Biphasic remodeling and trabecular-cortical uncoupling in the jawbone during antiresorptive therapy and medication-related osteonecrosis: A quantitative imaging analysis.
4 affiliations
- 1Division of Oral and Maxillofacial Surgery, Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan.
- 2Department of Dentistry, School of Dentistry, College of Medicine, National Taiwan University, Taipei, Taiwan.
- 3Department of Family Medicine, National Taiwan University Hospital, Taipei, Taiwan.
- 4Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Abstract
Background/purpose
Although antiresorptive therapy (ART) is crucial for managing oncology-related skeletal complications, it carries a risk of medication-related osteonecrosis of the jaw (MRONJ). Because conventional radiography relies on subjective interpretation, detecting early necrotic transition remains challenging. This study aimed to establish objective, quantitative imaging criteria for jawbone remodeling and MRONJ onset by evaluating 2D fractal dimension (FD) and 3D CBCT cortical thickness under zoledronic acid or denosumab therapy.Materials and methods
Panoramic radiographs and CBCT scans of cancer patients receiving zoledronic acid (ZA, n = 155) or denosumab (Dmab, n = 168), and healthy controls (n = 95) were analyzed. Longitudinal FD and contralateral and lesion-site cortical thicknesses were quantified to differentiate systemic remodeling from localized necrosis.Results
Systemic ART induced widespread jawbone osteosclerosis, characterized by significant longitudinal FD increases (ZA: P < 0.05; Dmab: P < 0.001) and contralateral cortical thickening (P < 0.05). Conversely, MRONJ onset triggered a distinct trabecular-cortical uncoupling: a paradoxical reduction in FD (osteolysis) at the necrotic site (P < 0.05) concurrent with reactive periosteal cortical thickening, most pronounced on the lingual aspect (P < 0.001). ZA induced diffuse sclerosis, whereas Dmab-induced changes were localized to the anterior mandible.Conclusion
Jawbone trabecular and cortical compartments exhibit distinct remodeling patterns during ART and osteonecrosis. Combining quantitative assessments of these compartments provides an objective, non-invasive method for monitoring skeletal burden and detecting early necrotic transitions before clinical bone exposure occurs.
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BibTeX
@article{wei2026biphasic,
title = {{Biphasic remodeling and trabecular-cortical uncoupling in the jawbone during antiresorptive therapy and medication-related osteonecrosis: A quantitative imaging analysis.}},
author = {Ling-Ying Wei and Jun-Ching Lee and Ching-Ming Chiu and Sang-Heng Kok and Hung-Ying Lin and Wei-Yih Chiu and Hao-Hueng Chang and Shih-Jung Cheng and Jang-Jaer Lee},
journal = {Journal of dental sciences},
year = {2026},
month = oct,
doi = {10.1016/j.jds.2025.07.3698},
url = {https://europepmc.org/article/MED/42924146},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Biphasic remodeling and trabecular-cortical uncoupling in the jawbone during antiresorptive therapy and medication-related osteonecrosis: A quantitative imaging analysis.
AU - Ling-Ying Wei
AU - Jun-Ching Lee
AU - Ching-Ming Chiu
AU - Sang-Heng Kok
AU - Hung-Ying Lin
AU - Wei-Yih Chiu
AU - Hao-Hueng Chang
AU - Shih-Jung Cheng
AU - Jang-Jaer Lee
PY - 2026
DA - 2026/10/01
JO - Journal of dental sciences
DO - 10.1016/j.jds.2025.07.3698
UR - https://europepmc.org/article/MED/42924146
AB - Background/purpose Although antiresorptive therapy (ART) is crucial for managing oncology-related skeletal complications, it carries a risk of medication-related osteonecrosis of the jaw (MRONJ). Because conventional radiography relies on subjective interpretation, detecting early necrotic transition remains challenging. This study aimed to establish objective, quantitative imaging criteria for jawbone remodeling and MRONJ onset by evaluating 2D fractal dimension (FD) and 3D CBCT cortical thickness under zoledronic acid or denosumab therapy.Materials and methods Panoramic radiographs and CBCT scans of cancer patients receiving zoledronic acid (ZA, n = 155) or denosumab (Dmab, n = 168), and healthy controls (n = 95) were analyzed. Longitudinal FD and contralateral and lesion-site cortical thicknesses were quantified to differentiate systemic remodeling from localized necrosis.Results Systemic ART induced widespread jawbone osteosclerosis, characterized by significant longitudinal FD increases (ZA: P < 0.05; Dmab: P < 0.001) and contralateral cortical thickening (P < 0.05). Conversely, MRONJ onset triggered a distinct trabecular-cortical uncoupling: a paradoxical reduction in FD (osteolysis) at the necrotic site (P < 0.05) concurrent with reactive periosteal cortical thickening, most pronounced on the lingual aspect (P < 0.001). ZA induced diffuse sclerosis, whereas Dmab-induced changes were localized to the anterior mandible.Conclusion Jawbone trabecular and cortical compartments exhibit distinct remodeling patterns during ART and osteonecrosis. Combining quantitative assessments of these compartments provides an objective, non-invasive method for monitoring skeletal burden and detecting early necrotic transitions before clinical bone exposure occurs.
SN - 1991-7902
SN - 2213-8862
ER -