title: Bone scintigraphy predicts bisphosphonate-induced osteonecrosis of the jaw (BRONJ) in patients with metastatic castration-resistant prostate cancer (mCRPC).
abstract: OBJECTIVE
  The aim of this study was to evaluate the role of bone scintigraphy (BS) in early prediction of clinically asymptomatic bisphosphonate (BP)-related osteonecrosis of the jaws (BRONJ) in patients with metastatic castration-resistant prostate cancer (mCRPC).
  
  
  METHODS
  BS of mCRPC patients treated with BP was evaluated for pathologic tracer uptake of the jaws in BS suspicious for BRONJ. Results were compared to development of clinically evident BRONJ. Sensitivity, specificity and predictive values of BS for the detection of BRONJ as well as time from beginning of BP therapy to pathologic tracer uptake in BS and time from pathologic tracer uptake in BS to clinically evident BRONJ were determined.
  
  
  RESULTS
  Thirty BP-treated patients were included. Nine patients (30%) had pathologic BS lesions of the jaws. Six patients (20%) developed BRONJ. Sensitivity and specificity of BS for BRONJ prediction were 67 and 79%. Median time from the start of BP treatment to pathologic tracer uptake in BS was 28 months (range 10-33) and from pathologic tracer uptake in BS to clinically evident BRONJ 6.5 months (range 2-19). Pathologic tracer uptake in BS was significantly more often observed in patients who developed BRONJ compared to patients who did not (p = 0.049; OR 7.6).
  
  
  CONCLUSIONS
  Patients with pathologic tracer uptake in the jaws in BS significantly more often develop BRONJ. An unsuspicious BS is predictive for absence of BRONJ in the future.
  
  
  CONCLUSIONS
  We conclude that when BS has been performed, it should not only be used to assess tumour stage and treatment response but also to check for pathologic tracer uptake in the jaws in BS to detect BRONJ at an early stage in mCRPC patients receiving bisphosphonates.
authors: Department of Urology, University of Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany. thomasch@uni-mainz.de.
authors: Christian
authors: C
authors: Thomas
authors: Department of Urology, University of Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany.
authors: Magdalena
authors: M
authors: Spanidis
authors: Department of Oral and Maxillofacial Surgery, University of Mainz, Augustusplatz 2, 55131, Mainz, Germany.
authors: Christina
authors: C
authors: Engel
authors: Department of Urology, University of Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany.
authors: Frederik C
authors: FC
authors: Roos
authors: Department of Urology, University of Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany.
authors: Sebastian
authors: S
authors: Frees
authors: Department of Urology, University of Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany.
authors: Andreas
authors: A
authors: Neisius
authors: Department of Urology, University of Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany.
authors: Christian
authors: C
authors: Hampel
authors: Department of Urology, University of Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany.
authors: Peter
authors: P
authors: Rubenwolf
authors: Department of Urology, University of Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany.
authors: Joachim W
authors: JW
authors: Thüroff
authors: Department of Oral and Maxillofacial Surgery, University of Mainz, Augustusplatz 2, 55131, Mainz, Germany.
authors: Christian
authors: C
authors: Walter
authors: Department of Nuclear Medicine, University of Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany.
authors: Matthias
authors: M
authors: Miederer
mesh_terms: D059266:Bisphosphonate-Associated Osteonecrosis of the Jaw / Q000150:complications / Q000000981:diagnostic imaging*; D050071:Bone Density Conservation Agents; D004164:Diphosphonates / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D007568:Jaw; D008297:Male; D010020:Osteonecrosis / Q000139:chemically induced; D064129:Prostatic Neoplasms, Castration-Resistant / Q000150:complications*; D011877:Radionuclide Imaging
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates
keywords: Bisphosphonate-related; Bone metastases; Osteonecrosis of the jaw; Prostate cancer