{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T11:16:25Z","timestamp":1782818185594,"version":"3.54.5"},"reference-count":14,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2024,2,27]],"date-time":"2024-02-27T00:00:00Z","timestamp":1708992000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"name":"departmental resources"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,4,15]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>Medication-related ear canal osteonecrosis (MRECO) is a growing concern linked to prolonged anti-resorptive medication use. Despite primary care providers being key prescribers of these medications, there is limited information about MRECO in primary care literature. This article presents a case of bisphosphonate-induced osteonecrosis of the external auditory canal (EAC), emphasizing the vital role of primary care providers in identifying this rare yet significant side effect of anti-resorptive medication.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Main symptoms and clinical findings<\/jats:title>\n                  <jats:p>A 65-year-old female, on long-term alendronic acid for osteoporosis, presented to primary care with a 2-year history of left-sided ear blockage and itchiness. Despite prolonged topical treatment for ear wax, symptoms persisted, leading to an Otolaryngology referral. Microsuction revealed exposed bone in the left EAC.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Diagnoses, interventions, and outcomes<\/jats:title>\n                  <jats:p>A computed tomography scan confirmed bony erosion of the left EAC, and in the absence of other osteonecrosis risk factors, bisphosphonate-induced osteonecrosis was diagnosed. Management involved bisphosphonate discontinuation, regular aural toilet, and topical treatment, achieving complete ear canal epithelialisation within 6 months.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>MRECO, a rare complication of anti-resorptive therapy, is anticipated to rise with increasing antiresorptive medication use in the ageing population. Unexplained ear symptoms in those with a history of current or prior anti-resorptive therapy should raise clinical concern, prompting evaluation for exposed bone in the EAC. Raising awareness of MRECO among primary care providers is crucial for early diagnosis and timely management.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/fampra\/cmae012","type":"journal-article","created":{"date-parts":[[2024,2,28]],"date-time":"2024-02-28T01:11:32Z","timestamp":1709082692000},"page":"219-222","source":"Crossref","is-referenced-by-count":3,"title":["Recognizing bisphosphonate-induced ear osteonecrosis in primary care: a case report"],"prefix":"10.1093","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4136-2505","authenticated-orcid":false,"given":"Alasdair W","family":"Mayer","sequence":"first","affiliation":[{"name":"ENT Department, Calderdale and Huddersfield NHS Foundation Trust , Halifax , United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dare","family":"Oladokun","sequence":"additional","affiliation":[{"name":"ENT Department, Calderdale and Huddersfield NHS Foundation Trust , Halifax , United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dipan","family":"Mistry","sequence":"additional","affiliation":[{"name":"ENT Department, Calderdale and Huddersfield NHS Foundation Trust , Halifax , United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2024,2,27]]},"reference":[{"issue":"7","key":"2024041512211018200_CIT0001","doi-asserted-by":"crossref","first-page":"2272","DOI":"10.1210\/jc.2012-1027","article-title":"Benefits and risks of bisphosphonate therapy for osteoporosis","volume":"97","author":"Khosla","year":"2012","journal-title":"J Clin Endocrinol Metab"},{"key":"2024041512211018200_CIT0002","author":"Medicines and Healthcare products Regulatory Agency","year":"2015"},{"issue":"2","key":"2024041512211018200_CIT0003","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1210\/jcemcr\/luad021","article-title":"Two cases of external auditory canal osteonecrosis in patients on antiresorptive therapy for osteoporosis","volume":"1","author":"Kumar","year":"2023","journal-title":"JCEM Case Reports"},{"issue":"0","key":"2024041512211018200_CIT0004","doi-asserted-by":"crossref","first-page":"014556132110533","DOI":"10.1177\/01455613211053389","article-title":"Denosumab-related osteonecrosis of the external auditory canal\u2014benefit of early surgical management","volume":"0","author":"Pe\u0159ina","year":"2021","journal-title":"Ear Nose Throat J"},{"issue":"1","key":"2024041512211018200_CIT0005","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1111\/j.1365-2141.2005.05833.x","article-title":"Bisphosphonate-associated osteonecrosis of the auditory canal","volume":"132","author":"Polizzotto","year":"2006","journal-title":"Br J Haematol"},{"issue":"2","key":"2024041512211018200_CIT0006","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1016\/j.oooo.2018.09.008","article-title":"Medication-related osteonecrosis of the jaw: definition and best practice for prevention, diagnosis, and treatment","volume":"127","author":"Nicolatou-Galitis","year":"2019","journal-title":"Oral Surg Oral Med Oral Pathol Oral Radiol"},{"issue":"4","key":"2024041512211018200_CIT0007","doi-asserted-by":"crossref","first-page":"527","DOI":"10.1111\/odi.12708","article-title":"Risk factors for medication-related osteonecrosis of the jaws: a systematic review","volume":"24","author":"McGowan","year":"2018","journal-title":"Oral Dis"},{"key":"2024041512211018200_CIT0008","author":"Scottish Dental Clinical Effectiveness Programme","year":"2017"},{"key":"2024041512211018200_CIT0009","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1016\/j.ctrv.2018.06.007","article-title":"Medication-related osteonecrosis of the jaw: prevention, diagnosis, and management in patients with cancer and bone metastases","volume":"69","author":"Otto","year":"2018","journal-title":"Cancer Treat 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Arthroplasty"},{"issue":"2","key":"2024041512211018200_CIT0013","doi-asserted-by":"crossref","first-page":"e167","DOI":"10.1016\/j.oooo.2013.12.089","article-title":"Jaw Osteonecrosis caused by prolonged use of corticosteroids in a patient with mycosis fungoides: case report","volume":"117","author":"Silva","year":"2014","journal-title":"Oral Surg Oral Med Oral Pathol Oral Radiol"},{"issue":"10","key":"2024041512211018200_CIT0014","doi-asserted-by":"crossref","first-page":"1002","DOI":"10.1017\/S0022215122000706","article-title":"Give ears some respite from regular microsuctioning in bisphosphonate-induced osteonecrosis of the external ear canal","volume":"136","author":"Abelardo","year":"2022","journal-title":"J Laryngol Otol"}],"container-title":["Family 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