Recognition of bisphosphonate-related osteonecrosis of the jaw among oral and maxillofacial radiologists: results from a questionnaire-based survey in Japan

Objectives

Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is becoming common in Japan. Oral and maxillofacial radiologists must diagnose BRONJ in general practice. However, little information on how to recognise BRONJ is available. The purpose of this study, therefore, was to confirm the recognition of BRONJ among Japanese oral and maxillofacial radiologists.

Methods

A questionnaire including 14 main queries and relevant branch queries was created and sent to 29 Japanese institutions employing oral and maxillofacial radiologists.

Results

A large number of patients (705) with BRONJ during the last 3 years were reported by 23 institutions (25 responders) that participated in our survey. The rate of osteonecrosis of the jaw associated with intravenous bisphosphonates was almost identical to that associated with oral bisphosphonates. This finding was inconsistent with worldwide data. About half of the responders felt that the diagnosis of BRONJ based on imaging was difficult. No specific modality was selected for identifying the early signs of BRONJ, although 19 responders selected multi-detector computed tomography followed by magnetic resonance imaging as the best modality for determining the extent of BRONJ. Almost all responders felt that the detection of early signs and determination of lesion extent on imaging were important roles of oral and maxillofacial radiologists.

Conclusions

Oral and maxillofacial radiologists recognised their roles in BRONJ diagnosis; however, insufficient evidence regarding the accomplishment of these roles is available. Japanese oral and maxillofacial radiologists must accumulate a large number of BRONJ images, analyse them in cooperation with one another and share the information obtained from their analysis.