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Clinical, radiographic, and biochemical characterization of multiple myeloma patients with osteonecrosis of the jaw
Clinical Cancer Research, 04/18/08

Raje N et al. – Osteonecrosis of the jaw (ONJ) is associated with a mean duration of 38.7 mo of aminobisphosphonate exposure, based on clinical ONJ confirmed on radiographic and functional imaging; gene and protein studies are consistent with altered bone remodeling shown by suppression of both bone resorption and formation

• Study to define ONJ clinically and radiographically and understand its pathophysiology
• Clinical, biochemical, radiographic, and molecular profiling for 11 pts with multiple myeloma (MM) and ONJ
• Controls for biochemical and molecular studies: 10 MM pts on aminobisphosphonates without ONJ and 5 healthy volunteers
• MM-ONJ pts treated with either pamidronate (3 pts), zoledronate (4), or both drugs sequentially (4) for a mean of 38.7 mo
• Bone sclerosis and fragmentation on plain films and CT

• Quantitative regional analysis of NaF-PET and FDG-PET scans confirmed increased standardized uptake value (SUVmax) in ONJ areas
• Target:background ratio of SUVmax: significantly greater for NaF-PET vs FDG-PET scan
• On biochemical bone marker data and transcriptional profiling studies, genes and proteins in osteoblast and osteoclast signaling cascades were significantly downregulated in ONJ pts

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