Pharmacology · patient case question
This patient takes methotrexate and a bisphosphonate for osteoporosis. Which radiographic finding is most expected?
Patient case: The Geriatric Patient
demo: 90-year-old female
chief: “My mouth is always dry and this tooth is throbbing.”
history: Osteoporosis, mild renal impairment, hypertension. Ambulates with a walker.
meds: Alendronate, methotrexate, zoledronate infusions in the past, hydrochlorothiazide
findings: Generalized xerostomia. Tooth #30 with a periapical abscess requiring antibiotic coverage. Panoramic radiograph shows thinned mandibular cortices.
Show answer and explanation
Correct answer: A. Thinning of the mandibular cortical bone
- A. Correct. Osteoporosis reduces bone mineral density, and the mandibular inferior cortex is a recognized site where thinning and porosity can be appreciated on a panoramic radiograph.
- B. That pattern suggests dentin dysplasia or pulpal calcification, not osteoporosis.
- C. Periapical radiolucencies indicate pulpal necrosis, unrelated to metabolic bone disease.
- D. Generalized PDL widening suggests occlusal trauma or scleroderma, not osteoporosis.