title: Osteoporosis and bisphosphonates-related osteonecrosis of the jaw: not just a sporadic coincidence--a multi-centre study.
abstract: BACKGROUND
  Bisphosphonates (BPs) are powerful drugs that inhibit bone metabolism. Adverse side effects are rare but potentially severe such as bisphosphonate-related osteonecrosis of the jaw (BRONJ). To date, research has primarily focused on the development and progression of BRONJ in cancer patients with bone metastasis, who have received high dosages of BPs intravenously. However, a potential dilemma may arise from a far larger cohort, namely the millions of osteoporosis patients on long-term oral BP therapy.
  
  
  METHODS
  This current study assessed 470 cases of BRONJ diagnosed between 2004 and 2008 at eleven different European clinical centres and has resulted in the identification of a considerable cohort of osteoporosis patients suffering from BRONJ. Each patient was clinically examined and a detailed medical history was raised.
  
  
  RESULTS
  In total, 37/470 cases (7.8%) were associated with oral BP therapy due to osteoporosis. The majority (57%) of affected individuals did not have any risk factors for BRONJ as defined by the American Association of Oral and Maxillofacial Surgery. The average duration of BP intake of patients without risk factors was longer and the respective patients were older compared to patients with risk factors, but no statistical significant difference was found. In 78% of patients the duration of oral BP therapy exceeded 3 years prior to BRONJ diagnosis.
  
  
  CONCLUSIONS
  The results from this study suggest that the relative frequency of osteoporosis patients on oral BPs suffering from BRONJ is higher than previously reported. There is an urgent need to substantiate epidemiological characteristics of BRONJ in large cohorts of individuals.
authors.affiliation: Department of Oral and Maxillofacial Surgery, University of Munich, Lindwurmstr. 2a, D-80336 Munich, Germany.
authors.forename: Sven
authors.initials: S
authors.lastname: Otto
authors.forename: Mario Hakim
authors.initials: MH
authors.lastname: Abu-Id
authors.forename: Stefano
authors.initials: S
authors.lastname: Fedele
authors.forename: Patrick H
authors.initials: PH
authors.lastname: Warnke
authors.forename: Stephan T
authors.initials: ST
authors.lastname: Becker
authors.forename: Andreas
authors.initials: A
authors.lastname: Kolk
authors.forename: Thomas
authors.initials: T
authors.lastname: Mücke
authors.forename: Gerson
authors.initials: G
authors.lastname: Mast
authors.forename: Robert
authors.initials: R
authors.lastname: Köhnke
authors.forename: Elias
authors.initials: E
authors.lastname: Volkmer
authors.forename: Florian
authors.initials: F
authors.lastname: Haasters
authors.forename: Olivier
authors.initials: O
authors.lastname: Lieger
authors.forename: Tateyuki
authors.initials: T
authors.lastname: Iizuka
authors.forename: Stephen
authors.initials: S
authors.lastname: Porter
authors.forename: Giuseppina
authors.initials: G
authors.lastname: Campisi
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Colella
authors.forename: Oliver
authors.initials: O
authors.lastname: Ploder
authors.forename: Andreas
authors.initials: A
authors.lastname: Neff
authors.forename: Jörg
authors.initials: J
authors.lastname: Wiltfang
authors.forename: Michael
authors.initials: M
authors.lastname: Ehrenfeld
authors.forename: Thomas
authors.initials: T
authors.lastname: Kreusch
authors.forename: Klaus-Dietrich
authors.initials: KD
authors.lastname: Wolff
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Stürzenbaum
authors.forename: Matthias
authors.initials: M
authors.lastname: Schieker
authors.forename: Christoph
authors.initials: C
authors.lastname: Pautke
mesh_terms: D000284:Administration, Oral; D050071:Bone Density Conservation Agents / Q000008:administration & dosage / Q000009:adverse effects*; D000075202:Contraindications; D004164:Diphosphonates / Q000008:administration & dosage / Q000009:adverse effects*; D004305:Dose-Response Relationship, Drug; D006801:Humans; D007571:Jaw Diseases / Q000139:chemically induced*; D019647:Oral Surgical Procedures; D010020:Osteonecrosis / Q000139:chemically induced*; D010024:Osteoporosis / Q000188:drug therapy; D013997:Time Factors
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates