The Differences in Panoramic Bone Density Between Bisphosphonates (BPs) Patients With, Without, or at Risk for Bisphosphonate-Related Osteonecrosis of the Jaw (BRONJ)

Abstract

Background: Since late 2003, there have been numerous reports in the literature illustrating the association between bisphosphonate use and the appearance of avascular necrosis of the jaws. Bisphosphonate-related osteonecrosis of the jaw (BRONJ) represents a growing concern for oral- and maxillofacial practice. Although many studies have been conducted in recent years evaluating the early manifestations of BRONJ, a clearer understanding of the significance of early radiographic alterations could improve the identification of patients at increased risk of this disease and may help to guide interventions. The purpose of this study is to compare the bone density of the posterior mandible in the panoramic radiographs of patients with BRONJ, patients who received bisphosphonate therapy and did not develop BRONJ, patients who received bisphosphonate therapy and eventually developed BRONJ, and controls. Materials and Methods: A convenience sample, consisted of 54 digital panoramic radiographs was divided in to four groups. Group 1 represented controls i.e. patients that have never been exposed to bisphosphonates of any kind and Group 2 represented the "at risk patients" i.e. received bisphosphonates but never developed BRONJ. Group 3A consists of early panoramic radiographs of patients who are on bisphosphonate therapy but at that time did not develop BRONJ. Group 3B is the BRONJ group, including those of 3A that went on to develop BRONJ and subjects that presented with BRONJ. The radiographs were evaluated using Planmeca Romexis software fully supported for radiographs were evaluated using Planmeca Romexis software fully supported for Windows operating system. The minimum and maximum density, averages and SD of the bone at the angle of the mandible on the right and the left sides were compared using ttest. Results: There was no significant difference in bone density of the digital panoramic radiographs between patients at risk of BRONJ, having BRONJ, and normal patients. Although the data is not significant, the findings indicate a clear trend whereas the minimum and maximum densities are highest in individuals taking BPs and these values decline as BRONJ develops, as compared with the controls. Conclusion: More studies are required to definitively determine the diagnostic and prognostic value of simple radiographic imaging as relates to the problem of BRONJ.