title: Bisphosphonate-associated osteonecrosis can hide jaw metastases.
abstract: 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.
authors: Section of Oral and Maxillofacial Surgery, University of Verona, Verona, Italy.
authors: Alberto
authors: A
authors: Bedogni
authors: Giorgia
authors: G
authors: Saia
authors: Mirko
authors: M
authors: Ragazzo
authors: Giordana
authors: G
authors: Bettini
authors: Paola
authors: P
authors: Capelli
authors: Emiliano
authors: E
authors: D'Alessandro
authors: Pier Francesco
authors: PF
authors: Nocini
authors: Lucio
authors: L
authors: Lo Russo
authors: Lorenzo
authors: L
authors: Lo Muzio
authors: Stella
authors: S
authors: Blandamura
mesh_terms: 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
chemical_list: D063065:Organophosphonates