Radiologic bone loss in patients with bisphosphonate-associated osteonecrosis of the jaws: a case-control study

Most patients with bisphosphonate-associated osteonecrosis of the jaws (BP-ONJ) report a previous tooth extraction at the necrosis site before the diagnosis was made. At older ages, most teeth are extracted due to periodontal disease, which is per se another BP-ONJ trigger factor. The aim of this study was to evaluate the periodontal status of BP-ONJ patients using panoramic radiographs compared to a control.

All patients treated for BP-ONJ up to January 1, 2010 comprised the study. The very first panoramic radiograph was analyzed. The number of remaining teeth and the radiographic bone loss from the cemento-enamel junction to the crestal bone were measured. For each patient, one control was analyzed (matching for gender and age).

One hundred twenty-nine BP-ONJ panoramic radiographs and 129 controls were analyzed (68 women, 61 men; 67.3 ± 9.7 years; osteoporosis [n = 11], breast cancer [n = 33], multiple myeloma [n = 61], prostate cancer [n = 24]). The average number of remaining teeth was 12.9 ± 8.4 for BP-ONJ and 16.4 ± 9.4 for the control (p = 0.02). The average radiographic bone loss was 5.5 ± 2.3 mm for BP-ONJ and 3.1 ± 1.1 mm for the control (p < 0.001); 96.6 % of BP-ONJ and 77.5 % had radiographic bone loss of more than 5 mm. Radiographic bone loss in the molar region was the highest for both groups (BP-ONJ 6.0 ± 2.3 mm; control 3.6 ± 1.4 mm).

Prevalence and severity of periodontal disease in patients with BP-ONJ is higher compared to healthy controls.

Patients with periodontal disease might be at a higher risk of developing BP-ONJ; therefore, periodontal disease therapy in patients who are about to receive bisphosphonates should be undertaken.