In our previous study, we found a rare type of medication-related osteonecrosis of the jaw (MRONJ), which shows periosteal reaction (PR) at a site distant from osteolytic lesions or the extraction site (periosteal reaction dominant type, PRd type), even though the osteolytic lesions in the bone marrow are localized. The causes and treatment of MRONJ remain unclear; hence, this study aimed to describe the imaging and clinical features of the PRd type.
Materials and methods
MRONJ patients who visited Nagasaki University Hospital between 2009 and 2020 and received conservative therapy as initial treatment were included in this study. The PR site, imaging findings, initial symptoms, outcome, and time to progression were examined.
Among 59 MRONJ patients treated with conservative therapy, 38 did not show PR (PR− type), 15 showed PR near the osteolytic region (PR + type), and 6 had the PRd type. All patients with the PRd type had submental abscesses, and computed tomography (CT) images demonstrated PR on the lingual side of the anterior mandible. Osteolytic lesions progressed in 6/6 PRd type (100%), 5/15 PR + type (33.3%), and 2/38 PR− type (5.3%) patients. Time to progression for the osteolytic region on CT was short for the PRd type, at 56–148 days (median 79 days).
Among the MRONJ types, the PRd type has a poor prognosis. Therefore, accumulating and analyzing more PRd cases in the future is warranted. This is the first report to describe the presence of this specific subtype of MRONJ.
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Availability of data and material
The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.
Yarom N, Shapiro CL, Peterson DE, Van Poznak CH, Bohlke K, Ruggiero SL, Migliorati CA, Khan A, Morrison A, Anderson H, Murphy BA, Alston-Johnson D, Mendes RA, Beadle BM, Jensen SB, Saunders DP (2019) Medication-related osteonecrosis of the jaw: MASCC/ISOO/ASCO Clinical Practice Guideline. J Clin Oncol 37:2270–2290
Ruggiero SL, Dodson TB, Fantasia J, Goodday R, Aghaloo T, Mehrotra B, O’Ryan F, Association of Oral and Maxillofacial Surgeons (2014) American Association of Oral and Maxillofacial Surgeons Position Paper on medication-related osteonecrosis of the jaw-2014 Update. J Oral Maxillofac Surg 72:1938–1956
Hayashida S, Soutome S, Yanamoto S, Fujita S, Hasegawa T, Komori T, Kojima Y, Miyamoto H, Shibuya Y, Ueda N, Kirita T, Nakahara H, Shinohara M, Umeda M (2017) Evaluation of the treatment strategies for medication-related osteonecrosis of the jaws (MRONJ) and the factors affecting treatment outcome: a multicenter retrospective study with propensity score matching analysis. J Bone Miner Res 32:2022–2029
Kojima Y, Kawaoka Y, Sawada S, Hayashida S, Okuyama K, Yutori H, Kawakita A, Ishida S, Soutome S, Yanamoto S, Umeda M, Iwai H (2019) Clinical significance of periosteal reaction as a predictive factor for treatment outcome of medication-related osteonecrosis of the jaw. J Bone Miner Metab 37:913–919
Soutome S, Yanamoto S, Sumi M, Hayashida S, Kojima Y, Sawada S, Rokutanda S, Iwai H, Saito T, Umeda M (2021) Effect of periosteal reaction in medication-related osteonecrosis of the jaw on treatment outcome after surgery. J Bone Miner Metab 39:302–310
Suei Y (2013) Radiographic findings of bisphosphonate-related osteomyelitis of the jaw: investigation of the diagnostic points by comparison with radiation osteomyelitis, suppurative osteomyelitis, and diffuse sclerosing osteomyelitis. Oral Radiol 29:121–134
Suei Y, Taguchi A, Tanimoto K (2003) Diagnotic points and possible origin of osteomyelitis in synovitis, acne, pustulosis, hyperostosis and osteitis (SAPHO) syndrome: a radiographic study of 77 mandibular osteomyelitis cases. Rheumatology 42:1398–1403
Conflict of interest
The authors declared that they have no conflict of interest.
This study was approved by the Institutional Review Board (#21021509) of Nagasaki University Hospital. Because this was a retrospective study; hence, the research plan was published on the homepage of the participating hospitals according to the instructions of the IRB in accordance with the guaranteed opt-out opportunity.
This was a retrospective study; hence, the research plan was published in the homepage of the participating hospitals according to the instructions of the IRB in accordance with the guaranteed opt-out opportunity.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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Otsuru, M., Soutome, S., Hayashida, S. et al. Imaging findings and treatment outcomes of a rare subtype of medication-related osteonecrosis of the jaw. J Bone Miner Metab (2021). https://doi.org/10.1007/s00774-021-01267-6
- Periosteal reaction