A comparison of the cone beam computed tomography findings in medication-related osteonecrosis of the jaws related to denosumab versus bisphosphonates: an observational pilot study.

OBJECTIVE

The aim of this study was to compare the radiographic abnormalities on cone beam computed tomography (CBCT) in patients with medication-related osteonecrosis of the jaws (MRONJ) related to denosumab use versus bisphosphonate use.

STUDY

DESIGN

The study included 34 consecutive patients with MRONJ who had a history of exclusive use of denosumab (n = 17) or bisphosphonates (n = 17) and had undergone CBCT for determination of extent of disease. Demographic data of the patients were collected. Differences in radiologic characteristics between patients with denosumab-related osteonecrosis of the jaws (DRONJ) and those with bisphosphonate-related osteonecrosis of the jaws (BRONJ) were scored and studied on CBCT.

RESULTS

In patients with DRONJ, sequestra (P = .015) and lysis of the cortical border of the jaw (P = .033) were significantly less common than in patients with BRONJ. Subperiosteal bone formation did not differ between the groups (P = .545). There was no association between stage of disease and duration of drug therapy or duration of symptoms for either medication group.

CONCLUSIONS

The radiologic features of DRONJ may be different from those of BRONJ with regard to the presence of sequestra and cortical lysis and might, therefore, be improperly diagnosed. Underestimation and undertreatment of DRONJ may potentially lead to progression of disease and, thus, make treatment more difficult.