Quantitative ultrasound at the hand phalanges in patients with bisphosphonate-related osteonecrosis of the jaws

Patients with bisphosphonate-related osteonecrosis of the jaws (BRONJ) who received intravenous or oral bisphosphonates (BP) were selected for determination of their bone microarchitecture as a risk predictor of BRONJ development. The diagnosis of BRONJ was made based on clinical and radiographic findings. The control group consisted of healthy patients. All patients underwent quantitative and qualitative ultrasound measurements of bone at the hand phalanges carried out using the DBM Sonic BP. Ultrasound bone profile index (UBPI), amplitude-dependent speed of sound (AD-SoS), bone biophysics profile (BBP), and bone transmission time (BTT) were measured. The BRONJ group consisted of 17 patients (62 ± 4.24; range: 45-82); 10 (58.8%) were male and seven (41.1%) were female, of whom 11 (64.7%) suffered from multiple myeloma, three (17.6%) from osteoporosis, one (5.8%) from prostate cancer, one (5.8%) from kidney cancer, and one (5.8%) from leukemia. Fourteen (82.3%) of them received intravenous BP whereas three (17.6%) received oral BP. Nine (9/17; 52.9%) patients developed bone exposure: two in the maxilla and seven in the mandible. Regarding quantitative parameters, Ad-SoS was low in the BRONJ group, but not significant. The UBPI score was significantly reduced in BRONJ patients with exposed bone when compared to controls (0.47 ± 0.12 vs. 0.70 ± 0.15; p = 0.004). The present study demonstrated that quantitative ultrasound was able to show bone microarchitecture alterations in BRONJ patients, and suggests that these analyses may be an important tool for early detection of bone degeneration associated with BRONJ.

本研究纳入接受静脉或口服双膦酸盐（bisphosphonates, BP）治疗的双膦酸盐相关性颌骨坏死（bisphosphonate-related osteonecrosis of the jaws, BRONJ）患者，对其骨微结构进行检测，以作为BRONJ发生的风险预测因子。BRONJ的诊断基于临床及影像学检查结果确立。对照组纳入健康受试者。所有受试者均采用DBM Sonic BP设备对手指指骨进行骨定量及定性超声检测。本次检测的超声参数包括超声骨轮廓指数（ultrasound bone profile index, UBPI）、振幅依赖声速（amplitude-dependent speed of sound, AD-SoS）、骨生物物理轮廓（bone biophysics profile, BBP）以及骨传播时间（bone transmission time, BTT）。BRONJ组共纳入17例患者，年龄为62 ± 4.24岁，范围45~82岁；其中男性10例（58.8%），女性7例（41.1%）。患者基础疾病包括：多发性骨髓瘤11例（64.7%）、骨质疏松症3例（17.6%）、前列腺癌1例（5.8%）、肾癌1例（5.8%）以及白血病1例（5.8%）。14例（82.3%）患者接受静脉双膦酸盐治疗，3例（17.6%）接受口服双膦酸盐治疗。其中9例（52.9%）患者出现骨暴露：上颌骨暴露2例，下颌骨暴露7例。在定量参数方面，BRONJ组的AD-SoS水平较低，但差异无统计学意义。与对照组相比，伴骨暴露的BRONJ患者的UBPI评分显著降低（0.47 ± 0.12 vs. 0.70 ± 0.15; p = 0.004）。本研究表明，定量超声检测可显示BRONJ患者的骨微结构改变，提示此类检测或可成为早期检测与BRONJ相关骨退变的重要工具。