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Bisphosphonate-Related Osteonecrosis of the Mandible and Maxilla: Clinical and Imaging Features

Gill, Sonia B. MD*; Valencia, Maria P. MD*; Sabino, Mary Lou C. DDS; Heideman, Gregory M. MD*; Michel, Michelle A. MD*

Journal of Computer Assisted Tomography: May-June 2009 - Volume 33 - Issue 3 - p 449-454
doi: 10.1097/RCT.0b013e318186b179
Musculoskeletal Imaging

Objective: Bisphosphonate-related osteonecrosis of the jaws is a rare, but morbid, condition. We present the clinical and imaging features of 19 patients.

Methods: A review of 19 bisphosphonate-related osteonecrosis patients was performed. Patient demographics, diagnosis, dental procedures, symptoms and clinical findings, location and pattern of involvement, and presence of fractures, sequestra, and fistulae were documented.

Results: Patients included 14 women and 5 men aged 48 to 80 years. Diagnoses included breast carcinoma (n = 11), multiple myeloma (n = 4), osteoporosis (n = 4), prostate carcinoma (n = 2), and lymphoma (n = 1). Seventeen patients received intravenous and 2 received oral bisphosphonates for 2 to 5 years. Bone involvement was noted in the mandible (74%), maxilla (16%), and both (10%). A lytic and sclerotic pattern was most common (58%). Additional findings included fractures (n = 5), sequestra (n = 4), and oroantral fistulae (n = 2).

Conclusions: Bisphosphonate-related osteonecrosis is a rare, but morbid, condition, and imaging features can mimic other conditions. It is important for the radiologist to consider this entity in the appropriate clinical setting.

From the *Department of Radiology, †Medical College of Wisconsin, Milwaukee, WI.

Received for publication May 16, 2008; accepted July 11, 2008.

Reprints: Michelle A. Michel, MD, Department of Radiology, Medical College of Wisconsin, 9200 W Wisconsin Ave, Milwaukee, WI 53226 (e-mail:

No funding was received from any organization for this work.

© 2009 Lippincott Williams & Wilkins, Inc.