Bisphosphonate-related osteonecrosis of the mandible and maxilla: clinical and imaging features.
OBJECTIVE
Bisphosphonate-related osteonecrosis of the jaws is a rare, but morbid, condition. We present the clinical and imaging features of 19 patients.


METHODS
A review of 19 bisphosphonate-related osteonecrosis patients was performed. Patient demographics, diagnosis, dental procedures, symptoms and clinical findings, location and pattern of involvement, and presence of fractures, sequestra, and fistulae were documented.


RESULTS
Patients included 14 women and 5 men aged 48 to 80 years. Diagnoses included breast carcinoma (n = 11), multiple myeloma (n = 4), osteoporosis (n = 4), prostate carcinoma (n = 2), and lymphoma (n = 1). Seventeen patients received intravenous and 2 received oral bisphosphonates for 2 to 5 years. Bone involvement was noted in the mandible (74%), maxilla (16%), and both (10%). A lytic and sclerotic pattern was most common (58%). Additional findings included fractures (n = 5), sequestra (n = 4), and oroantral fistulae (n = 2).


CONCLUSIONS
Bisphosphonate-related osteonecrosis is a rare, but morbid, condition, and imaging features can mimic other conditions. It is important for the radiologist to consider this entity in the appropriate clinical setting.
Gill
Sonia B
SB
Department of Radiology, Medical College of Wisconsin, Milwaukee, WI 53226, USA.
Valencia
Maria P
MP
Sabino
Mary Lou C
ML
Heideman
Gregory M
GM
Michel
Michelle A
MA
D000368:Aged; D000369:Aged, 80 and over; D050071:Bone Density Conservation Agents / Q000009:adverse effects; D004164:Diphosphonates / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008336:Mandibular Diseases / Q000139:chemically induced* / Q000000981:diagnostic imaging*; D008439:Maxillary Diseases / Q000139:chemically induced* / Q000000981:diagnostic imaging*; D008875:Middle Aged; D010020:Osteonecrosis / Q000139:chemically induced* / Q000000981:diagnostic imaging*; D011859:Radiography
D050071:Bone Density Conservation Agents; D004164:Diphosphonates