Higher Bone Matrix Density Exists in Only a Subset of Patients With Bisphosphonate-Related Osteonecrosis of the Jaw
Purpose
Because few treatment options exist for bisphosphonate-related osteonecrosis of the jaw (BRONJ), developing methods of early detection and prevention is vital. Computed tomography could represent a useful tool for early detection of BRONJ, yet its effectiveness would necessitate changes in tissue density. The aim of this study was to quantify bone matrix density of tissue from patients with BRONJ.
Patients and Methods
Bone samples from 13 patients with confirmed BRONJ were scanned by use of high-resolution micro-computed tomography. Mean density and density distribution were assessed and compared with mandible samples from cadaveric controls (n = 8; age range, 43-94 years).
Results
The bone matrix in BRONJ samples had a significantly higher mean density (+8.5%, P = .01) compared with cadaveric samples. The higher density in BRONJ tissue was evident in a clear shift in the tissue density profile. In controls, less than 5% of the tissue had a density above the median gray-scale value, whereas on average, BRONJ tissue had approximately 15% of the tissue density in this range. By use of z score analyses of mean density values, a large degree of heterogeneity is evident among BRONJ specimens, with some samples having z scores of 0 and others having z scores well above 6 compared with controls.
Conclusions
On the basis of these findings, higher tissue density appears to manifest in only a subset of BRONJ patients, suggesting that density may have limitations as a biomarker for early detection of this condition.
⁎Assistant Professor, Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis, IN
†Attending, New York Center for Orthognathic and Maxillary Surgery, Lake Success, NY, and Associate Professor, Department of Oral and Maxillofacial Surgery, School of Dental Medicine, The State University of New York, Stony Brook, NY
Address correspondence and reprint requests to Dr Allen: Department of Anatomy and Cell Biology, 635 Barnhill Dr, MS-5035, Indianapolis, IN 46202
The micro–computed tomography equipment used in this research was purchased through a National Institutes of Health equipment grant (S10-RR023710).
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