Diabetes Microvascular Disease and the Risk for bisphosphonate-related Osteonecrosis of the Jaw: A Single Center Study

Abstract

Bisphosphonate-related osteonecrosis of the jaws (BRONJ) is a severe bone disease for which the exact pathogenesis mechanisms are not fully understood. The objective of the study is to investigate a possible contribution of diabetes and microvascular disease to the pathophysiology of BRONJ. We identified 46 patients treated with bisphosphonates who were diagnosed with BRONJ based on their medical history during 2009 to 2012 and invited them for a dental assessment to confirm the diagnosis. Diabetes diagnosis was based on the American Diabetes Association criteria. The study group was compared to a control group of 38 patients treated with bisphosphonates without evidence of BRONJ. The study was conducted at Rambam Health Care Campus, a referral center, Haifa, Israel. The results of our study showed that of the 46 patients with BRONJ, 31 (67.4%) had diabetes or impaired fasting glucose. The proportion with diabetes (37%) was higher than in the control group (26.3%; P = .009). The presence of diabetes or impaired fasting glucose increased the association with BRONJ by 2.78-fold (confidence interval = 1.27-6.07, P = .009). The prevalence of microvascular disease (neuropathy, retinopathy, nephropathy) was significantly higher in the BRONJ than in the control group (P = .01). The presence of diabetic nephropathy increased the association with BRONJ by 3.9-fold (confidence interval = 1.12-13.52, P = .02). This retrospective study suggests an association between diabetes, perhaps mediated through microvascular complications, and the development of BRONJ.