Case Report

Bisphosphonate-associated Scleritis: A Case Report and Review

Authors: Sophia Leung, BS, Bimal H. Ashar, MD, Redonda G. Miller, MD

Abstract

An 86-year-old female was treated for osteoporosis with alendronate, an aminobisphosphonate. Six weeks after alendronate therapy began, scleritis developed in the patient’s right eye. The alendronate was discontinued, and, with the administration of prednisone, the symptoms of scleritis fully resolved. Rechallenge resulted in recurrence of the symptoms. Bisphosphonates are commonly used in the management of osteoporosis and are generally safe agents. Rarely, they have been linked with ocular inflammation. This case report reviews the literature on the ocular effects of bisphosphonates and discusses a possible mechanism for the association.


Key Points


* Aminobisphosphonates are common and highly effective agents used for the prevention and treatment of osteoporosis.


* Adverse ocular events, including uveitis, scleritis, and conjunctivitis, have been reported with aminobisphosphonate use, particularly pamidronate.


* Resolution of ocular findings usually occurs with withdrawal of the agent; occasionally systemic steroids are also required.

This content is limited to qualifying members.

Existing members, please login first

If you have an existing account please login now to access this article or view purchase options.

Purchase only this article ($25)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1. Eastell R. Treatment of postmenopausal osteoporosis. N Engl J Med 1998;338:737–746.
 
2. Liberman UA, Weiss SR, Broll J, et al. Effect of oral alendronate on bone mineral density and the incidence of fractures in postmenopausal osteoporosis. N Engl J Med 1995;333:1437–1496.
 
3. Harris ST, Watts NB, Genant HK, et al. Effects of risedronate treatment on vertebral and nonvertebral fractures in women with postmenopausal osteoporosis. JAMA 1999;282:1344–1352.
 
4. De Groen PC, Lubbe DF, Hirsch LJ, et al. Esophagitis associated with the use of alendronate. N Engl J Med 1996;335:1016–1021.
 
5. Ghose K, Waterworth R, Trolove P, et al. Uveitis associated with pamidronate. Aust N Z J Med1994;24:320.
 
6. O’Donnell NP, Rao GP, Aguis-Fernandez A. Paget’s disease: ocular complications of disodium pamidronate treatment. Br J Clin Pract 1995;49:272–273.
 
7. Macarol V, Fraunfelder FT. Pamidronate disodium and possible ocular adverse drug reactions. Am J Ophthalmol 1994;118:220–224.
 
8. Fraunfelder FT, Fraunfelder FW, Jensvold B. Scleritis and other ocular side effects associated with pamidronate disodium. Am J Ophthalmol 2003;135:219–222.
 
9. Mbekeani JN, Slamovits TL, Schwartz BH, et al. Ocular inflammation associated with alendronate therapy. Arch Ophthalmol 1999;117:837–838.
 
10. Salmen S, Berrueta L, Sanchez N, et al. Nongranulomatous anterior uveitis associated with alendronate therapy. Invest Clin 2002;43:49–52.
 
11. Siris ES. Bisphosphonates and iritis. Lancet 1993;341:436–437.
 
12. Fraunfelder FW, Fraunfelder FT. Bisphosphonates and ocular inflammation (letter to the editor). N Engl J Med 2003;348:1187–8.
 
13. Watts NB. Bisphosphonate treatment of osteoporosis. Clin Geriatr Med 2003;19:395–414.
 
14. Moorthy RS, Valluri S, Jampol L. Drug-induced uveitis. Surv Ophthalmol 1998;42:557–570.
 
15. Thiebaud D, Burckhardt P, Melchior J, et al. Two years’ effectiveness of intravenous pamidronate (APD) versus oral fluoride for osteoporosis occurring in the postmenopause. Osteoporos Int 1994;4:76–83.
 
16. Boutsen Y, Jamart J, Esselinckx W, et al. Primary prevention of glucocorticoid-induced osteoporosis with intravenous pamidronate and calcium: a prospective controlled 1-year study comparing a single infusion, an infusion given once every 3 months, and calcium alone. J Bone Miner Res 2001;16:104–112.
 
17. Adami S, Bhalla AK, Dorizzi R, et al. The acute-phase response after bisphosphonate administration. Calcif Tissue Int 1987;41:326–331.