Bisphosphonates Related Ocular Side Effects: A Case Series and Review of Literature

ABSTRACT

Objective

To describe the clinical features of patients with bisphosphonate related ocular side effects (BROSE).

Methods

The medical records of all patients with BROSE between January 2009 and December 2019 were reviewed.

Results

Nine cases with BROSE were identified. All subjects were female. Median age at diagnosis was of 69 years. The leading indication for bisphosphonate treatment was osteoporosis (n=7), Paget’s disease of bone (n=1) and breast cancer (n=1). Six (66.67%) patients presented with uveitis, one (11%) episcleritis and two (22%) with orbital inflammation. Five events (55.5%) occurred within 10 days of initiating the bisphosphonate and the rest (44.44%) developed within 2 weeks to 3 years later. Four (44.44%) patients had concurrent thyroid disease. An association was found between underlying thyroid disease or autoimmunity.

Conclusion

BROSE is an uncommon complication of bisphosphonate therapy occurring more frequently in patients with an autoimmune predisposition.

KEYWORDS:

• Bisphosphonates
• ocular inflammation
• γδ T cells
• IL-17

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.