title: Possible association between diabetes and bisphosphonate-related jaw osteonecrosis.
abstract: BACKGROUND
  Bisphosphonate-related osteonecrosis (BON) of the jaws is a newly identified condition for which the exact mechanism involved in its pathogenesis remains obscure.
  
  
  OBJECTIVE
  The objective of the study was to evaluate whether diabetes mellitus (DM) may be a contributing factor in the development of BON.
  
  
  METHODS
  From 2004 to 2006, 31 patients were diagnosed with BON. The diagnosis of BON was based on the medical and dental history of each patient as well as the observation of clinical signs and symptoms of this pathological process. DM was based on two consecutive fasting blood glucose levels above 7 mmol/liter.
  
  
  METHODS
  The study was completed in the Hebrew University-Hadassah Hospital referral center.
  
  
  RESULTS
  Of the 31 patients with BON, 18 (58%) were found to have DM or impaired fasting glucose. The proportion of diabetic patients was much higher than expected relative to the incidence of DM in the general population (14%) and compared with the proportion of diabetic patients in a control group of oncological patients treated with bisphosphonates and without BON (12%) (P = 0.00003).
  
  
  CONCLUSIONS
  This finding indicates that DM may be a risk factor for BON and that DM patients treated with bisphosphonates should be carefully monitored. We discuss here the bone metabolic pathways characteristic of DM patients and the way in which these pathways can augment the effects of bisphosphonates.
authors.affiliation: Department of Internal Medicine B and the Diabetes Center, Hebrew University-Hadassah Medical Center, Kiryat Hadassah, P.O. Box 12000, Jerusalem 91120, Israel. murir@hadassah.org.il
authors.forename: Mogher
authors.initials: M
authors.lastname: Khamaisi
authors.forename: Eran
authors.initials: E
authors.lastname: Regev
authors.forename: Noam
authors.initials: N
authors.lastname: Yarom
authors.forename: Batia
authors.initials: B
authors.lastname: Avni
authors.forename: Eran
authors.initials: E
authors.lastname: Leitersdorf
authors.forename: Itamar
authors.initials: I
authors.lastname: Raz
authors.forename: Sharon
authors.initials: S
authors.lastname: Elad
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000453:epidemiology; D004164:Diphosphonates / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007571:Jaw Diseases / Q000139:chemically induced* / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications / Q000188:drug therapy; D010020:Osteonecrosis / Q000139:chemically induced* / Q000453:epidemiology
chemical_list: D004164:Diphosphonates