Bisphosphonate-associated osteonecrosis can hide jaw metastases.
BACKGROUND
Osteonecrosis of the jaw is a well known potential complication of bisphosphonate treatment but its pathogenesis is poorly understood. The current management of patients with bisphosphonate-associated osteonecrosis (BON) is based on "expert recommendations" and there is a recognized need of better evidence. We report two cases where BON hid jaw metastases and use them to discuss some limitations of the current recommendations.


METHODS
Two patients undergoing long-term I.V. amino-bisphosphonate treatment for metastatic cancer presented with areas of intraorally exposed jawbone. Bisphosphonate-associated osteonecrosis was diagnosed on the basis of medical history, clinical and radiological features. They underwent surgical resection of the affected jaw due to unrelenting pain and lack of response to conservative treatments.


RESULTS
Histological examination of the surgical specimen revealed cancer cells at the margins of the site of osteonecrosis. Our patients did not undergo bone biopsy according to current recommendations, due to lack of clinical and radiological signs suggestive of jaw metastases.


CONCLUSIONS
Our findings show that: i) patients with BON may also have jaw metastases; ii) there may not be clinical or imaging hints to this fact and; iii) that a biopsy based on careful selection of the site (with inclusion of necrotic margins) may be needed to reach the correct diagnosis. Further studies should be performed on this topic because of its very important prognostic implications.
Bedogni
Alberto
A
Section of Oral and Maxillofacial Surgery, University of Verona, Verona, Italy.
Saia
Giorgia
G
Ragazzo
Mirko
M
Bettini
Giordana
G
Capelli
Paola
P
D'Alessandro
Emiliano
E
Nocini
Pier Francesco
PF
Lo Russo
Lucio
L
Lo Muzio
Lorenzo
L
Blandamura
Stella
S
D000368:Aged; D001859:Bone Neoplasms / Q000473:pathology / Q000556:secondary*; D005260:Female; D006801:Humans; D007571:Jaw Diseases / Q000139:chemically induced / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D063065:Organophosphonates / Q000627:therapeutic use*; D010020:Osteonecrosis / Q000139:chemically induced / Q000473:pathology*; D015898:Tomography Scanners, X-Ray Computed
D063065:Organophosphonates