title: Bisphosphonates are associated with increased risk for jaw surgery in medical claims data: is it osteonecrosis?
abstract: OBJECTIVE
  Bisphosphonates (BPs) have recently been associated with increased risk of osteonecrosis of the jaw. Using a large automated insurance database, we searched the medical claims for common procedure codes (CPT codes) denoting major surgery to the mandible or the maxilla. The primary aim of this pilot study was to alert readers to clinically relevant but preliminary information regarding the risk of jaw surgery among patients who received BPs, as compared with patients who did not.
  
  
  METHODS
  The study utilized 2001-2004 claims data from a large nationwide medical insurer. Medical claims from 255,757 cancer patients with breast, lung, or prostate malignancies, or multiple myeloma were analyzed for CPT codes 21015, 21025, 21026, 21034, 21040, 21045, 21046, and 21047.
  
  
  RESULTS
  We identified 224 cases of jaw surgery; of those, 39 cases were found among 26,288 BP users and 185 cases were found among 229,469 never-users. The odds ratio of jaw surgery for intravenous BP users was 4.24 (P<.05). Breast cancer patients experienced a 6-fold increase in risk as compared with nonusers. A trend of increased risk was noted for those on orally administered BPs, but the association was not significant.
  
  
  CONCLUSIONS
  A significant association was noted between the administration of IV BPs and oral surgery in cancer patients. More studies are needed to understand the role of BPs in bone biology and necrosis along with the associated biologic pathways.
authors.affiliation: Assistant Professor, Department of Oral Health Policy & Epidemiology, Harvard School of Dental Medicine, Boston, MA 02115, USA. zavras@hms.harvard.edu
authors.forename: Athanasios I
authors.initials: AI
authors.lastname: Zavras
authors.forename: Shao
authors.initials: S
authors.lastname: Zhu
mesh_terms: D000284:Administration, Oral; D050071:Bone Density Conservation Agents / Q000008:administration & dosage / Q000009:adverse effects*; D001943:Breast Neoplasms / Q000188:drug therapy; D004164:Diphosphonates / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007275:Injections, Intravenous; D007344:Insurance Claim Reporting; D007571:Jaw Diseases / Q000139:chemically induced*; D008175:Lung Neoplasms / Q000188:drug therapy; D008297:Male; D008334:Mandible / Q000601:surgery; D008437:Maxilla / Q000601:surgery; D008875:Middle Aged; D009101:Multiple Myeloma / Q000188:drug therapy; D019647:Oral Surgical Procedures / Q000009:adverse effects*; D010020:Osteonecrosis / Q000139:chemically induced*; D010024:Osteoporosis / Q000188:drug therapy; D010865:Pilot Projects; D011471:Prostatic Neoplasms / Q000188:drug therapy; D012306:Risk
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates