Basic and patient-oriented researchRadiographic Findings in Bisphosphonate-Treated Patients With Stage 0 Disease in the Absence of Bone Exposure
Section snippets
Materials and Methods
The Predicting Risk of Osteonecrosis with Bisphosphonate Exposure (PROBE) Study was conducted by Kaiser Permanente Northern California in 2007 to ascertain the prevalence of BRONJ among adult members with a history of chronic oral bisphosphonate therapy, excluding those with known exposure to intravenous bisphosphonates.10 Among 8,572 mailed survey respondents, 2,159 individuals reporting osteonecrosis, exposed bone, gingival sores, moderate periodontal disease, persistent dental symptoms, or
Results
Among the 1,005 patients undergoing clinical examination (excluding BRONJ, osteomyelitis, or implant complications),10 there were a total of 30 individuals with findings concerning for development of BRONJ (persisting bone pain, delayed healing after extraction, infection or periodontal fistula not related to caries, or unexplained tooth mobility), who underwent radiographic imaging during clinical follow-up. Within this subset, 10 patients had radiographic evidence of regional or diffuse
Discussion
A wide spectrum of radiographic features have recently been reported in BRONJ, with the emergence of typical patterns now readily identifiable in affected patients.18, 19, 20, 21, 22, 23, 24 These include osteosclerosis, thickened and disorganized medullary trabeculation, cortical disruption, increased thickness of the lamina dura and IAN canal margins, periosteal bone formation, and sequestration.18, 19, 20, 21, 22, 23, 24 In our cohort of stage 0 patients with radiographic abnormalities, a
Acknowledgments
The authors sincerely appreciate the Maxillofacial Surgery Clinics at Kaiser Permanente Oakland, South Sacramento, and Santa Clara for their support of the study visits and for providing follow-up care of patients who had concerning symptoms or findings. They also thank Jingrong Yang, Malini Chandra, Rita Hui, and Lindsay Kwong for their assistance in data extraction.
J.C.L. has a household family member who receives research funding from GlaxoSmithKline and Johnson & Johnson. A non-household
References (38)
Efficacy of bisphosphonates in reducing fracture risk in postmenopausal osteoporosis
Am J Med
(2009)- et al.
Oral bisphosphonate-induced osteonecrosis: Risk factors, prediction of risk using serum CTX testing, prevention, and treatment
J Oral Maxillofac Surg
(2007) - et al.
Bisphosphonate-induced exposed bone (osteonecrosis/osteopetrosis) of the jaws: Risk factors, recognition, prevention, and treatment
J Oral Maxillofac Surg
(2005) - et al.
Osteonecrosis of the jaws associated with the use of bisphosphonates: A review of 63 cases
J Oral Maxillofac Surg
(2004) - et al.
Incidence of osteonecrosis of the jaw in patients with multiple myeloma and breast or prostate cancer on intravenous bisphosphonate therapy
J Oral Maxillofac Surg
(2007) - et al.
Nature and frequency of bisphosphonate-associated osteonecrosis of the jaws in Australia
J Oral Maxillofac Surg
(2007) - et al.
American Association of Oral and Maxillofacial Surgeons position paper on bisphosphonate-related osteonecrosis of the jaws—2009 Update
J Oral Maxillofac Surg
(2009) - et al.
Sinus tracts—An early sign of bisphosphonate-associated osteonecrosis of the jaws?
J Oral Maxillofac Surg
(2009) - et al.
Thirteen cases of jaw osteonecrosis in patients on bisphosphonate therapy
Joint Bone Spine
(2008) - et al.
Characteristics of implant failures in patients with a history of oral bisphosphonate therapy
J Oral Maxillofac Surg
(2010)
Imaging findings in bisphosphonate-related osteonecrosis of jaws
J Oral Maxillofac Surg
Bisphosphonate-associated jawbone osteonecrosis: A correlation between imaging techniques and histopathology
Oral Surg Oral Med Oral Pathol Oral Radiol Endod
Computerized tomographic findings in bisphosphonate-associated osteonecrosis of the jaw in patients with cancer
Oral Surg Oral Med Oral Pathol Oral Radiol Endod
Biphosphonate-induced osteonecrosis of the jaws: CT and MRI spectrum of findings in 32 patients
Clin Radiol
Persisting alveolar sockets—A radiologic symptom of BP-ONJ?
J Oral Maxillofac Surg
Osteoclast heterogeneity: Lessons from osteopetrosis and inflammatory conditions
Biochim Biophys Acta
Osteopetrosis-associated osteomyelitis of the jaws: A report of 4 cases
Oral Surg Oral Med Oral Pathol Oral Radiol Endod
The pathogenesis of bisphosphonate-related osteonecrosis of the jaw: So many hypotheses, so few data
J Oral Maxillofac Surg
Histologic and histomorphometric features of bisphosphonate-related osteonecrosis of the jaws: An analysis of 31 cases with confocal laser scanning microscopy
Bone
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