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Bone scintigraphy predicts bisphosphonate-induced osteonecrosis of the jaw (BRONJ) in patients with metastatic castration-resistant prostate cancer (mCRPC)

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Abstract

Objectives

The aim of this study was to evaluate the role of bone scintigraphy (BS) in early prediction of clinically asymptomatic bisphosphonate (BP)-related osteonecrosis of the jaws (BRONJ) in patients with metastatic castration-resistant prostate cancer (mCRPC).

Material and methods

BS of mCRPC patients treated with BP was evaluated for pathologic tracer uptake of the jaws in BS suspicious for BRONJ. Results were compared to development of clinically evident BRONJ. Sensitivity, specificity and predictive values of BS for the detection of BRONJ as well as time from beginning of BP therapy to pathologic tracer uptake in BS and time from pathologic tracer uptake in BS to clinically evident BRONJ were determined.

Results

Thirty BP-treated patients were included. Nine patients (30 %) had pathologic BS lesions of the jaws. Six patients (20 %) developed BRONJ. Sensitivity and specificity of BS for BRONJ prediction were 67 and 79 %. Median time from the start of BP treatment to pathologic tracer uptake in BS was 28 months (range 10–33) and from pathologic tracer uptake in BS to clinically evident BRONJ 6.5 months (range 2–19). Pathologic tracer uptake in BS was significantly more often observed in patients who developed BRONJ compared to patients who did not (p = 0.049; OR 7.6).

Conclusions

Patients with pathologic tracer uptake in the jaws in BS significantly more often develop BRONJ. An unsuspicious BS is predictive for absence of BRONJ in the future.

Clinical relevance

We conclude that when BS has been performed, it should not only be used to assess tumour stage and treatment response but also to check for pathologic tracer uptake in the jaws in BS to detect BRONJ at an early stage in mCRPC patients receiving bisphosphonates.

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Acknowledgments

This study is part of the doctoral thesis of Magdalena Spanidis.

Conflict of interest

The authors declare that they have no competing interests.

Funding

None.

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Authors and Affiliations

  1. Department of Urology, University of Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany

    Christian Thomas, Magdalena Spanidis, Frederik C. Roos, Sebastian Frees, Andreas Neisius, Christian Hampel, Peter Rubenwolf & Joachim W. Thüroff

  2. Department of Oral and Maxillofacial Surgery, University of Mainz, Augustusplatz 2, 55131, Mainz, Germany

    Christina Engel & Christian Walter

  3. Department of Nuclear Medicine, University of Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany

    Matthias Miederer

Authors
  1. Christian Thomas
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  2. Magdalena Spanidis
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  3. Christina Engel
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  4. Frederik C. Roos
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  5. Sebastian Frees
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  6. Andreas Neisius
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  7. Christian Hampel
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  9. Joachim W. Thüroff
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  10. Christian Walter
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  11. Matthias Miederer
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Corresponding author

Correspondence to Christian Thomas.

Additional information

Christian Walter and Matthias Miederer contributed equally as senior authors.

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Thomas, C., Spanidis, M., Engel, C. et al. Bone scintigraphy predicts bisphosphonate-induced osteonecrosis of the jaw (BRONJ) in patients with metastatic castration-resistant prostate cancer (mCRPC). Clin Oral Invest 20, 753–758 (2016). https://doi.org/10.1007/s00784-015-1563-8

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  • DOI: https://doi.org/10.1007/s00784-015-1563-8

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