Alterations of the jaw bone in cancer patients with metastatic bone carcinoma

Keywords: bisphosphonate-related osteonecrosis of the jaw.        
The therapeutic protocols for patients whose oncologic pathology affects the bone (multiple myeloma, breast or prostate cancer) include the use of bisphosphonates to limit the destructive effect of the neoplasm spreading to the skeleton. Cases of osteonecrosis of the jaw as a complication of this medication have been published in recent years. There is little available information on the etio-physio-pathogenesis of this condition, known as bisphosphonate-related osteonecrosis of the jaw (BRONJ). In a previous paper (SAIO-2009) we reported the histopathological features of BRONJ observed in 4 patients. Aim: This paper reports the alterations of the jaw bone observed in cancer patients under treatment for metastatic bone carcinoma. Materials and methods: Thirteen (13) patients diagnosed with cancer and bone metastasis treated at Hospital Alemán in Buenos Aires from March 2008 to January 2010 were studied. Clinical-radiographic features of the mouth were evaluated. The histopathological analysis of the jaw bone was performed in 9 cases. Results: Six (6) cases (46%) exhibited clinical signs of BRONJ. In the 9 cases for which the histopathological analysis of bone tissue was performed, a pagetoid trabecular structure was observed. Four (4) of these cases (31%) did not exhibit clinical signs of BRONJ but evidenced a pagetoid bone at a histological level. One of these patients had not started bisphosphonate treatment at the time of the biopsy. Conclusions: Similar histopathological alterations, corresponding to a pagetoid trabecular structure, were observed in all the cancer patients with metastatic bone carcinoma for whom the histopathological analysis of the jaw bone was performed. The patient with histological alterations of the jaw bone who was not undergoing bisphosphonate treatment poses the need to perform prospective studies, increase the number of cases analyzed and correlate the findings with the oncologic treatments applied.