however, raloxifene-associated osteonecrosis of the jaw (ONJ) has recently been reported. While most of the reported cases were treated with antiresorptive therapy in addition to raloxifene, ONJ can also occur with the isolated use of raloxifene. This report presents a case where there was no prior exposure to bisphosphonates, in which the patient incidentally had florid cemento-osseous dysplasia (FCOD). Raloxifene-associated ONJ has never been reported before in a patient with FCOD. It is unclear whether the presence of FCOD increases the risk of ONJ. Case report: Clinical and radiographic findings regarding an African-American patient with FCOD and raloxifene-induced ONJ are described. The patient underwent a battery of investigations and surgical debridement of the area in question. She has remained disease free in the 2 years following the treatment. Conclusions:The aim of this report is to shed some light on a serious complication of raloxifene, a medication that is increasingly encountered in dental practices. Dental practitioners should use this knowledge to increase their awareness of possible ONJ development after the use of raloxifene. Brief recommendations and guidance in general dental practice for management of patients on raloxifene are also presented.