Effect of Bisphosphonate Treatment on the Jawbone: an Exploratory Study Using Periapical and Panoramic Radiographic Evaluation

Overview

Journal Oral Radiol

Specialty Radiology

Date 2018 Nov 29

PMID 30484213

Citations 10

Authors

Imad Barngkgei

Esam Halboub

Abeer Almashraqi

Affiliations

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Abstract

Objective: This cross-sectional study aimed to explore potential jawbone changes secondary to bisphosphonate (BP) treatment of osteoporosis using digital panoramic and periapical radiography.

Methods: Thirty-nine women, previously examined with dual-energy X-ray absorptiometry, were radiographed by digital panoramic and/or periapical radiography. On periapical radiographs, trabecular bone structure and fractal dimension analyses of the mandibular first molar and edentulous regions were performed. On panoramic radiographs, the mandibular cortical width (MCW) was calculated, and trabecular bone structure and fractal dimension analyses of the trabecular bone in the alveolar and basal bones were performed. The results were compared between patients treated or not treated with BP using linear regression analysis to adjust for potential confounding factors.

Results: The analyses of periapical and panoramic radiological images showed no statistical differences in the jawbones between groups after bisphosphonate use for mean intervals of 4.3 and 5 years; respectively. Although the mandibular cortical width on panoramic radiography was correlated with BP use, it was not noted to be statistically significant.

Conclusions: The trabecular parts of the alveolar and basal bones and the MCW were not significantly altered by BP treatment in patients with osteoporosis over 4.3-5 years, as detected by digital periapical and panoramic radiography. The low dosages of bisphosphonates used in the treatment of osteoporosis may explain this lack of change in MCW. Dental radiographs should not be considered as a method to monitor BP-induced jaw bone alterations among osteoporotic patients.

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References

. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. Report of a WHO Study Group. World Health Organ Tech Rep Ser. 1994; 843:1-129. View

Khan A, Morrison A, Hanley D, Felsenberg D, McCauley L, ORyan F . Diagnosis and management of osteonecrosis of the jaw: a systematic review and international consensus. J Bone Miner Res. 2014; 30(1):3-23. DOI: 10.1002/jbmr.2405. View

Sener E, Cinarcik S, Baksi B . Use of Fractal Analysis for the Discrimination of Trabecular Changes Between Individuals With Healthy Gingiva or Moderate Periodontitis. J Periodontol. 2015; 86(12):1364-9. DOI: 10.1902/jop.2015.150004. View

Bertoldo F, Santini D, Lo Cascio V . Bisphosphonates and osteomyelitis of the jaw: a pathogenic puzzle. Nat Clin Pract Oncol. 2007; 4(12):711-21. DOI: 10.1038/ncponc1000. View

Pornprasertsuk S, Ludlow J, Webber R, Tyndall D, Yamauchi M . Analysis of fractal dimensions of rat bones from film and digital images. Dentomaxillofac Radiol. 2001; 30(3):179-83. DOI: 10.1038/sj/dmfr/4600597. View

Shrout M, Potter B, Hildebolt C . The effect of image variations on fractal dimension calculations. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1997; 84(1):96-100. DOI: 10.1016/s1079-2104(97)90303-6. View

Karayianni K, Horner K, Mitsea A, Berkas L, Mastoris M, Jacobs R . Accuracy in osteoporosis diagnosis of a combination of mandibular cortical width measurement on dental panoramic radiographs and a clinical risk index (OSIRIS): the OSTEODENT project. Bone. 2006; 40(1):223-9. DOI: 10.1016/j.bone.2006.07.025. View

Almasoud N, Tanneru N, Marei H . Alveolar bone density and its clinical implication in the placement of dental implants and orthodontic mini-implants. Saudi Med J. 2016; 37(6):684-9. PMC: 4931651. DOI: 10.15537/Smj.2016.6.14274. View

. Osteoporosis prevention, diagnosis, and therapy. JAMA. 2001; 285(6):785-95. DOI: 10.1001/jama.285.6.785. View

10.

Janovska Z . Bisphosphonate-related osteonecrosis of the jaws. A severe side effect of bisphosphonate therapy. Acta Medica (Hradec Kralove). 2013; 55(3):111-5. DOI: 10.14712/18059694.2015.47. View

11.

Tennis P, Rothman K, Bohn R, Tan H, Zavras A, Laskarides C . Incidence of osteonecrosis of the jaw among users of bisphosphonates with selected cancers or osteoporosis. Pharmacoepidemiol Drug Saf. 2012; 21(8):810-7. DOI: 10.1002/pds.3292. View

12.

Bollen A, Taguchi A, Hujoel P, Hollender L . Fractal dimension on dental radiographs. Dentomaxillofac Radiol. 2001; 30(5):270-5. DOI: 10.1038/sj/dmfr/4600630. View

13.

Licks R, Licks V, Ourique F, Radke Bittencourt H, Fontanella V . Development of a prediction tool for low bone mass based on clinical data and periapical radiography. Dentomaxillofac Radiol. 2010; 39(4):224-30. PMC: 3520227. DOI: 10.1259/dmfr/23760876. View

14.

Miles D . The future of dental and maxillofacial imaging. Dent Clin North Am. 2008; 52(4):917-28, viii. DOI: 10.1016/j.cden.2008.06.003. View

15.

Nackaerts O, Jacobs R, Devlin H, Pavitt S, Bleyen E, Yan B . Osteoporosis detection using intraoral densitometry. Dentomaxillofac Radiol. 2008; 37(5):282-7. DOI: 10.1259/dmfr/30424604. View

16.

Jett S, Shrout M, Mailhot J, Potter B, Borke J . An evaluation of the origin of trabecular bone patterns using visual and digital image analysis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2004; 98(5):598-604. DOI: 10.1016/S1079210404005244. View

17.

Ruggiero S, Dodson T, Fantasia J, Goodday R, Aghaloo T, Mehrotra B . American Association of Oral and Maxillofacial Surgeons position paper on medication-related osteonecrosis of the jaw--2014 update. J Oral Maxillofac Surg. 2014; 72(10):1938-56. DOI: 10.1016/j.joms.2014.04.031. View

18.

Jolley L, Majumdar S, Kapila S . Technical factors in fractal analysis of periapical radiographs. Dentomaxillofac Radiol. 2006; 35(6):393-7. DOI: 10.1259/dmfr/30969642. View

19.

Taguchi A . Triage screening for osteoporosis in dental clinics using panoramic radiographs. Oral Dis. 2009; 16(4):316-27. DOI: 10.1111/j.1601-0825.2009.01615.x. View

20.

Barngkgei I, Halboub E, Almashraqi A, Khattab R, Al Haffar I . IDIOS: An innovative index for evaluating dental imaging-based osteoporosis screening indices. Imaging Sci Dent. 2016; 46(3):185-202. PMC: 5035724. DOI: 10.5624/isd.2016.46.3.185. View