WOMEN’S HEALTH PREGNANT WOMEN AND OSTEOPOROSIS

GROUP 6 DMD 6B

MARASIGAN, APRIL JOYCE

MONCAYO, KRISTINE RHOBERT
ORUGA, NICOLE ANDREA
PORMILDA, BEA MARIE
QUINANAHAN, DIEGO EMMANUEL
REA, JAMMILA CLAIRE
ROXAS, CHESKA FAYE
SALAZAR, MARIA BEATRIZ
SAYSON, ZELINE RAPHAELLE
 WOMEN’S HEALTH

Women’s Health
focuses on the treatment and diagnosis of diseases and conditions that
affect a woman's physical and emotional well-being.
patient-centered health care.

PREGNANCY OSTEOPOROSIS

BIRTH CONTROL SEXUAL HEALTH

BREAST AND WOMEN AND HEART

OVARIAN CANCER DISEASE

SEXUALLY TRANSMITTED
MAMMOGRAPHY
INFECTIONS

MENOPAUSE GYNECOLOGY

GROUP 6 DMD6B
PREGNANCY
 WOMEN’S HEALTH

Pregnancy
special considerations are necessary when oral surgery is required to protect
the mother and the developing fetus.

Potential for creating fetal damage :

Dental Imaging
Drug administration

primary concern: prevention of genetic damage to the fetus.

GROUP 6 DMD6B
 Dental Significance in Pregnant Women
“The storm of hormones which is induced during pregnancy causes
changes in the mother’s body, and the oral cavity is no exception.”
Dental considerations in pregnancy-a critical review on the oral care. Journal of clinical and diagnostic research : JCDR, 7(5), 948–953.

The increased hormonal secretion and the fetal

growth induce several systemic, as well as local
physiologic and physical changes in a pregnant
woman.
The main salivary changes in pregnancy involve its
flow, composition, pH and hormone levels.

Pregnancy Gingivitis is a well-recognized entity.

“A mother loses a tooth for every baby”

GROUP 6 DMD6B
 Challenges and Protocols During Management PREGNANCY

Possible Complications Protocol

MANAGEMENT FOR SEVERE FEATURES:

delivery is recommended unless <34 weeks
concerns about fetal well-being may prompt delivery before 34 weeks.
MANAGEMENT FOR MILD FEATURES:
managed conservatively until 37 weeks with close monitoring for
PREECLAMPSIA development of severe features, careful fetal surveillance, and limited
persistent high blood pressure physical activity to reduce blood pressure.
during pregnancy HYPERTENSION MANAGEMENT:
Timely management of blood pressures >160/110 mmHg.
Labetalol or hydralazine IV are first-line agents for severe hypertension.
Consideration of oral agents once blood pressure is controlled.
Slow reduction of elevated arterial pressure to avoid hypotension and
decreased blood flow to the fetus.

GROUP 6 DMD6B
 Challenges and Protocols During Management PREGNANCY

Possible Complications Protocol

PREVENTION OF PREECLAMPSIA:
PREECLAMPSIA Magnesium sulfate.
persistent high blood pressure Administered as an IV loading dose followed by a continuous infusion.
during pregnancy Caution in patients with impaired renal function or pulmonary edema.
Superior to phenytoin and diazepam in reducing the risk of seizures.

GROUP 6 DMD6B
 Challenges and Protocols During Management
Possible Complications
DIABETES MELLITUS
Gestational diabetes occurs due to
an increase in insulin resistance in
pregnant women.
GROUP 6 DMD6B
PREGNANCY
Protocol
GLYCEMIC CONTROL:
Continuous glucose monitoring
Assess blood glucose when fasting and 1 or 2 hours after a meal.
Fasting blood glucose <5.3 mmol/L (<95 mg/dL).
Postprandial targets:
<7.8 mmol/L (140 mg/dL) at 1 hour, <6.7 mmol/L (120 mg/dL) at 2 hours.
MEDICAL THERAPY:
Insulin Needs
first trimester: 0.7–0.8 units/kg
third trimester: 0.9–1.2 units/kg
Utilize a combination of basal insulin with short-acting insulin at mealtime or
continue insulin pump use.
THIRD TRIMESTER MANAGEMENT:
Tight glycemic control at delivery
 Challenges and Protocols During Management
Possible Complications
HYPERTHYROIDISM
increased levels of circulating
thyroid hormones, as well as
a decreased level of thyroid-
stimulating hormone (TSH).
GROUP 6 DMD6B
PREGNANCY
Protocol
MEDICATIONS:
Methimazole
Crosses the placenta more than propylthiouracil.
Associated with fetal aplasia cutis.
Propylthiouracil
Can be associated with maternal liver failure.
Some experts recommend propylthiouracil in the first trimester and methimazole
thereafter.
Radioiodine
Should not be used during pregnancy (for scanning or treatment).
Due to potential adverse effects on the fetal thyroid.
IN CASE OF THYROID STORM:
Additional treatment with beta blockers may be necessary.
Management should be carefully tailored to balance maternal and fetal risks.
 Challenges and Protocols During Management
Possible Complications
HYPOTHYROIDISM
hCG levels in the first
trimester may result in a low
TSH that returns to normal
throughout the duration of
pregnancy.
GROUP 6 DMD6B
PREGNANCY
Protocol
MEDICATIONS:
Thyroxine (Levothyroxine)
Increase thyroxine dose by 30% (two additional pills weekly) as soon as
pregnancy is diagnosed.
Adjust the dose according to TSH levels.
MANAGEMENT APPROACH:
Regular monitoring of TSH levels
management is often individualized based on the patient's specific needs and
thyroid function.
 Challenges and Protocols During Management
Possible Complications
VENUS
THROMBOEMBOLISM
increased risk of VTE due to
hypercoagulability.
GROUP 6 DMD6B
PREGNANCY
Protocol
ANTICOAGULANT THERAPY:
Low-molecular-weight heparin (LMWH) or unfractionated heparin
Anticoagulants increase the risk of epidural hematoma in women receiving
neuraxial analgesia during labor.
Transition to Unfractionated Heparin
As delivery approaches, transitioning to unfractionated heparin can shorten the
time between anticoagulant administration and epidural placement.
NEURAXIAL ANALGESIA IN LABOR:
Anticoagulants must be withheld until after delivery to avoid fetal exposure.
Timing of Anticoagulant Stoppage for Neuraxial Analgesia
Prophylactic LMWH: Stop 12 hours before epidural catheter placement.
Therapeutic LMWH: Withhold for a full 24 hours.
 Challenges and Protocols During Management PREGNANCY

Possible Complications Protocol

IONIZING RADIATION:
Highest sensitivity during the first trimester (organogenesis phase).
alternative modalities should be considered.

CHEMOTHERAPY:
MALIGNANCY First Trimester
breast, cervical and ovarian Avoid cytotoxic chemotherapy (risk of spontaneous abortion)
malignant tumours. If maternal health requires chemotherapy during the first trimester, counsel about
the role of therapeutic abortion to avoid serious neonatal sequelae.

Second and Third Trimesters

Various single agents and combinations have been administered without a high
frequency of toxic effects.

GROUP 6 DMD6B
 Challenges and Protocols During Management PREGNANCY

Possible Complications Protocol

Treatment in Pregnancy with Early Delivery Plans

If patient is beyond the first trimester, treatment might be initiated with plans for
preterm delivery to minimize fetal exposure.
MALIGNANCY
breast, cervical and ovarian
Timing of Delivery
malignant tumours.
Neonatal prognosis is closely linked to gestational age at delivery.
Decisions regarding delivery timing should consider the natural history of the
disease and the safety of the proposed treatment.

GROUP 6 DMD6B
 Challenges and Protocols During Management PREGNANCY

Possible Complications Protocol

Treatment in Pregnancy with Early Delivery Plans

If patient is beyond the first trimester, treatment might be initiated with plans for
preterm delivery to minimize fetal exposure.
MALIGNANCY
breast, cervical and ovarian
Timing of Delivery
malignant tumours.
Neonatal prognosis is closely linked to gestational age at delivery.
Decisions regarding delivery timing should consider the natural history of the
disease and the safety of the proposed treatment.

GROUP 6 DMD6B
 Challenges and Protocols During Management PREGNANCY

Possible Complications Protocol

Treatment in Pregnancy with Early Delivery Plans

If patient is beyond the first trimester, treatment might be initiated with plans for
preterm delivery to minimize fetal exposure.
MALIGNANCY
breast, cervical and ovarian
Timing of Delivery
malignant tumours.
Neonatal prognosis is closely linked to gestational age at delivery.
Decisions regarding delivery timing should consider the natural history of the
disease and the safety of the proposed treatment.

GROUP 6 DMD6B
 Dental Management of Patients
During and After Pregnancy
1. Defer elective surgery until after delivery, if possible.
2. Consult the patient’s obstetrician if surgery cannot be delayed.
3. Avoid dental radiographs unless information about tooth roots or bone is necessary for
proper dental care.
4. Avoid the use of drugs with teratogenic potential. Use local anesthetics when
anesthesia is necessary.
5. Use at least 50% oxygen if nitrous oxide sedation is used, but avoid use during the first
trimester.
6. Avoid keeping the patient in the supine position for long periods to prevent vena caval
compression.
7. Allow the patient to take trips to the restroom as often as needed.

WOMEN’S HEALTH
 Dental Management of Patients
During and After Pregnancy
MEDICATIONS
least likely to harm a fetus when
used in moderate amounts:
lidocaine,
bupivacaine,
acetaminophen,
codeine,
penicillin,
and cephalosporins.

best avoided in pregnant patients:

NSAIDS (aspirin and ibuprofen)
sedative drugs
nitrous oxide

WOMEN’S HEALTH
 Dental Management of Patients
During and After Pregnancy
The U.S. Food and Drug Administration created a system of drug categorization based on the
known degree of risk to the human fetus posed by particular drugs.

Category Human Fetus Risk

Controlled studies in women show no risk to the fetus and the possibility of fetal harm
A
appears remote

No controlled studies have been conducted in humans; animal studies show no risk to the
B
fetus.

C No controlled studies have been conducted in animals or humans.

Positive evidence of human fetal risk exists; however, benefits may outweigh risks in
D
certain situations.

X Controlled studies in both animals and humans demonstrate fetal abnormalities.

 WOMEN’S HEALTH

Things to Consider: PREGNANCY

DENTAL IMAGING
DRUG ADMINISTRATION
HEALTHY DIET
SMOKING
Secondhand smoke can cause low birth weight and cause death.
ALCOHOL
Alcohol can affect your baby throughout pregnancy
Fetal Alcohol Syndrome (FAS). Children with this syndrome have:
1. restricted growth
2. facial abnormalities
3. learning and behavioural disorders.

GROUP 6 DMD6B
 WOMEN’S HEALTH

Things to Consider: PREGNANCY

ILLEGAL DRUGS
cannabis, ecstasy, cocaine and heroin can harm the baby.
X-RAYS
EXERCISE

GROUP 6 DMD6B
OSTEOPOROSIS
 WOMEN’S HEALTH

Osteoporosis
reduction in the strength of bone that leads to an increased risk of fractures.

chief clinical manifestations: vertebral and hip fractures

Mostly age related (women: 50 yrs old; men: 70-80 yrs old)
Prevalent among postmenopausal women
five times more common in postmenopausal women.
Calcium intake, vitamin D, and estrogen plays an important role in bone loss.

GROUP 6 DMD6B
 WOMEN’S HEALTH

Osteoporosis
OSTEOPOROSIS-RELATED FRACTURES
Trauma less than or equal to fall from standing height
Exceptions of fingers, toes, face, and skull.

As many of the fractures defined as related to osteoporosis occur in individuals

with low bone mass, identification of those at high risk of fracture and their
evaluation and treatment have become important issues in clinical
management.

GROUP 6 DMD6B
 Dental Management in Women with Osteoporosis
“evidence suggests that osteoporosis may be associated with oral health
conditions such as periodontal disease, reduced jaw bone density and tooth loss.”

Impact of Osteoporosis and Its Treatment on Oral Health: The American Journal of the Medical Sciences 346(5)

The dental and oral effects of osteoporosis tend to

affect more women than men.
Studies also show that sufferers of the disease are
at risk of requiring new dentures more often than
those who have strong, healthy bones.
difficulties linked to ill-fitting or loose dentures.

Bisphosphonate-related osteonecrosis of the jaws

is a recently described adverse effect of
bisphosphonate therapy.

GROUP 6 DMD6B
 WOMEN’S HEALTH

Challenges During Management of Osteoporosis

MENOPAUSAL TRANSITION(late 50s):
During menopause, estrogen levels fall.
rapid decrease in bone density.
bone density testing and osteoporosis evaluation

The FRAX® tool

an osteoporosis risk assessment test
uses information about your bone density and
other risk factors for breaking a bone to
estimate your 10-year fracture risk.

GROUP 6 DMD6B
 WOMEN’S HEALTH

Challenges During Management of Osteoporosis

I. ROUTINE LABORATORY HIGH LOW
EVALUATION
General evaluation SERUM CALCIUM LEVEL hyperparathyroidism or malnutrition or a
complete blood count, serum malignancy malabsorption disease,
and 24-h urine calcium, and (e.g., celiac disease)
renal and hepatic function SERUM PTH LEVEL hyperparathyroidism malignancy
tests hypercalcemia
indicators: (PTHrP: humoral
1. serum calcium level hypercalcemia of
2. serum PTH level malignancy)
3. urine calcium URINE CALCIUM
(<50 mg/24 h)
malnutrition, or disease
Mastocytosis with selective
24-h urine histamine collection malabsorption
or serum tryptase.

GROUP 6 DMD6B
 WOMEN’S HEALTH

Challenges During Management of Osteoporosis

I. ROUTINE LABORATORY EVALUATION

Assessment of Myeloma
1. Serum and urine electrophoresis
and/or evaluation for serum free
MYELOMA
light chains in urine

2. Monoclonal gammopathy of
undetermined significance (MGUS)

3. Bone marrow biopsy

GROUP 6 DMD6B
 WOMEN’S HEALTH

Challenges During Management of Osteoporosis

DIABETES (TYPE I AND II)
important cause of fracture among the aging population

effects on muscle and nerve that increase the risk of falls

underlying skeletal fragility

GROUP 6 DMD6B
 WOMEN’S HEALTH

Challenges During Management of Osteoporosis

BONE BIOPSY
Tetracycline labeling of the skeleton
determination of the rate of remodeling
evaluation for other metabolic bone diseases
diagnosis of chronic kidney disease– mineral bone disease (CKD-MBD)
evaluating the mechanism of action of osteoporosis pharmacologies,
and in clinical research

GROUP 6 DMD6B
 WOMEN’S HEALTH

Challenges During Management of Osteoporosis

III. BIOCHEMICAL MARKERS
CLINICAL USES: Biochemical tests
1. Help in the prediction of fracture risk, independently of bone - measure the overall state
density, particularly in older individuals.
of bone remodeling at a
women ≥65 years: greater bone density
2. Monitor the response to treatment single point in time.
antiresorptive therapeutic agents -> bone remodeling declines rapidly Bone Turnover Markers
bone resorption before initiating therapy and 2–6 months after - useful in monitoring the
starting therapy
effects of 1–34hPTH, or
decline in resorptive markers (after tx)
teriparatide, which rapidly
3. Evaluation on the off-effect of drugs
“drug holidays”
increases bone formation

GROUP 6 DMD6B
 WOMEN’S HEALTH

Protocols for the Management of Osteoporosis

MANAGEMENT OF FRACTURES:

1. Acute fracture management

2. Surgical repair (hip fractures)
3. Surgical procedures (open reduction, internal fixation,
hemiarthroplasties, and total arthroplasties)
4. Intense rehabilitation following surgery
5. External/internal fixation (long bone fractures)
6. Supportive care

GROUP 6 DMD6B
 WOMEN’S HEALTH

Protocols for the Management of Osteoporosis

VERTEBRAL COMPRESSION FRACTURES:

~25–30% : sudden onset back pain

Treatment:
acutely symptomatic fractures - analgesics
pain management - Calcitonin; Percutaneous injection of
cement (vertebroplasty or kyphoplasty); short periods of bed
rest; muscle relaxants and heat
> severe pain resolves: 6-10 weeks
Risks of procedure: cement extravasation, neurologic
impairment, and possible increased risk of adjacent vertebral
fractures
GROUP 6
DMD6B
 WOMEN’S HEALTH

Protocols for the Management of Osteoporosis

RISK FACTOR REDUCTION OF UNDERLYING DISEASE:

1. Patient education
2. Review medications
3. TSH Testing
4. Efforts should be made for smoker patients
5. Reduce frequency - if nocturia occurs
6. Treatment for impaired vision
7. Specialized supervision and care - elderly patients with neurologic disorder

GROUP 6
DMD6B
 WOMEN’S HEALTH

Protocols for the Management of Osteoporosis

NUTRITION:

CALCIUM VITAMIN D OTHER NUTRIENTS

Preferred sources: - Synthesized in the skin Adequate Vitamin K
diet, calcium under UV light Calorie and protein
supplementation. - Supplementation supplementation
Best sources: recommended:
<50 years: 200 IU, NEGATIVE EFFECTS:
dairy products,
50–70 years: 400 IU 1. calcium excretion or
nondairy milks,
>70 years: 600 IU absorption
fortified foods,
- Multivitamins and 2. reduced bone mass
vegetables, and
calcium supplements 3. increase renal
fruits
calcium excretion

GROUP 6
DMD6B
 WOMEN’S HEALTH

Protocols for the Management of Osteoporosis

EXERCISE:

1. Weight-bearing exercise at least 3x a week

2. Exercise programs involving resistance and balance training

for individuals with osteoporosis or osteoporotic vertebral fractures

slow controlled movements

GROUP 6
DMD6B
 WOMEN’S HEALTH

Protocols for the Management of Osteoporosis

PHARMACOLOGIC TREATMENT:

ESTROGEN conjugated equine estrogens

Administered orally, transdermally, or by estradiol
subcutaneous implant. estrone
esterified estrogens
Combined estrogen/progestin preparations
ethinyl estradiol
available. mestranol.

BIPHOSPHONATES
for the prevention and treatment of postmenopausal osteoporosis.
1. ALENDRONATE,
2. RISEDRONATE,
3. IBANDRONATE,
4. ZOLEDRONIC ACID
GROUP 6
DMD6B
 WOMEN’S HEALTH

Things to Consider: OSTEOPOROSIS

BIPHOSPHONATES
1. inhibit bone resorption
2. bone renewal
stabilize bone loss --> reducing their risk of pathologic fractures

GROUP 6 DMD6B
 WOMEN’S HEALTH

Things to Consider: OSTEOPOROSIS

1. AGE-RELATED CHANGES
2. HORMONAL INFLUENCES
3. PHYSICAL ACTIVITY
4. GENETIC FACTORS
5. CALCIUM NUTRITIONAL STATE
6. SECONDARY CAUSES OF OSTEOPOROSIS

GROUP 6 DMD6B
 Case Report (Pregnancy) WOMEN’S HEALTH

HISTORY OF PRESENT ILLNESS:

a 34-year-old woman of Haitian origin, presented to the obstetrical triage at
40 weeks gestation with worsening jaw pain.
CLINICAL EVALUATION:
Patient exhibited significant symptoms, including swelling of the floor of the mouth,
bilateral neck swelling, and trismus.
MEDICAL AND DENTAL HISTORY:
history of a diagnosed dental cavity, but no treatment was initiated, and she
did not comply with recommended follow-up.
SOCIAL HISTORY:
patient also smoked cigarettes throughout the pregnancy and engaged in prenatal
care irregularly.
MANAGEMENT:
broad-spectrum intravenous antibiotic therapy was administered and awake fiberoptic intubation to secure the
airway. The patient underwent an urgent cesarean delivery, and a healthy infant was born.
 Case Report (Pregnancy) WOMEN’S HEALTH

TREATMENT PLAN:
patient remained intubated and was diagnosed with Ludwig's angina through a
computed tomography scan. Incision and drainage of the abscess were
performed, and the patient received intravenous antibiotics for nine days. She
was discharged on oral antibiotics with outpatient follow-up.

CLINICAL SIGNIFICANCE
The report emphasizes the importance of oral health care during pregnancy, citing the increased risk of
periodontal disease and its complications in pregnant women. The case underscores the potential severe
consequences of untreated dental issues during pregnancy, such as Ludwig's angina, which can lead to
airway obstruction and even mortality if not promptly addressed.
The authors advocate for counseling pregnant women on the significance of maintaining oral health care,
especially in the presence of risk factors for periodontal disease, to prevent future morbidity associated
with inadequate oral health care during pregnancy.
The case highlights the need for collaboration among family physicians, obstetricians, and dentists to
educate women and dispel misperceptions regarding the safety of dental procedures during pregnancy.
 Case Report (Pregnancy) WOMEN’S HEALTH

CASE:
This case report presents a pregnant woman who has Chronic Hepatit B with high viral load in the 26th week of
her pregnancy. A two-week antiviral treatment was proposed before cesarean section. However, it was learned
that she has not received any antiviral therapy until her admission to the Teratogenity Unit. A total of only six
days of 245 mg TDF was taken until she had to be taken to the cesarean section because of impairment alteration
in blood glucose regulation.
OUTCOME:
Pregnant woman, gave birth to a healthy baby who had a normal APGAR score without any malformation.
Hepatitis B vaccine and immunoglobulin were administered to the infant within 24 hours after delivery for
preventing the vertical transmission. Baby’s Hepatitis B markers and liver function tests were found within normal
limits at 14th and 25th weeks after delivery. The mother’s HBV-DNA level was determined as 5670 IU/mL and liver
function tests were within normal limits at 14th weeks after birth.
Case Report (Pregnancy) WOMEN’S HEALTH

CLINICAL SIGNIFICANCE
For pregnant women patients without active or advanced chronic HBV infection, antiviral therapy can be
recommended.
Since pregnancy-associated hepatitis B reactivation can occur for both treated and untreated women,
close monitoring is essential during pregnancy and for at least 6 months after delivery
 Case Report (Osteoporosis) WOMEN’S HEALTH

HISTORY OF PRESENT ILLNESS:

a 49-year-old woman presented with a worsening jaw pain with a
progressively growing, unilateral swelling of the jaw and an open release of
the corresponding alveolar bone. Symptoms started a week after a dental
removal.
MEDICAL AND DENTAL HISTORY: an osteonecrosis aspect of the
history of early menopause and low energy fracture of the upper end of the left lower jaw with extensive osteolysis
in the posterior region of the horizontal
right humerus.
branch of the left maxillary bone and
Ostenel 35 mg weekly in July 2012. bone sequestrum
Previous dental extraction.
CLINICAL EVALUATION:
clinical appearance simulated dental abscesses.
RADIOGRAPHIC EVALUATION:
A panoramic X-ray bone necrosis aspect of the left lower jaw with extensive osteolysis in the posterior region of
the horizontal branch of the left maxillary bone and sequestration
 Case Report (Osteoporosis) WOMEN’S HEALTH

Ad integrum restitution of radiological
lesions.
TREATMENT PLAN:
surgical removal of the secestrum, intensive antibiotic therapy with hyperbaric
oxygen sessions.
OUTCOME:
favorable with an ad integrum restitution of radiological lesions after eight
months. The ostenel has not been stopped.

CLINICAL SIGNIFICANCE
The report suggests preventive measures such as maintaining oral hygiene, regular dental check-ups, and
addressing dental issues before and during bisphosphonate treatment.
Surgical interventions are difficult and may include the excision of necrotic bone, with the complete
removal being crucial for efficacy. Preventive measures, such as regular oral hygiene, frequent dental
consultations, and addressing dental issues before and during bisphosphonate treatment, are
recommended despite the minimal risk of jaw necrosis.
 Case Report (Osteoporosis) WOMEN’S HEALTH

HISTORY OF PRESENT ILLNESS:

a 77-year-old female patient complains of “an exposed bone that appeared after tooth extraction performed six
months earlier”. She reported painful swelling in the mentonian region, including abscess and fistula, after 1 year of
dental treatment. She stated that her previous dentist performed periodontal therapy by scraping all the teeth and
extracting teeth 33 and 34, including antibiotic therapy (cephalexin and amoxicillin with potassium clavulanate).
However, bone exposure advanced.
CLINICAL EVALUATION:
exposure of bone and alveolar ridge in the region of teeth #33 and #34.
RADIOGRAPHIC EVALUATION:
Panoramic:
evidence of radiopaque image suggestive of bone necrosis involving the region of
lower incisors. An extensive area of bone sequestration spread across the body
of the mandible (symphysis region) to the region of pre-molars.
CBCT:
radiolucent, well-defined injury, covering the area of teeth #35 to #43, with
impairment of buccal and lingual cortical bones, but with mandibular basal lamina
preserved.
 Case Report (Osteoporosis) WOMEN’S HEALTH

MEDICAL HISTORY:
no history of chronic use of steroids or radiotherapy in the head and neck region.
patient was on medications for control of type-2 diabetes mellitus (glargine insulin and sitagliptin phosphate),
cardiopathy, and systemic hypertension (salicylic acetyl acid, atenolol, enalapril maleate, and
hydrochlorothiazide) and dyslipidemia (simvastatin and ciprofibrate).
She also reported undergoing cardiac surgeries (2 mammary and 1 saphenous bypass grafts) in 2005.
thyroidectomy in 2011 (using levothyroxine sodium).
The patient was also taking cholecalciferol and tribasic calcium phosphate for control of
osteoporosis/osteopenia for many years as well as sodium ibandronate for two years. Pantoprazole was also
used.
DIAGNOSIS:
osteonecrosis associated with the use of bisphosphonate (sodium ibandronate).
TREATMENT PLAN:
removal of bone sequestration and teeth, including antibiotic therapy.
 Case Report (Osteoporosis) WOMEN’S HEALTH

OUTCOMES:
After the surgery, the patient presented proper healing and no sign of new bone exposure and/or surgical
wound dehiscence.
The patient was followed up for six years (a total of 6 appointments), presenting good general health, no sign
of bone exposure, and did not have paresthesia. Imaging findings showed no changes related to BRONJ
either.

CLINICAL SIGNIFICANCE
All patients should be asked about the current or past use of bisphosphonate drugs and the mode of
administration.
Patients yet to start with bisphosphonate therapy should be first examined for requirement of any surgical
dental procedures prior to the therapy, if the risk factors allows.
For patients who have already started with the therapy, any elective procedures should be avoided if
possible to avoid the risk of bisphosphonate induced osteonecrosis of the jaw.
Patients should be routinely examined radiographically for osteonecrosis and baseline data should be
recorded for the patient.
WOMEN’S HEALTH
PREGNANT WOMEN AND OSTEOPOROSIS

REFERENCES:
Fauci, A., Hauser, S., Jameson, J., Kasper, D., Longo, D. & Loscalzo, J. (2022). Harrison's Principles
of Internal Medicine, 21e. McGraw Hill.
Figueiredo, M. A., Medeiros, F. B., & Ortega, K. L. (2021). Osteonecrosis of the jaw in a patient
under treatment of osteoporosis with oral bisphosphonate. Autopsy Case Reports, 11.
https://doi.org/10.4322/acr.2020.186
Güven, H., Arıcı, M. A., Aktürk, G., & Güner, Ö. (2020). A Case Report of a Pregnant Woman with
Chronic Hepatit B: Use of Tenofovir in Pregnancy. The Journal of Basic and Clinical Health
Sciences. https://doi.org/10.30621/jbachs.2020.807
Hemalatha, V., Amudhan, A., Sarumathi, T., & Manigandan, T. (2013). Dental Considerations in
Pregnancy-A Critical Review on the Oral Care. Journal of Clinical and Diagnostic Research.
https://doi.org/10.7860/jcdr/2013/5405.2986 GROUP 6 DMD 6B

Hupp, J., Ellis, E. & Tucker, M. (2014). Contemporary oral and maxillofacial surgery (6th ed.).
MARASIGAN, APRIL JOYCE
Elsevier.
MONCAYO, KRISTINE RHOBERT
Kaouther, B. A., & Souabni Leila, D. R. (2015). Jaw Avascular Osteonecrosis after Treatment of ORUGA, NICOLE ANDREA
Post-menopausal Osteoporosis with Residronate: A Case Report. Journal of Clinical Case Reports, PORMILDA, BEA MARIE
05(06). https://doi.org/10.4172/2165-7920.1000543 QUINANAHAN, DIEGO EMMANUEL
Rosenfeld, J. A. (2009). Handbook of Women’s Health. Cambridge Core. REA, JAMMILA CLAIRE
The Pregnancy Book. St George’s University Hospitals NHS Foundation Trust. (2009). ROXAS, CHESKA FAYE
Trahan, M.-J., Nicholls-Dempsey, L., Richardson, K., & Wou, K. (2020). Ludwig’s Angina in SALAZAR, MARIA BEATRIZ
Pregnancy: A Case Report. Journal of Obstetrics and Gynaecology Canada, 42(10), 1267–1270. SAYSON, ZELINE RAPHAELLE
https://doi.org/10.1016/j.jogc.2020.03.014