Impact of bisphosphonate-related osteonecrosis of the jaw on osteoporotic patients after dental extraction: a population-based cohort study.

Yi Fang Huang,Chung Ta Chang,Yu Fu Shen,Ching Zong Wu,Chih Hsin Muo,Chun Hao Tsai,Deepak Vashishth

doi:10.1371/journal.pone.0120756

Abstract

Background and AimsLittle is currently known about the risk of developing bisphosphonate-related osteonecrosis of the jaw (BRONJ). This study sought to determine the incidence of BRONJ in osteoporotic patients. We also sought to identify the nature and types of risk factors of osteonecrosis of jaw (ONJ) related to the use of oral bisphosphonates (BPs).Materials and MethodsData from the National Health Insurance system of Taiwan. This cohort study included 19,399 adult osteoporosis patients received dental extraction in 2000-2010 (osteoporosis cohort) and 38,669 age and gender matched comparisons selected from dental extraction people without osteoporosis and osteonecrosis history (comparison cohort). All study subjects were followed from the date of their dental extraction (index date) to the development of ONJ and were included in the study up to 2011 or were lost to the study, whichever occurred first. Cox proportional hazard regression was used to estimate the hazard ratio and 95% confidence intervals for the two cohorts.ResultsPatients with osteoporosis had a significantly higher risk to develop ONJ than healthy persons (adjusted HR, 2.05; 95% confidence interval, 1.58–2.65). The risk of ONJ increased with the severity of osteoporosis, no matter whether patient with cancer or not. A cumulative effect of dental extraction frequency may increase the risk of ONJ.ConclusionsWe concluded that ONJ is caused by a number of factors. Osteoporosis and past dental history play the very important roles, while BPs play the synergistic effect.

Highlights

Many people older than 50 years are suffered from osteoporosis and the incidence of wrist, spine, and hip fractures are expected to increase
The percentage of developing bisphosphonate-related osteonecrosis of the jaw (BRONJ) after oral BPs administration ranges from 2.5% to 27.3% in another research [10] and most reported cases occurred in patients with malignancies
Despite the extensive researches focused on the risk of ONJ in cancer patients with BPs used [19,20], to our knowledge, there is less information about the correlation between ONJ and BPs use in noncancer patients. The aims of this population-based cohort study are going to fill the following gaps in knowledge: (1) to investigate the incidence of BRONJ in osteoporotic patients with oral BPs administration, and (2) to estimate the correlation between BRONJ and BPs usage in patients with osteoporosis according to the National Health Insurance system of Taiwan

Summary

Background and Aims

Little is currently known about the risk of developing bisphosphonate-related osteonecrosis of the jaw (BRONJ). This study sought to determine the incidence of BRONJ in osteoporotic patients. We sought to identify the nature and types of risk factors of osteonecrosis of jaw (ONJ) related to the use of oral bisphosphonates (BPs)

Materials and Methods

Results

Introduction

Discussion

Conclusion