Advertisement

Oral Radiology

, Volume 35, Issue 2, pp 159–170 | Cite as

Effect of bisphosphonate treatment on the jawbone: an exploratory study using periapical and panoramic radiographic evaluation

  • Imad BarngkgeiEmail author
  • Esam Halboub
  • Abeer Almashraqi
Original Article
  • 82 Downloads

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.

Keywords

Bisphosphonates Dental radiography Osteoporosis Panoramic radiography 

Notes

Funding

This study was part of the OSTEOSYR project, a fully funded MSc and PhD project by the Faculty of Dentistry, Damascus University, Syria. Imad Barngkgei was the principal investigator.

Compliance with ethical standards

Conflict of interest

Imad Barngkgei, Esam Halboub, and Abeer Almashraqi declare that they have no conflict of interest.

Ethical statement

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008 (5). Informed consent was obtained from all patients for being included in the study.

Human rights statements and informed consent

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later versions. Informed consent was obtained from all patients for being included in the study.

References

  1. 1.
    NIH Consensus Development Panel on Osteoporosis Prevention Diagnosis and Therapy. Osteoporosis prevention, diagnosis, and therapy. JAMA. 2001;285:785–95.CrossRefGoogle Scholar
  2. 2.
    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.Google Scholar
  3. 3.
    Gutta R, Louis PJ. Bisphosphonates and osteonecrosis of the jaws: science and rationale. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2007;104:186–93.CrossRefGoogle Scholar
  4. 4.
    Petrut B, Trinkaus M, Simmons C, Clemons M. A primer of bone metastases management in breast cancer patients. Curr Oncol. 2008;15:50–7.CrossRefGoogle Scholar
  5. 5.
    Janovska Z. Bisphosphonate-related osteonecrosis of the jaws. A severe side effect of bisphosphonate therapy. Acta Medica (Hradec Kralove). 2012;55:111–5.CrossRefGoogle Scholar
  6. 6.
    Ruggiero SL, Dodson TB, Fantasia J, Goodday R, Aghaloo T, Mehrotra B, et al. American Association of Oral and Maxillofacial Surgeons position paper on medication-related osteonecrosis of the jaw—2014 update. J Oral Maxillofac Surg. 2014;72:1938–56.CrossRefGoogle Scholar
  7. 7.
    Khan AA, Morrison A, Hanley DA, Felsenberg D, McCauley LK, O’Ryan F, et al. Diagnosis and management of osteonecrosis of the jaw: a systematic review and international consensus. J Bone Miner Res. 2015;30:3–23.CrossRefGoogle Scholar
  8. 8.
    Badros A, Weikel D, Salama A, Goloubeva O, Schneider A, Rapoport A, et al. Osteonecrosis of the jaw in multiple myeloma patients: clinical features and risk factors. J Clin Oncol. 2006;24:945–52.CrossRefGoogle Scholar
  9. 9.
    Tennis P, Rothman KJ, Bohn RL, Tan H, Zavras A, Laskarides C, et al. Incidence of osteonecrosis of the jaw among users of bisphosphonates with selected cancers or osteoporosis. Pharmacoepidemiol Drug Saf. 2012;21:810–7.CrossRefGoogle Scholar
  10. 10.
    Dannemann C, Zwahlen R, Gratz KW. Clinical experiences with bisphosphonate induced osteochemonecrosis of the jaws. Swiss Med Wkly. 2006;136:504–9.Google Scholar
  11. 11.
    Lapi F, Cipriani F, Caputi AP, Corrao G, Vaccheri A, Sturkenboom MC, et al. Assessing the risk of osteonecrosis of the jaw due to bisphosphonate therapy in the secondary prevention of osteoporotic fractures. Osteoporos Int. 2013;24:697–705.CrossRefGoogle Scholar
  12. 12.
    Mavrokokki T, Cheng A, Stein B, Goss A. Nature and frequency of bisphosphonate-associated osteonecrosis of the jaws in Australia. J Oral Maxillofac Surg. 2007;65:415–23.CrossRefGoogle Scholar
  13. 13.
    Bedogni A, Fedele S, Bedogni G, Scoletta M, Favia G, Colella G, et al. Staging of osteonecrosis of the jaw requires computed tomography for accurate definition of the extent of bony disease. Br J Oral Maxillofac Surg. 2014;52:603–8.CrossRefGoogle Scholar
  14. 14.
    Diniz-Freitas M, Fernandez-Montenegro P, Fernandez-Feijoo J, Limeres-Posse J, Gonzalez-Mosquera A, Vazquez-Garcia E, et al. Mandibular cortical indices on cone-beam computed tomography images in osteoporotic women on treatment with oral bisphosphonates. Gerodontology. 2014;33:155–60.CrossRefGoogle Scholar
  15. 15.
    Barngkgei I, Halboub E, Almashraqi AA, Khattab R, Al Haffar I. IDIOS: An innovative index for evaluating dental imaging-based osteoporosis screening indices. Imaging Sci Dent. 2016;46:185–202.CrossRefGoogle Scholar
  16. 16.
    Torres SR, Chen CS, Leroux BG, Lee PP, Hollender LG, Lloid M, et al. Mandibular inferior cortical bone thickness on panoramic radiographs in patients using bisphosphonates. Oral Surg Oral Med Oral Pathol Oral Radiol. 2015;119:584–92.CrossRefGoogle Scholar
  17. 17.
    Yamada S, Uchida K, Iwamoto Y, Sugino N, Yoshinari N, Kagami H, et al. Panoramic radiography measurements, osteoporosis diagnoses and fractures in Japanese men and women. Oral Dis. 2015;21:335–41.CrossRefGoogle Scholar
  18. 18.
    Yajima N, Munakata M, Fuchigami K, Sanda M, Kasugai S. Influence of bisphosphonates on implant failure rates and characteristics of postmenopausal woman mandibular jawbone. J Oral Implantol. 2017;43:345–9.CrossRefGoogle Scholar
  19. 19.
    White SC, Rudolph DJ. Alterations of the trabecular pattern of the jaws in patients with osteoporosis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1999;88:628–35.CrossRefGoogle Scholar
  20. 20.
    Karayianni K, Horner K, Mitsea A, Berkas L, Mastoris M, Jacobs R, et al. 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. 2007;40:223–9.CrossRefGoogle Scholar
  21. 21.
    Nackaerts O, Jacobs R, Devlin H, Pavitt S, Bleyen E, Yan B, et al. Osteoporosis detection using intraoral densitometry. Dentomaxillofac Radiol. 2008;37:282–7.CrossRefGoogle Scholar
  22. 22.
    Taguchi A. Triage screening for osteoporosis in dental clinics using panoramic radiographs. Oral Dis. 2010;16:316–27.CrossRefGoogle Scholar
  23. 23.
    Verheij JG, Geraets WG, van der Stelt PF, Horner K, Lindh C, Nicopoulou-Karayianni K, et al. Prediction of osteoporosis with dental radiographs and age. Dentomaxillofac Radiol. 2009;38:431–7.CrossRefGoogle Scholar
  24. 24.
    Kavitha MS, Asano A, Taguchi A, Kurita T, Sanada M. Diagnosis of osteoporosis from dental panoramic radiographs using the support vector machine method in a computer-aided system. BMC Med Imaging. 2012;12:1.CrossRefGoogle Scholar
  25. 25.
    Hamada H, Matsuo A, Koizumi T, Satomi T, Chikazu D. A simple evaluation method for early detection of bisphosphonate-related osteonecrosis of the mandible using computed tomography. J Craniomaxillofac Surg. 2014;42:924–9.CrossRefGoogle Scholar
  26. 26.
    Miles DA. The future of dental and maxillofacial imaging. Dent Clin North Am. 2008;52:917–28 (viii) CrossRefGoogle Scholar
  27. 27.
    Bertoldo F, Santini D, Lo Cascio V. Bisphosphonates and osteomyelitis of the jaw: a pathogenic puzzle. Nat Clin Pract Oncol. 2007;4:711–21.CrossRefGoogle Scholar
  28. 28.
    Mavropoulos A, Kiliaridis S, Rizzoli R, Ammann P. Normal masticatory function partially protects the rat mandibular bone from estrogen-deficiency induced osteoporosis. J Biomech. 2014;47:2666–71.CrossRefGoogle Scholar
  29. 29.
    Shimizu Y, Ishida T, Hosomichi J, Kaneko S, Hatano K, Ono T. Soft diet causes greater alveolar osteopenia in the mandible than in the maxilla. Arch Oral Biol. 2013;58:907–11.CrossRefGoogle Scholar
  30. 30.
    White SC. Oral radiographic predictors of osteoporosis. Dentomaxillofac Radiol. 2002;31:84–92.CrossRefGoogle Scholar
  31. 31.
    Otto S, Sotlar K, Ehrenfeld M, Pautke C. Osteonecrosis of the jaw as a possible rare side effect of annual bisphosphonate administration for osteoporosis: a case report. J Med Case Rep. 2011;5:477.CrossRefGoogle Scholar
  32. 32.
    Ulmner M, Jarnbring F, Torring O. Osteonecrosis of the jaw in Sweden associated with the oral use of bisphosphonate. J Oral Maxillofac Surg. 2014;72:76–82.CrossRefGoogle Scholar
  33. 33.
    Bassi F, Procchio M, Fava C, Schierano G, Preti G. Bone density in human dentate and edentulous mandibles using computed tomography. Clin Oral Implants Res. 1999;10:356–61.CrossRefGoogle Scholar
  34. 34.
    Almasoud NN, Tanneru N, Marei HF. Alveolar bone density and its clinical implication in the placement of dental implants and orthodontic mini-implants. Saudi Med J. 2016;37:684–9.CrossRefGoogle Scholar
  35. 35.
    Jolley L, Majumdar S, Kapila S. Technical factors in fractal analysis of periapical radiographs. Dentomaxillofac Radiol. 2006;35:393–7.CrossRefGoogle Scholar
  36. 36.
    Shrout MK, Potter BJ, Hildebolt CF. The effect of image variations on fractal dimension calculations. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1997;84:96–100.CrossRefGoogle Scholar
  37. 37.
    Jett S, Shrout MK, Mailhot JM, Potter BJ, Borke JL. 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;98:598–604.CrossRefGoogle Scholar
  38. 38.
    Pornprasertsuk S, Ludlow JB, Webber RL, Tyndall DA, Yamauchi M. Analysis of fractal dimensions of rat bones from film and digital images. Dentomaxillofac Radiol. 2001;30:179–83.CrossRefGoogle Scholar
  39. 39.
    Sener E, Cinarcik S, Baksi BG. Use of fractal analysis for the discrimination of trabecular changes between individuals with healthy gingiva or moderate periodontitis. J Periodontol. 2015;86:1364–9.CrossRefGoogle Scholar
  40. 40.
    Chappard C, Brunet-Imbault B, Lemineur G, Giraudeau B, Basillais A, Harba R, et al. Anisotropy changes in post-menopausal osteoporosis: characterization by a new index applied to trabecular bone radiographic images. Osteoporos Int. 2005;16:1193–202.CrossRefGoogle Scholar
  41. 41.
    Bollen AM, Taguchi A, Hujoel PP, Hollender LG. Fractal dimension on dental radiographs. Dentomaxillofac Radiol. 2001;30:270–5.CrossRefGoogle Scholar
  42. 42.
    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;39:224–30.CrossRefGoogle Scholar
  43. 43.
    Horner K, Karayianni K, Mitsea A, Berkas L, Mastoris M, Jacobs R, et al. The mandibular cortex on radiographs as a tool for osteoporosis risk assessment: the OSTEODENT Project. J Clin Densitom. 2007;10:138–46.CrossRefGoogle Scholar
  44. 44.
    Bruce N, Pope D, Stanistreet D. Quantitative methods for health research: a practical interactive guide to epidemiology and statistics. Oxford: Wiley; 2008.CrossRefGoogle Scholar
  45. 45.
    Emaus N, Wilsgaard T, Ahmed LA. Impacts of body mass index, physical activity, and smoking on femoral bone loss: the Tromso study. J Bone Miner Res. 2014;29:2080–9.CrossRefGoogle Scholar
  46. 46.
    Callreus M, McGuigan F, Akesson K. Adverse effects of smoking on peak bone mass may be attenuated by higher body mass index in young female smokers. Calcif Tissue Int. 2013;93:517–25.CrossRefGoogle Scholar
  47. 47.
    Oyen J, Gram Gjesdal C, Nygard OK, Lie SA, Meyer HE, Apalset EM, et al. Smoking and body fat mass in relation to bone mineral density and hip fracture: the Hordaland Health Study. PLoS One. 2014;9:e92882.CrossRefGoogle Scholar

Copyright information

© Japanese Society for Oral and Maxillofacial Radiology and Springer Nature Singapore Pte Ltd. 2018

Authors and Affiliations

  1. 1.Department of Oral Medicine, Faculty of DentistrySyrian Private University (SPU)DamascusSyria
  2. 2.Department of Oral Medicine, Faculty of DentistryDamascus UniversityDamascusSyria
  3. 3.Department of Maxillofacial Surgery and Diagnostic Sciences, College of DentistryJazan UniversityJazanSaudi Arabia

Personalised recommendations