{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T11:07:54Z","timestamp":1788865674408,"version":"build-2803163510"},"reference-count":17,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T00:00:00Z","timestamp":1788825600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Geriatrics"],"abstract":"<jats:p>Background: Oral bisphosphonates are first-line osteoporosis therapy but can cause mucosal chemical injury when tablets are retained rather than swallowed correctly. This risk is heightened in cognitively impaired older adults with dysphagia or difficulty complying with medication administration guidelines. Case Presentation: A 73-year-old female nursing home resident with advanced vascular dementia presented with 24 h of oral pain, reduced intake, lethargy and new facial swelling. She had received monthly ibandronic acid 150 mg for two years, with documented difficulty swallowing tablets but no formal swallowing assessment. Examination showed ulceration of the left lower lip and anterior tongue with mild vestibular swelling. Clinical investigations excluded haematinic deficiency and osteonecrosis; traumatic, lichenoid, vesiculobullous and neoplastic causes were considered unlikely based on distribution, clinical features and temporal association with the recent dose. Bisphosphonate-associated chemical mucosal injury was diagnosed by hospital dental services. Ibandronic acid was discontinued, topical treatment initiated, and ulcers resolved by three weeks. Denosumab was substituted in view of the patient\u2019s dysphagia and cognitive status. Discussion: This case supports the existing literature identifying inappropriate administration\u2014often linked to dysphagia or physical impairment\u2014as a leading cause of oral bisphosphonate-associated ulceration, typically affecting the tongue and lower lip. Ibandronate-related cases are rarely reported, likely reflecting prescribing frequency rather than lower risk. Current guidelines lack explicit recommendations addressing dysphagia or cognition in prescribing decisions. Conclusions: Presence of dysphagia and cognitive status should be assessed before and during oral bisphosphonate therapy. New oral pain, ulceration or facial swelling should prompt oral examination and medication review, with alternative antiresorptive agents considered when oral administration is impaired.<\/jats:p>","DOI":"10.3390\/geriatrics11050128","type":"journal-article","created":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T10:00:04Z","timestamp":1788861604000},"page":"128","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Burning Questions: Oral Ulceration Secondary to Improper Bisphosphonate Administration in Advanced Dementia"],"prefix":"10.3390","volume":"11","author":[{"given":"Kate","family":"Murphy","sequence":"first","affiliation":[{"name":"Department of Geriatric Medicine, Mercy University Hospital, T12 WE28 Cork City, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5496-7151","authenticated-orcid":false,"given":"Eleanor","family":"Marks","sequence":"additional","affiliation":[{"name":"Department of Geriatric Medicine, Mercy University Hospital, T12 WE28 Cork City, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-8329-8928","authenticated-orcid":false,"given":"Kieran","family":"O\u2019Connor","sequence":"additional","affiliation":[{"name":"Department of Geriatric Medicine, Mercy University Hospital, T12 WE28 Cork City, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth","family":"Moloney","sequence":"additional","affiliation":[{"name":"Department of Geriatric Medicine, Mercy University Hospital, T12 WE28 Cork City, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,8]]},"reference":[{"key":"ref_1","first-page":"e74542","article-title":"Efficacy of Bisphosphonates in Reducing Fracture Risk Among Postmenopausal Women With Osteoporosis","volume":"16","author":"Ullah","year":"2024","journal-title":"Cureus"},{"key":"ref_2","first-page":"e751","article-title":"Oral bisphosphonate-related osteonecrosis of the jaws: Clinical characteristics of a series of 20 cases in Spain","volume":"17","year":"2012","journal-title":"Med. Oral Patol. Oral Y Cir. Bucal"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"839","DOI":"10.1016\/j.joms.2008.01.026","article-title":"Inhibition of Oral Mucosal Cell Wound Healing by Bisphosphonates","volume":"66","author":"Landesberg","year":"2008","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1980","DOI":"10.1074\/jbc.M109.016741","article-title":"Farnesyl Pyrophosphate Inhibits Epithelialization and Wound Healing through the Glucocorticoid Receptor","volume":"285","author":"Vukelic","year":"2010","journal-title":"J. Biol. Chem."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1007\/s11657-025-01588-3","article-title":"The 2024 UK clinical guideline for the prevention and treatment of osteoporosis","volume":"20","author":"Gregson","year":"2025","journal-title":"Arch. Osteoporos."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"330","DOI":"10.1111\/ger.12590","article-title":"Oral bisphosphonates: Adverse effects on the oral mucosa not related to the jaw bones. A scoping review","volume":"39","author":"Psimma","year":"2021","journal-title":"Gerodontology"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1943","DOI":"10.1007\/s00198-024-07211-4","article-title":"Sex differences and predictors of anti-osteoporosis medication use in the 12 months after hip fracture surgery in adults 65 or older","volume":"35","author":"Kirk","year":"2024","journal-title":"Osteoporos. Int."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1111\/ors.12540","article-title":"Alendronic acid-induced oral mucosal ulceration: Two case reports","volume":"14","author":"McLean","year":"2020","journal-title":"Oral Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"514","DOI":"10.1034\/j.1600-0714.2000.291006.x","article-title":"Alendronate-related oral mucosa ulcerations","volume":"29","year":"2000","journal-title":"J. Oral Pathol. Med."},{"key":"ref_10","unstructured":"European Medicines Agency (2026, August 20). Ibandronic Acid Teva. Available online: https:\/\/www.ema.europa.eu\/en\/medicines\/human\/EPAR\/ibandronic-acid-teva."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"830","DOI":"10.1016\/j.joms.2011.03.046","article-title":"Oral Ulcers, a Little Known Adverse Effect of Alendronate: Review of the Literature","volume":"70","author":"Kharazmi","year":"2012","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1007\/s00198-018-4704-5","article-title":"European Guidance for the Diagnosis and Management of Osteoporosis in Postmenopausal Women","volume":"30","author":"Kanis","year":"2019","journal-title":"Osteoporos. Int."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Bellander, L., Wijk, H., Andersson, P., and H\u00e4gglin, C. (2025). Oral health care for frail older adults in nursing homes from a management perspective: A survey-based study. BMC Oral Health, 25.","DOI":"10.1186\/s12903-025-07327-x"},{"key":"ref_14","unstructured":"Royal College of Speech and Language Therapy (2026, May 20). Dementia Guidance Position Paper. Available online: https:\/\/www.rcslt.org\/wp-content\/uploads\/2024\/05\/Dementia-guidance_position-paper_2024.pdf."},{"key":"ref_15","unstructured":"Health Service Executive (2025, November 10). Health Service Executive National Oral Care Guideline (Supporting Smiles) for Health and Social Care Teams Supporting Daily Oral Care for Adults Who Require Assistance, Available online: https:\/\/www2.healthservice.hse.ie\/organisation\/national-pppgs\/hse-national-oral-care-guideline-supporting-smiles-for-health-and-social-care-teams-supporting-daily-oral-care-for-adults-who-require-assistance\/."},{"key":"ref_16","unstructured":"National Institute of Clinical Excellence (NICE) (2026, August 19). Oral Health for Adults in Care Homes. Available online: https:\/\/www.nice.org.uk\/guidance\/ng48."},{"key":"ref_17","unstructured":"AIHW (Australian Institute of Health and Welfare) (2026, August 20). Caring for Oral Health in Australian Residential Care, Available online: https:\/\/www.aihw.gov.au\/reports\/aged-care\/caring-for-oral-health-in-australian-residential-c\/summary."}],"container-title":["Geriatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2308-3417\/11\/5\/128\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T10:18:43Z","timestamp":1788862723000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2308-3417\/11\/5\/128"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,8]]},"references-count":17,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2026,10]]}},"alternative-id":["geriatrics11050128"],"URL":"https:\/\/doi.org\/10.3390\/geriatrics11050128","relation":{},"ISSN":["2308-3417"],"issn-type":[{"value":"2308-3417","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,8]]}}}