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. 2017 Apr;46(4):20160260.
doi: 10.1259/dmfr.20160260. Epub 2017 Feb 17.

Interrelationship of clinical, radiographic and haematological features in patients under bisphosphonate therapy

Valesca S Koth  1 , Maria A Figueiredo  1 , Fernanda G Salum  1 , Karen Cherubini  1
Affiliations

Interrelationship of clinical, radiographic and haematological features in patients under bisphosphonate therapy

Valesca S Koth et al. Dentomaxillofac Radiol. 2017 Apr.

Abstract

Objectives: 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.

Keywords: bisphosphonate-associated osteonecrosis of the jaw; diagnostic X-ray; drug-related side effects; haematologic test.

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Figures

Figure 1
Figure 1
Analysis of panoramic radiography in Photoshop CS6 v. 13.0 software (Adobe Systems Inc., San Jose, CA): the image was divided into six segments, with the paramedian region as reference.
Figure 2
Figure 2
Radiographic analysis: periapical radiographs were used to analyze Segments 2 and 5.
Figure 3
Figure 3
Radiographic features: (a) bone sclerosis and thickening of the lamina dura associated with widening of the periodontal ligament space; (b) diffuse osteolysis of the jaw with areas of bone sclerosis and sequestrum; (c) persisting alveolar socket; (d) periradicular radiolucency; (e) osteolysis; (f) periradicular radiolucency; (g) thickening of the lamina dura; (h) osteolysis; and (i) diffuse osteolysis of the jaw with areas of bone sclerosis.
Figure 4
Figure 4
Clinical and radiographic images of bisphosphonate-related osteonecrosis of the jaw in a patient subjected to zoledronic acid therapy for metastatic kidney cancer: (a) frank bone exposure in the mandible; site of probing bone through oral mucosa in the maxilla (arrows). (b) Panoramic radiography showing persisting alveolar sockets in the maxilla and mandible.
See this image and copyright information in PMC

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