In reply

Abstract

In their comment on our article published in the Journal of Oral and Maxillofacial Surgery (J Oral Maxillofac Surg 68:107, 2010), Kyrgidis et al made some useful observations on important aspects of osteonecrosis of the jaw (ONJ) in patients receiving intravenous bisphosphonates (BP). In particular, using raw data from one of their studies, they suggest putative incidence of ONJ following dental extraction in the absence of preventive treatment to be greater than 40%. Kyrgidis et al state that the risk of ONJ in such patients can be up to 53-fold greater; however, we think that reliable figures will not be available until studies specifically aimed at this subject determine incidence rates from prospective follow-up of patients who receive intravenous BP and undergo tooth extraction. In fact, data from retrospective studies are clearly affected by bias. Those presented by Kyrgidis et al, for example, although among the best available, are based on patient interviews and thus lack important details, such as the number of multiple extractions and surgical procedures and whether there was antibacterial treatment. In addition, the low number of extractions in the group without ONJ (68 in 1,541 patients, with a mean age >60, who were likely to receive immunosuppressant therapy) seems to indicate some detection bias. A much sounder estimate, reported by the Greek colleagues, is the proportion of cases of ONJ preceeded by dental extraction (57%), a figure gathered by interviewing subjects with the condition and thus less prone to missing particularly relevant details. 1 Kyrgidis A. Vahtsevanos K. Koloutsos G. et al. Bisphosphonate-related osteonecrosis of the jaws: A case-control study of risk factors in breast cancer patients. J Clin Oncol. 2008; 26: 4634 Crossref PubMed Scopus (158) Google Scholar Dental Extractions in Patients Receiving Bisphosphonate TherapyJournal of Oral and Maxillofacial SurgeryVol. 68Issue 7PreviewIn their recent article, Lodi et al1 proposed a protocol for the prevention of osteonecrosis of the jaws (ONJ) in patients receiving intravenous (IV) bisphosphonates (BP). The authors provided sufficient follow-up data to document null incidence of ONJ in 23 patients receiving IV BP following their extraction protocol. Importantly, the risk for ONJ in patients receiving IV BP following routinely performed dental extractions has been reported to range from 16-fold2 to 53-fold.3 The authors note that one cannot know the exact proportion of dental extractions performed on at-risk subjects that result in osteonecrotic lesions. Full-Text PDF