Detecting the earliest radiological signs of bisphosphonate-related osteonecrosis

Abstract

Introduction Oral bisphosphonates are the most commonly prescribed anti-resorptive drugs used in the treatment of osteoporosis, but osteonecrosis of the jaw is a serious complication. The early diagnosis of this destructive side effect is crucial in preventing excessive bone loss, pain and infection.Objective To aid dental practitioners in the early identification of bisphosphonate-related osteonecrosis of the jaw.Method A scoping review was carried out.Data sources We searched MEDLINE via OVID, EMBASE via OVID, Dentistry and Oral Sciences Source (DOSS), Proquest Dissertation and Theses Search, to identify references that described clinical and radiological findings in medication-related osteonecrosis of the jaw (MRONJ).Data selection Nineteen references mentioned the earliest radiological changes in MRONJ with a description of the observations and were included in the analysis.Data synthesis The radiographic signs included osteosclerosis/lysis, widening of the periodontal ligament and thickening of the lamina dura and cortex. To assess the quality of original data on which recommendations had been made, these 19 studies were subjected to a quality appraisal.Conclusion Using bone exposure as a criterion for diagnosis of MRONJ, leads to delayed diagnosis and a poor response to treatment. In those patients at risk of bone exposure with MRONJ, insufficient information is present in the literature to allow the general dental practitioner to reliably identify the radiographic features indicating imminent bone exposure. A well-designed prospective study is needed.

Use of bone scintigraphy in the early diagnosis of bisphosphonate related osteonecrosis of the jaw. Case report and review of the literature

“…Moreover, it is extremely cost-effective. Technetium-99mm is the most commonly used medical radioisotope (5).…”

Workshop of European task force on medication‐related osteonecrosis of the jaw—Current challenges

“…However, there remains no consensus on the efficacy of different radiological imaging modalities (e.g., CT, MRI, or nuclear imaging) in assessing, with high accuracy, the "true" MRONJ disease extent. (Bisdas et al, 2008;Devlin et al, 2018). A number of studies have compared specific imaging modalities and found inconsistent results in terms of overestimation/underestimation of the extension of MRONJ (Guggenberger et al, 2013;Stockmann et al, 2010).…”

Rescue bisphosphonate treatment of alveolar bone improves extraction socket healing and reduces osteonecrosis in zoledronate-treated mice

“…Twenty (20) to fifty (50) percent of non-exposed BRONJ patients were reported to develop subsequent bone exposure [9,12]. Therefore, non-exposed variant, Stage 0 BRONJ may be considered a sign of disease development or a latent form [15]. However, without a bone biopsy report, it would be difficult to differentially diagnose BRONJ in the non-exposed variant cases.…”