title: Bisphosphonate-associated jawbone osteonecrosis: a correlation between imaging techniques and histopathology.
abstract: OBJECTIVE
  Recently, jawbone osteonecrosis has been reported as a potential adverse effect of bisphosphonates administration. This paper considers and highlights histopathologic and radiologic features of this condition.
  
  
  METHODS
  Eleven patients, owing to unresponsiveness to conservative treatment and uncontrollable pain, underwent surgical resection of diseased jawbone after extensive hyperbaric oxygen therapy. A thorough clinical, laboratory, and imaging study was performed. Surgical specimens underwent histopathologic and immunohistochemical evaluation.
  
  
  RESULTS
  Computerized tomography (CT) scans showed increased bone density, periosteal reaction, and bone sequestration in advanced stages. With magnetic resonance imaging (MRI), exposed areas showed a low signal in T1- and T2-weighted and inversion recovery images, which suggests low water content and is histopathologically correlated with paucity in cells and vessels (osteonecrotic pattern). Unexposed diseased bone was characterized by T1 hypointensity and T2 and IR hyperintensity, which suggests high water content and inflammation, associated with hypercellularity, osteogenesis, and hypervascularity (osteomyelitic pattern).
  
  
  CONCLUSIONS
  Diseased bone extends beyond the limits of the bone exposed in the oral cavity. Histopathologic examination correlated well with CT and MRI, which are the choice for the evaluation of bisphosphonate-associated jawbone osteonecrosis.
authors.affiliation: Unit of Dentistry and Maxillofacial Surgery, University of Verona, Verona, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Bedogni
authors.forename: Stella
authors.initials: S
authors.lastname: Blandamura
authors.forename: Zerina
authors.initials: Z
authors.lastname: Lokmic
authors.forename: Carla
authors.initials: C
authors.lastname: Palumbo
authors.forename: Mirko
authors.initials: M
authors.lastname: Ragazzo
authors.forename: Francesca
authors.initials: F
authors.lastname: Ferrari
authors.forename: Alberto
authors.initials: A
authors.lastname: Tregnaghi
authors.forename: Francesco
authors.initials: F
authors.lastname: Pietrogrande
authors.forename: Olindo
authors.initials: O
authors.lastname: Procopio
authors.forename: Giorgia
authors.initials: G
authors.lastname: Saia
authors.forename: Marzia
authors.initials: M
authors.lastname: Ferretti
authors.forename: Giorgio
authors.initials: G
authors.lastname: Bedogni
authors.forename: Luigi
authors.initials: L
authors.lastname: Chiarini
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Ferronato
authors.forename: Vito
authors.initials: V
authors.lastname: Ninfo
authors.forename: Lucio
authors.initials: L
authors.lastname: Lo Russo
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Lo Muzio
authors.forename: Pier Francesco
authors.initials: PF
authors.lastname: Nocini
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015519:Bone Density; D050071:Bone Density Conservation Agents / Q000009:adverse effects*; D001943:Breast Neoplasms / Q000188:drug therapy; D004164:Diphosphonates / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007093:Imidazoles / Q000009:adverse effects; D007568:Jaw / Q000098:blood supply; D007571:Jaw Diseases / Q000139:chemically induced / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000188:drug therapy; D010020:Osteonecrosis / Q000139:chemically induced / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000601:surgery; D000077268:Pamidronate; D036542:Tomography, Spiral Computed; D014081:Tooth Extraction / Q000009:adverse effects; D014867:Water; D000077211:Zoledronic Acid
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D007093:Imidazoles; D014867:Water; D000077211:Zoledronic Acid; D000077268:Pamidronate