Warning signs of osteoporosis

A 61-year-old white Caucasian lady, who was a long-term patient of the practice, attended mid-April last, reporting having heard a loud crack in her left jaw on biting, followed by pain, trismus and swelling. The pain at first resembled an electric shock but, owing to an impending holiday, the patient struggled through with pain-killers and a restricted diet. This had all occurred three weeks previous to her visit.

On attendance there were no obvious physical signs, no pain on palpation, but left condylar deviation was palpable.

Her mouth was not heavily restored but she had a history of sleep apnoea and wore a snoring appliance and attended a sleep clinic. Her medical history showed that she had had rheumatic fever, a heart murmur, angina pectoris (cardiac syndrome) and high blood pressure.

A panoramic x-ray showed what appeared to be bilateral fractures of both condyles just below the severe osteoporosis (Figure 1 - incidental finding on OPG x-ray and Figure 2 - TMJ views). Consequently, Forsteo 2x daily injection (osteoporosis) and Calcichew D3 forte (osteoporosis) were added to the patient's pre-diagnosis list of medications: Bisoprolol (high blood pressure), Zirtec (antihistamine) and Beconase nasal spray.