Osteonecrosis of the jaw in patients taking Atorvastatin: Case series


  • Jenizan Nordin Ikhlas Dental Clinic, Malaysia.
  • Ahmad Badruddin Ghazali Department of Oral Maxillofacial Surgery & Oral Diagnosis, Kulliyyah of Dentistry, International Islamic University Malaysia.




bisphosphonate, MRONJ, mevalonate pathway, osteonecrosis, statin


Osteonecrosis of the jawbones commonly seen in patients taking bisphosphonates, denosumab, and several antiangiogenic medications with several oral factors such as tooth extraction or dental infection. Currently, patients taking Simvastatin, a medication commonly used to treat hypercholesteremia, were reported of developing osteonecrosis of the jaw. Thus, it is important that clinicians know about the risk of osteonecrosis for patients taking this hypercholesteremia medication. It is not known if the undesirable effect only occurs with Simvastatin or other types of statin medication. We report in detail three cases of osteonecrosis of patients taking Atorvastatin calcium, a second-generation statin medication.


Beth-Tasdogan, N. H., Mayer, B., Hussein, H., & Zolk, O. (2017). Interventions for managing medication related osteonecrosis of the jaw. Cochrane Database of Systematic Reviews, 2017(10).

Fede, O. Di, Panzarella, V., Mauceri, R., Fusco, V., Bedogni, A., Muzio, L. et al.. (2018). The Dental Management of Patients at Risk of MedicationRelated Osteonecrosis of the Jaw?: New Paradigm of Primary Prevention. BioMed Research International, 2018, 2684924.

Giladi, H. Z., Gabay, E., & Machtei, E. E. (2020). Medication-Related Osteonecrosis of the Jaw in Patients Taking High-Dose Simvastatin. Journal of Oral Maxillofacial Surgery, 78(6), 862–863.

He, L., Sun, X., Liu, Z., Qiu, Y., & Niu, Y. (2020). Pathogenesis and multidisciplinary management of medication-related osteonecrosis of the jaw. International Journal of Oral Science, August, 1–11.

Hinson, A. M., Siegel, E. R., & Stack, B. C. J. (2015). Temporal correlation between bisphosphonate termination and symptom resolution in osteonecrosis of the jaw: a pooled case report analysis. Journal of Oral and Maxillofacial Surgery, 73(1), 53–62.

Peer, A., & Khamaisi, M. (2015). Diabetes as a Risk Factor for Medication- Related Osteonecrosis of the Jaw. Critical Reviews in Oral Biology & Medicine Diabetes, 94(2), 252–260.

Riley, D. S., Barber, M. S., Kienle, G. S., Aronson, J. K., von Schoen-Angerer, T., Tugwell, P., et al. (2017). CARE guidelines for case reports: explanation and elaboration document. Journal of Clinical Epidemiology, 89, 218–235.

Ruggiero, S. L., Dodson, T. B., Fantasia, J., Goodday, R., Aghaloo, T., Mehrotra, B., et al. (2014). American Association of Oral and Maxillofacial Surgeons position paper on medication-related osteonecrosis of the jaw--2014 update. Journal of Oral and Maxillofacial Surgery, 72(10), 1938–1956.

Samieirad, S., Labafchi, A., Famili, K., & Hashemzadeh, H. (2021). medication-related osteonecrosis of the jaw (MRONJ) due to simvastatin: an unusual case report. World Journal of Plastic Surgery, 10(1), 132–135.

Uzzan, B., Cohen, R., Nicolas, P., Cucherat, M., & Perret, G. (2007). Effects of statins on bone mineral density?: A meta-analysis of clinical studies. Bone, 40, 1581–1587.




How to Cite

Nordin, J., & Ghazali, A. B. (2022). Osteonecrosis of the jaw in patients taking Atorvastatin: Case series. IIUM Journal of Orofacial and Health Sciences, 3(2), 219–222. https://doi.org/10.31436/ijohs.v3i2.73