Oliver Ristow1, Carlos Gerngroß2, Markus Schwaiger3, Bettina Hohlweg-Majert4, Victoria Kehl5, Heike Jansen6, Lilian Hahnefeld7, Sven Otto8, Christoph Pautke9. 1. Resident, Medizin and Ästhetik, Clinic for Oral and Maxillofacial and Plastic Surgery, Munich, Germany; and Dental Medical Student, University of Munich, Munich, Germany. Electronic address: ristow@aesthetik-muenchen.de. 2. Resident, Department of Nuclear Medicine, Technische Universität München, Munich, Germany. 3. Head, Department of Nuclear Medicine, Technische Universität München, Munich, Germany. 4. Senior Consultant, Department of Oral and Maxillofacial Surgery, Technische Universität Munich, Munich, Germany; and Partner, Medizin and Ästhetik, Clinic for Oral and Maxillofacial and Plastic Surgery, Munich, Germany. 5. Statsistician, Institute of Medical Statistics and Epidemiology, Technische Universität München, Munich, Germany. 6. Resident, Department of Obstetrics and Gynecology, Technische Universität München, Munich, Germany. 7. Dental Medical Student, University of Munich, Munich, Germany; and Resident, Medizin and Ästhetik, Clinic for Oral and Maxillofacial and Plastic Surgery, Munich, Germany. 8. Senior Consultant, Department of Oral and Maxillofacial Surgery, Ludwig-Maximilians Universität München, Munich, Germany. 9. Senior Consultant, Department of Oral and Maxillofacial Surgery, University of Munich, Munich, Germany; and Partner, Medizin and Ästhetik, Clinic for Oral and Maxillofacial and Plastic Surgery, Munich, Germany.
Abstract
PURPOSE: The pathogenesis of bisphosphonate-related osteonecrosis of the jaw (BRONJ) is not completely understood. The most popular hypothesis has suggested that the bone turnover (BT) in the jawbone is greater than that in other sites and that this turnover will be overly suppressed by bisphosphonates. Using bone scintigraphy, a simple tool for the quantitative evaluation of bone metabolism and blood flow, the goals of the present study were to determine whether the rate of bone remodeling is greater in the jaw and whether the bone BT in the jaw is differentially altered after bisphosphonate intake compared with that in other skeletal sites. MATERIALS AND METHODS: The bone scintigraphies of 90 female patients with breast cancer were retrospectively analyzed (n = 45 with bisphosphonate intake; n = 45 without bisphosphonate intake [control group]). All patients in the study group had undergone bone scintigraphy before therapy and during the treatment (course after 12 and 24 months). The data were quantitatively analyzed using 6 predetermined regions of interest. RESULTS: The bone BT of the mandible was similar to that of the femur and significantly reduced compared with that of the maxilla (P < .01). None of the investigated bone regions (including the mandible and maxilla) were significantly altered after bisphosphonate administration (P > .05). CONCLUSIONS: The finding that the mandible had significantly lower bone BT than that of the maxilla and that two thirds of BRONJ cases occur in the mandible were inconsistent with the investigated hypothesis. Furthermore, the bone BT in the jawbone was not overly suppressed by bisphosphonates. Thus, it is unlikely that over suppression of bone BT is the exclusive causation playing a role in the pathomechanism of BRONJ.
PURPOSE: The pathogenesis of bisphosphonate-related osteonecrosis of the jaw (BRONJ) is not completely understood. The most popular hypothesis has suggested that the bone turnover (BT) in the jawbone is greater than that in other sites and that this turnover will be overly suppressed by bisphosphonates. Using bone scintigraphy, a simple tool for the quantitative evaluation of bone metabolism and blood flow, the goals of the present study were to determine whether the rate of bone remodeling is greater in the jaw and whether the bone BT in the jaw is differentially altered after bisphosphonate intake compared with that in other skeletal sites. MATERIALS AND METHODS: The bone scintigraphies of 90 female patients with breast cancer were retrospectively analyzed (n = 45 with bisphosphonate intake; n = 45 without bisphosphonate intake [control group]). All patients in the study group had undergone bone scintigraphy before therapy and during the treatment (course after 12 and 24 months). The data were quantitatively analyzed using 6 predetermined regions of interest. RESULTS: The bone BT of the mandible was similar to that of the femur and significantly reduced compared with that of the maxilla (P < .01). None of the investigated bone regions (including the mandible and maxilla) were significantly altered after bisphosphonate administration (P > .05). CONCLUSIONS: The finding that the mandible had significantly lower bone BT than that of the maxilla and that two thirds of BRONJ cases occur in the mandible were inconsistent with the investigated hypothesis. Furthermore, the bone BT in the jawbone was not overly suppressed by bisphosphonates. Thus, it is unlikely that over suppression of bone BT is the exclusive causation playing a role in the pathomechanism of BRONJ.
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