Metastatic cancer identified in osteonecrosis specimens of the jaws in patients receiving intravenous bisphosphonate medications.
OBJECTIVE
The aim of the present study was to investigate the microscopic presence of metastatic cancer in jaw specimens clinically and histologically diagnosed as having osteonecrosis in patients receiving intravenous bisphosphonate medications.


METHODS
A retrospective cohort multicenter study was designed. Patients from the University of Tennessee Medical Center, New York University Medical Center, and New York Center for Orthognathic and Maxillofacial Surgery were enrolled who had been treated with intravenous bisphosphonate medications for an underlying diagnosis of cancer and who had been clinically diagnosed with bisphosphonate-related osteonecrosis of the jaws (BRONJ). The institutional review boards approved the present study. The primary predictor variable was the clinical presence of BRONJ. The primary outcome variable was the microscopic presence of metastatic cancer in the osteonecrotic jaw specimens.


RESULTS
A total of 744 sites of BRONJ were clinically diagnosed. Of these sites, 552 (74%) were diagnosed in patients who had received intravenous bisphosphonate medications. Of these 552 sites, 357 (65%) underwent microscopic evaluation through biopsy, sequestrectomy, or resection with curative intent. Of the 357 sites of BRONJ subjected to microscopic analysis, 19 (5.3%) sites were diagnosed with 20 cancers in 16 patients.


CONCLUSIONS
Albeit rare, the presence of cancer in a BRONJ specimen represents 1 explanation for the development of osteonecrosis in patients exposed to intravenous bisphosphonate medications in whom a clinical diagnosis of BRONJ has been applied. Additional molecular information is needed to provide an explanation for this observation.
Professor and Kelly L. Krahwinkel Chair, Department of Oral and Maxillofacial Surgery; Director, Oral and Maxillofacial Surgery Residency Program; Director, Oral/Head and Neck Oncologic Surgery Fellowship Program, University of Tennessee Medical Center and University of Tennessee Cancer Institute, Knoxville, TN. Electronic address: ecarlson@mc.utmck.edu.
Eric R
ER
Carlson
Kenneth E
KE
Fleisher
Salvatore L
SL
Ruggiero
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D059266:Bisphosphonate-Associated Osteonecrosis of the Jaw / Q000150:complications*; D001943:Breast Neoplasms / Q000150:complications; D015331:Cohort Studies; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007573:Jaw Neoplasms / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy / Q000556:secondary*; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000150:complications; D012189:Retrospective Studies