The Influence of Alendronate and Tooth Extraction on the Incidence of Osteonecrosis of the Jaw Among Osteoporotic Subjects

Overview

Journal PLoS One

Specialties General Medicine
Science

Date 2018 Apr 26

PMID 29694412

Citations 12

Authors

Wei-Yih Chiu

Wei-Shiung Yang

Jung-Yien Chien

Jang-Jaer Lee

Keh-Sung Tsai

Affiliations

Soon will be listed here.

Abstract

Background: Although bisphosphonate-related osteonecrosis of the jaw (ONJ) develops mainly after tooth extractions (TEs), the strength of the association between them and how the existence of the disease among bisphosphonate (BP)-treated osteoporotic patients exposed to TE remain uncertain.

Methods: A nationwide retrospective cohort study investigated the influence of alendronate and TE on the development of ONJ.

Results: Incidence of ONJ following long-term alendronate therapy was 262/100,000 person-years, while no event developed in the control group on raloxifene. Overall prevalence of ONJ in osteoporotic subjects receiving alendronate was estimated at 0.34% which rose to 2.16% after TE. Multiple logistic regression analysis, adjusted for the potential confounders, showed TE (adjusted odds ratio, 9.60 [4.33-21.29]), drug duration exceeding 3 years (3.00 [1.33-6.76]), and concomitant rheumatoid arthritis (4.94 [1.64-14.90]) were independent predictors of ONJ.

Conclusions: This article strengthens the relationship between ONJ and BPs. Among osteoporotic patients exposed to alendronate, TE confers a 9.6-fold increased risk for ONJ and it should be performed with caution irrespective of drug duration.

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References

Palaska P, Cartsos V, Zavras A . Bisphosphonates and time to osteonecrosis development. Oncologist. 2009; 14(11):1154-66. DOI: 10.1634/theoncologist.2009-0115. View

Saad F, Brown J, Van Poznak C, Ibrahim T, Stemmer S, Stopeck A . Incidence, risk factors, and outcomes of osteonecrosis of the jaw: integrated analysis from three blinded active-controlled phase III trials in cancer patients with bone metastases. Ann Oncol. 2011; 23(5):1341-1347. DOI: 10.1093/annonc/mdr435. View

Yamazaki T, Yamori M, Tanaka S, Yamamoto K, Sumi E, Nishimoto-Sano M . Risk factors and indices of osteomyelitis of the jaw in osteoporosis patients: results from a hospital-based cohort study in Japan. PLoS One. 2013; 8(11):e79376. PMC: 3815193. DOI: 10.1371/journal.pone.0079376. View

Ruggiero S, Dodson T, Fantasia J, Goodday R, Aghaloo T, Mehrotra B . American Association of Oral and Maxillofacial Surgeons position paper on medication-related osteonecrosis of the jaw--2014 update. J Oral Maxillofac Surg. 2014; 72(10):1938-56. DOI: 10.1016/j.joms.2014.04.031. View

Yamazaki T, Yamori M, Yamamoto K, Saito K, Asai K, Sumi E . Risk of osteomyelitis of the jaw induced by oral bisphosphonates in patients taking medications for osteoporosis: a hospital-based cohort study in Japan. Bone. 2012; 51(5):882-7. DOI: 10.1016/j.bone.2012.08.115. View

Khan A, Morrison A, Hanley D, Felsenberg D, McCauley L, ORyan F . Diagnosis and management of osteonecrosis of the jaw: a systematic review and international consensus. J Bone Miner Res. 2014; 30(1):3-23. DOI: 10.1002/jbmr.2405. View

Hong J, Nam W, Cha I, Chung S, Choi H, Kim K . Oral bisphosphonate-related osteonecrosis of the jaw: the first report in Asia. Osteoporos Int. 2009; 21(5):847-53. DOI: 10.1007/s00198-009-1024-9. View

Vestergaard P, Schwartz K, Rejnmark L, Mosekilde L, Pinholt E . Oral bisphosphonate use increases the risk for inflammatory jaw disease: a cohort study. J Oral Maxillofac Surg. 2011; 70(4):821-9. DOI: 10.1016/j.joms.2011.02.093. View

Kwok T, Choy T, Kwok W . Prevalence of bisphosphonate-related osteonecrosis of the jaw in Hong Kong. Hong Kong Med J. 2016; 22 Suppl 2:S46-7. View

10.

Hasegawa T, Ri S, Umeda M, Komatsubara H, Kobayashi M, Shigeta T . The observational study of delayed wound healing after tooth extraction in patients receiving oral bisphosphonate therapy. J Craniomaxillofac Surg. 2013; 41(7):558-63. DOI: 10.1016/j.jcms.2012.11.023. View

11.

. Adjuvant bisphosphonate treatment in early breast cancer: meta-analyses of individual patient data from randomised trials. Lancet. 2015; 386(10001):1353-1361. DOI: 10.1016/S0140-6736(15)60908-4. View

12.

Lo J, ORyan F, Yang J, Hararah M, Gonzalez J, Gordon N . Oral health considerations in older women receiving oral bisphosphonate therapy. J Am Geriatr Soc. 2011; 59(5):916-22. DOI: 10.1111/j.1532-5415.2011.03371.x. View

13.

Barasch A, Cunha-Cruz J, Curro F, Hujoel P, Sung A, Vena D . Risk factors for osteonecrosis of the jaws: a case-control study from the CONDOR dental PBRN. J Dent Res. 2011; 90(4):439-44. PMC: 3144129. DOI: 10.1177/0022034510397196. View

14.

Chiu W, Chien J, Yang W, Juang J, Lee J, Tsai K . The risk of osteonecrosis of the jaws in Taiwanese osteoporotic patients treated with oral alendronate or raloxifene. J Clin Endocrinol Metab. 2014; 99(8):2729-35. DOI: 10.1210/jc.2013-4119. View

15.

Bamias A, Kastritis E, Bamia C, Moulopoulos L, Melakopoulos I, Bozas G . Osteonecrosis of the jaw in cancer after treatment with bisphosphonates: incidence and risk factors. J Clin Oncol. 2005; 23(34):8580-7. DOI: 10.1200/JCO.2005.02.8670. View

16.

Fehm T, Beck V, Banys M, Lipp H, Hairass M, Reinert S . Bisphosphonate-induced osteonecrosis of the jaw (ONJ): Incidence and risk factors in patients with breast cancer and gynecological malignancies. Gynecol Oncol. 2009; 112(3):605-9. DOI: 10.1016/j.ygyno.2008.11.029. View

17.

Lo J, ORyan F, Gordon N, Yang J, Hui R, Martin D . Prevalence of osteonecrosis of the jaw in patients with oral bisphosphonate exposure. J Oral Maxillofac Surg. 2009; 68(2):243-53. PMC: 10159647. DOI: 10.1016/j.joms.2009.03.050. View

18.

Yoneda T, Hagino H, Sugimoto T, Ohta H, Takahashi S, Soen S . Antiresorptive agent-related osteonecrosis of the jaw: Position Paper 2017 of the Japanese Allied Committee on Osteonecrosis of the Jaw. J Bone Miner Metab. 2016; 35(1):6-19. DOI: 10.1007/s00774-016-0810-7. View

19.

Thumbigere-Math V, Tu L, Huckabay S, Dudek A, Lunos S, Basi D . A retrospective study evaluating frequency and risk factors of osteonecrosis of the jaw in 576 cancer patients receiving intravenous bisphosphonates. Am J Clin Oncol. 2012; 35(4):386-92. DOI: 10.1097/COC.0b013e3182155fcb. View

20.

Lo J, Hui R, Grimsrud C, Chandra M, Neugebauer R, Gonzalez J . The association of race/ethnicity and risk of atypical femur fracture among older women receiving oral bisphosphonate therapy. Bone. 2016; 85:142-7. PMC: 5108728. DOI: 10.1016/j.bone.2016.01.002. View