Bisphosphonate-associated jawbone osteonecrosis: a correlation between imaging techniques and histopathology.
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.
Bedogni
Alberto
A
Unit of Dentistry and Maxillofacial Surgery, University of Verona, Verona, Italy.
Blandamura
Stella
S
Lokmic
Zerina
Z
Palumbo
Carla
C
Ragazzo
Mirko
M
Ferrari
Francesca
F
Tregnaghi
Alberto
A
Pietrogrande
Francesco
F
Procopio
Olindo
O
Saia
Giorgia
G
Ferretti
Marzia
M
Bedogni
Giorgio
G
Chiarini
Luigi
L
Ferronato
Giuseppe
G
Ninfo
Vito
V
Lo Russo
Lucio
L
Lo Muzio
Lorenzo
L
Nocini
Pier Francesco
PF
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
D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D007093:Imidazoles; D014867:Water; D000077211:Zoledronic Acid; D000077268:Pamidronate