title: Bisphosphonate-induced osteonecrosis of the jaws: clinical, imaging, and histopathology findings.
abstract: OBJECTIVE
  To assess the main clinical, radiographic, and histopathologic features of patients with bisphosphonate-induced osteonecrosis of the jaws (BIONJ).
  
  
  METHODS
  Patients with BIONJ diagnosed and treated at the Head and Neck Department, Instituto Nacional de Cancerología, Bogotá, DC, Colombia, between January 2012 and February 2014 were retrospectively included. Patients treated with sequestrectomy or curettage were excluded. Specimens from selected patients were reexamined under a light microscope. Clinical and imaging findings and sociodemographic variables were also reviewed.
  
  
  RESULTS
  Five stage 3 BIONJ cases were included. Imaging found massive osteolysis. Histopathology found devitalized trabecular bone, an absence of osteoblastic rimming, osteoclastic necrosis, and viable periosteum. Actinomyces spp colonies were limited to superficial layers.
  
  
  CONCLUSIONS
  BIONJ histopathology is different from that of other necrotizing and inflammatory bone diseases. This relates to the known antiresorptive mechanism of bisphosphonates, which is the basis of their therapeutic action. Nevertheless, further study with larger series should be accomplished.
authors.affiliation: Chief Resident, Oral and Maxillofacial Surgery Program, Hospital Militar Central, Universidad Militar Nueva Granada, Bogotá, DC, Colombia. Electronic address: elias.pretto@gmail.com.
authors.forename: Elias
authors.initials: E
authors.lastname: Franco-Pretto
authors.affiliation: General Surgeon and Surgical Oncology Fellow, Instituto Nacional de Cancerología, Universidad Militar Nueva Granada, Bogotá, DC, Colombia.
authors.forename: Maikel
authors.initials: M
authors.lastname: Pacheco
authors.affiliation: Head and Neck Surgeon, Head and Neck Surgery Department, Instituto Nacional de Cancerología, Bogotá, DC, Colombia.
authors.forename: Andrey
authors.initials: A
authors.lastname: Moreno
authors.affiliation: Oncology Pathologist, Pathology group, Instituto Nacional de Cancerología, Bogotá, DC, Colombia.
authors.forename: Oscar
authors.initials: O
authors.lastname: Messa
authors.affiliation: Oral and Maxillofacial Surgeon, Head and Neck Surgery Department, Instituto Nacional de Cancerología, Bogotá, DC, Colombia.
authors.forename: Juan
authors.initials: J
authors.lastname: Gnecco
mesh_terms: D000368:Aged; D059266:Bisphosphonate-Associated Osteonecrosis of the Jaw / Q000000981:diagnostic imaging* / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed