CONCURRENT METASTATIC DISEASE AND MEDICATION RELATED OSTEONECROSIS OF THE JAWS

Abstract

BACKGROUNDAntiresorptive medications are often used in the management of cancer and cancer-related conditions including primary and metastatic disease. A rare but well-established complication of antiresorptives is osteonecrosis of the jaws (ONJ). ONJ can manifest with radiographic features similar to those of metastatic diseases, which makes differentiating between these diseases a diagnostic challenge.CASE REPORTWe present the pertinent radiologic features from 11 patients with concurrent metastatic diseases and ONJ. The radiologic appearances of the metastatic lesions varied from well-defined radiolucencies to radiopacities with periosteal bone deposition. The areas affected by ONJ shared a common spectrum of osseous changes, demonstrating lytic defects, sequestration of bone, diffuse sclerosis, and periosteal bone formation.DISCUSSION/CONCLUSIONSMetastatic disease and ONJ possess similar radiographic features, with patchy lytic and sclerotic changes in the affected region of bone. Likewise, both entities evoke periosteal reactions, although the pattern may vary. Although exposed bone in the oral cavity for 8 weeks or longer was once considered the hallmark for diagnosis of MRONJ, the American Association of Oral and Maxillofacial Surgeons modified the definition in 2014 to include a Stage 0, where radiographic changes are apparent without any bone exposure. Similarly, the absence of specific radiologic appearances complicates the differentiation between these 2 entities in the establishment of MRONJ. Antiresorptive medications are often used in the management of cancer and cancer-related conditions including primary and metastatic disease. A rare but well-established complication of antiresorptives is osteonecrosis of the jaws (ONJ). ONJ can manifest with radiographic features similar to those of metastatic diseases, which makes differentiating between these diseases a diagnostic challenge. We present the pertinent radiologic features from 11 patients with concurrent metastatic diseases and ONJ. The radiologic appearances of the metastatic lesions varied from well-defined radiolucencies to radiopacities with periosteal bone deposition. The areas affected by ONJ shared a common spectrum of osseous changes, demonstrating lytic defects, sequestration of bone, diffuse sclerosis, and periosteal bone formation. Metastatic disease and ONJ possess similar radiographic features, with patchy lytic and sclerotic changes in the affected region of bone. Likewise, both entities evoke periosteal reactions, although the pattern may vary. Although exposed bone in the oral cavity for 8 weeks or longer was once considered the hallmark for diagnosis of MRONJ, the American Association of Oral and Maxillofacial Surgeons modified the definition in 2014 to include a Stage 0, where radiographic changes are apparent without any bone exposure. Similarly, the absence of specific radiologic appearances complicates the differentiation between these 2 entities in the establishment of MRONJ.