Early radiographic changes of MRONJ could help in identifying patients at increased risk of developing the disease. This study compared and contrasted bone density in the posterior mandible of patients with, without, or at risk of developing MRONJ. This was a retrospective study of 46 patients (18 with MRONJ, 20 at risk but without MRONJ, and 8 controls with no exposure to MRONJ associated drugs). ImageJ software was used for bone density evaluation of the radiographs. Bone density was significantly higher in MRONJ patients when compared to at risk patients and controls. In a sub-cohort of patients with MRONJ where we had pre- and post-MRONJ images, the density was significantly higher in the pre-MRONJ radiographs when compared to after MRONJ radiographs and also higher than the at risk radiographs (p-value = 0.03). ImageJ analysis of the panoramic radiographs was successful in detecting significant differences in bone density in our sample.