Abstract
Patients with bisphosphonate-related osteonecrosis of the jaws (BRONJ) who received intravenous or oral bisphosphonates (BP) were selected for determination of their bone microarchitecture as a risk predictor of BRONJ development. The diagnosis of BRONJ was made based on clinical and radiographic findings. The control group consisted of healthy patients. All patients underwent quantitative and qualitative ultrasound measurements of bone at the hand phalanges carried out using the DBM Sonic BP. Ultrasound bone profile index (UBPI), amplitude-dependent speed of sound (AD-SoS), bone biophysics profile (BBP), and bone transmission time (BTT) were measured. The BRONJ group consisted of 17 patients (62 ± 4.24; range: 45-82); 10 (58.8%) were male and seven (41.1%) were female, of whom 11 (64.7%) suffered from multiple myeloma, three (17.6%) from osteoporosis, one (5.8%) from prostate cancer, one (5.8%) from kidney cancer, and one (5.8%) from leukemia. Fourteen (82.3%) of them received intravenous BP whereas three (17.6%) received oral BP. Nine (9/17; 52.9%) patients developed bone exposure: two in the maxilla and seven in the mandible. Regarding quantitative parameters, Ad-SoS was low in the BRONJ group, but not significant. The UBPI score was significantly reduced in BRONJ patients with exposed bone when compared to controls (0.47 ± 0.12 vs. 0.70 ± 0.15; p = 0.004). The present study demonstrated that quantitative ultrasound was able to show bone microarchitecture alterations in BRONJ patients, and suggests that these analyses may be an important tool for early detection of bone degeneration associated with BRONJ.
Highlights
bisphosphonate-related osteonecrosis of the jaw (BRONJ) has been characterized by accumulation of physiological damage in the jaw bones, which results from a marked suppression of normal metabolic turnover.[8,9,10]
Patients Patients presenting with BRONJ selected from the Surgery Clinics of the School of Dentistry of Ribeirão Preto and from the Clinical Hospital of the Universidade de São Paulo at Ribeirão Preto participated in the cross-sectional study
The mean age of BRONJ patients was 62 ± 4.24, and the disease was more frequent in white subjects (13/17; 76.4%)
Summary
Bisphosphonates (BP) are inhibitors of bone resorption and angiogenesis used for the treatment of diseases that affect bone metabolism, since they directly or indirectly inhibit osteoclastic bone resorption.[1,2] The most important side effect of these drugs is bisphosphonate-related osteonecrosis of the jaw (BRONJ), whose definition has been recently updated as medication-related osteonecrosis of the jaw (ONJ) since itBraz Oral Res [online]. 2015;29(1):[1,2,3,4,5,6,7,8,9]includes other antiresorptive or antiangiogenic agents than BPs.[3]. Bisphosphonates (BP) are inhibitors of bone resorption and angiogenesis used for the treatment of diseases that affect bone metabolism, since they directly or indirectly inhibit osteoclastic bone resorption.[1,2] The most important side effect of these drugs is bisphosphonate-related osteonecrosis of the jaw (BRONJ), whose definition has been recently updated as medication-related osteonecrosis of the jaw (ONJ) since it. BRONJ has been characterized by accumulation of physiological damage in the jaw bones, which results from a marked suppression of normal metabolic turnover.[8,9,10] The presence of trauma, including dental invasive procedures and infection, increases the demand for osseous repair that exceeds the capacity of the hypodynamic bone, resulting in bone necrosis.[9] In addition, the antiangiogenic effects of BP on the tissues and the presence of comorbid factors, such as immunosuppression and other pathologies, may increase the risk for progression of this condition.[9,10]
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