Bisphosphonates are drugs used in the treatment of lytic bone metastases, multiple myeloma, hypercalcemia of malignant origin, osteoporosis, and diseases such as Paget's disease. Recently osteonecrosis of the jaw has been associated with the use of bisphosphonates. This study describes the imaging findings of bisphosphonate-associated osteonecrosis of the jaws.

Eleven patients, 6 men and 5 women, mean age 52 years (range 41- 76 years) who were treated with bisphosphonates were prospectively examined. They were reffered to the Department of the Maxillofacial and Oral Surgery with pain on affected side, nonhealing extraction sockets, purulent discharge and swelling in soft tissue. The indication for treatment with bisphosphonates was multiple myeloma in 6 patients (55%), breast cancer bone matastases in 3 patients (27%) and prostate cancer bone metastases in 2 patients (18%). Nine patients were treated with...

The degree of bone involvment on CT scanshowed osteolytic and sclerotic lesions with cortical bone destruction in all patients, followed by periostal bone proliferation in 7 patients. The sclerotic change enchroached on the mandibular (inferior alveolar) canal in 4 patients and 1 patient had sequestration of mandibula. On gadolinium- enhanced MRI of the jaw the intensity changes of the cortical and subcortical bone structures in all pateints were recorded. The osteonecrosis was identified as delimited focal lesions with reduction of the signal on T1- weighted...

Bisphosphonate related osteonecrosis of the jaw is a well described clinical condition with consistent radiographic findings; however they are not specific for this disease. It is important for radiologist to recognize this entity, because imaging could be used for early detection in patients susceptible to this disease, which means better prognosis due to early treatment, avoiding biopsy and less necessity of surgery.

García-Ferrer L, Bagán JV, Martínez-Sanjuan V, Hernandez-Bazan S, García R, Jiménez-Soriano Y, Hervas V. MRI of mandibular osteonecrosis secondary to bisphosphonates. Am J Roentgenol 2008; 190: 949-55. Cheng A, Mavrokokki A, Carter G, Stein B, Fazzalari NL, Wilson DF, et al. The dental implications of bisphosphonates and bone disease. Aust Dent J 2005; 50: 4-13. Phal PM, Myall RW, Assael LA, Weissman JL. Imaging findings of bisphosphonate-associated osteonecrosis of the jaws. Am J Neuroradiol 2007; 28: 1139-45. Migliorati CA. Bisphosphonate-associated oral osteonecrosis. Oral Surg Oral...

Katarina Šurlan Popovič, MD PhD Department of neuroradiology Clinical institute of radiology University medical centre Ljubljana Zaloška 7, 1000 Ljubljana e-mail: [email protected]