title: Interrelationship of clinical, radiographic and haematological features in patients under bisphosphonate therapy.
abstract: OBJECTIVE
  To analyze the clinical, radiographic and haematological aspects of patients under bisphosphonate therapy.
  
  
  METHODS
  A retrospective study was conducted where the records of patients taking bisphosphonates were analyzed considering the occurrence of bisphosphonate-related osteonecrosis of the jaw (BRONJ). Evaluation included panoramic and periapical radiographies, haematological examinations and clinical features. Radiographies were analyzed determining the presence or absence of bone sclerosis, osteolysis, persisting alveolar socket, narrowing of the mandibular canal, widening of the periodontal ligament space, periradicular radiolucency, sequestrum and thickening of the lamina dura. Laboratory tests consisted of complete blood count, fasting serum glucose, erythrocyte sedimentation rate (ESR) and serum levels of calcium, phosphorus, alkaline phosphatase, parathormone (PTH) and C-terminal telopeptide of collagen I (CTX).
  
  
  RESULTS
  Alkaline phosphatase and ESR were significantly higher in the BRONJ group, whereas fasting serum glucose, CTX, PTH, calcium and phosphorus did not significantly differ. BRONJ showed association with smoking, tooth extraction, anaemia and leukocytosis. On radiographic analysis, persisting alveolar socket, osteolysis, bone sclerosis and narrowing of the mandibular canal were significantly more prevalent in the BRONJ group. Thickening of the lamina dura, periapical radiolucencies, widening of the periodontal ligament space and sequestrum did not significantly differ between the groups.
  
  
  CONCLUSIONS
  BRONJ is a multifactorial disease with high morbidity, which requires experimental studies to clarify the role of the reported risk factors and clinical radiographic signs to improve its diagnosis.
authors.affiliation: Dental College, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil.
authors.forename: Valesca S
authors.initials: VS
authors.lastname: Koth
authors.affiliation: Dental College, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil.
authors.forename: Maria A
authors.initials: MA
authors.lastname: Figueiredo
authors.affiliation: Dental College, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil.
authors.forename: Fernanda G
authors.initials: FG
authors.lastname: Salum
authors.affiliation: Dental College, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil.
authors.forename: Karen
authors.initials: K
authors.lastname: Cherubini
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D059266:Bisphosphonate-Associated Osteonecrosis of the Jaw / Q000097:blood* / Q000000981:diagnostic imaging*; D050071:Bone Density Conservation Agents / Q000009:adverse effects*; D004164:Diphosphonates / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D011862:Radiography, Panoramic; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D015415:Biomarkers; D050071:Bone Density Conservation Agents; D004164:Diphosphonates
keywords: bisphosphonate-associated osteonecrosis of the jaw; diagnostic X-ray; drug-related side effects; haematologic test