CT imaging in bisphosphonate-associated mandibular osteonecrosis: case report, pathological correlates, and review of literature

Abstract

Osteonecrosis of the jaw is a severe bone disease that occurs as a result of reduced local blood supply. Bisphosphonate-associated osteonecrosis of the jaw usually occurs following dental procedures. We report clinical and radiological findings in a case of mandibular osteonecrosis associated with the use of bisphosphonate; the mandibular osteonecrosis was undiagnosed prior to cross-sectional imaging with computed tomography. The radiological correlation to the underlying pathological process and a correlative assessment of history, clinical, and imaging findings enabled the diagnosis. A discussion of differential diagnoses is provided to alert the oral radiologist to the presence of this condition in cases with typical imaging findings. The literature on indications for advanced imaging is reviewed to simplify the selection of the appropriate imaging modality for mandibular osteonecrosis.

Suspected bisphosphate‐related osteonecrosis of the jaw in a cat being treated with alendronate for idiopathic hypercalcaemia

“…Bisphosphonate‐related osteonecrosis of the jaw (BRONJ) has been well documented in the human literature; it was first described by Marx in 2003 8. It occurs as a result of ischaemic or avascular necrosis due to an inhibitory effect on circulating levels of endothelial growth factor leading to reduced local blood supply to the bone 9. The aetiology is not fully understood, but risk factors are thought to include high dosages of bisphosphonates, intravenous preparations of the drugs, invasive craniomaxillofacial surgeries, periodontal disease and tooth extractions 10 11.…”

Role of Bisphosphonates in the Development of the Osteonecrosis of the Jaws

“…BON is diagnosed in such cases, when osteonecrosis, lasting more than 8 weeks, develops in patients without previous radiation treatment but who were taking BPs. Osteonecrosis develops and bone tissue of the jaws becomes uncovered [8][9][10][11]. The first case of osteonecrosis related to use of BPs was described in 2003 [9].…”