Bisphosphonate-induced osteonecrosis of the jaws: clinical, imaging, and histopathology findings.

Objective: To assess the main clinical, radiographic, and histopathologic features of patients with bisphosphonate-induced osteonecrosis of the jaws (BIONJ).

Study Design: Patients with BIONJ diagnosed and treated at the Head and Neck Department, Instituto Nacional de Cancerología, Bogotá, DC, Colombia, between January 2012 and February 2014 were retrospectively included. Patients treated with sequestrectomy or curettage were excluded. Specimens from selected patients were reexamined under a light microscope. Clinical and imaging findings and sociodemographic variables were also reviewed.

Results: Five stage 3 BIONJ cases were included. Imaging found massive osteolysis. Histopathology found devitalized trabecular bone, an absence of osteoblastic rimming, osteoclastic necrosis, and viable periosteum. Actinomyces spp colonies were limited to superficial layers.

Conclusions: BIONJ histopathology is different from that of other necrotizing and inflammatory bone diseases. This relates to the known antiresorptive mechanism of bisphosphonates, which is the basis of their therapeutic action. Nevertheless, further study with larger series should be accomplished.