RADIOGRAPHIC BONE CHANGES IN MULTIPLE MYELOMA PATIENTS WHO DEVELOPED MEDICATION-RELATED OSTEONECROSIS OF THE JAW: A CASE CONTROL STUDY

Abstract

<h3>Background</h3> Medication-related osteonecrosis of the jaw (MRONJ) is a severe adverse effect caused by antiresorptive medications, which are used for multiple myeloma (MM) patients. Currently, new evidence suggests that there are early radiographic changes in the bone of patients that eventually will develop into clinical MRONJ. The detection of early bone changes may be important in early diagnosis and prevention of MRONJ by drug cessation. <h3>Objective(s)</h3> The aim of this study was to evaluate the radiographic changes in the jaws of patients with MM who developed MRONJ compared with those in whom MRONJ did not develop. <h3>Study Design</h3> A retrospective study was performed for MM patients who were referred to the oral medicine clinic at the University of Florida College of Dentistry from 2006 to 2018. The patient information and radiographs (panoramic and intraoral radiographs) were retrieved from their dental chart (axiUm). For evaluating the cortical border, the mental index (MI), panoramic mandibular index (PMI), and mandibular cortical index (MCI) were measured. The bone density ratio was measured by using Image J 1.51 j8 (NIH, Bethesda, MD) in 5 locations in the bone and 1 in the dentin. <h3>Results</h3> Of 87 patients with MM who were examined, 48 were females (56%), and 38 were males (44%). The mean age was 63.97 years. In total, 29 were diagnosed with MRONJ. Our study indicated that patients with MRONJ had denser bone compared with patients without MRONJ (<i>t</i> test <i>P</i> < .0001). In addition, classifying the cortical border with the MCI showed that the association between MRONJ and the thickness and the sharpness of the cortical border is considered to be statistically significant (Fisher's test, <i>P</i> = .0003). The MI and PMI differences between the 2 groups were not statically significant. <h3>Discussion/Conclusions</h3> The increase of radiographic bone density was significantly related to the development of MRONJ in patients with MM. The cortical border thickness and sharpness should be evaluated as prognostic factors for development of MRONJ in patients on antiresorptive medications.