Osteoporosis and bisphosphonates-related osteonecrosis of the jaw: not just a sporadic coincidence--a multi-centre study.
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.
Otto
Sven
S
Department of Oral and Maxillofacial Surgery, University of Munich, Lindwurmstr. 2a, D-80336 Munich, Germany.
Abu-Id
Mario Hakim
MH
Fedele
Stefano
S
Warnke
Patrick H
PH
Becker
Stephan T
ST
Kolk
Andreas
A
Mücke
Thomas
T
Mast
Gerson
G
Köhnke
Robert
R
Volkmer
Elias
E
Haasters
Florian
F
Lieger
Olivier
O
Iizuka
Tateyuki
T
Porter
Stephen
S
Campisi
Giuseppina
G
Colella
Giuseppe
G
Ploder
Oliver
O
Neff
Andreas
A
Wiltfang
Jörg
J
Ehrenfeld
Michael
M
Kreusch
Thomas
T
Wolff
Klaus-Dietrich
KD
Stürzenbaum
Stephen R
SR
Schieker
Matthias
M
Pautke
Christoph
C
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
D050071:Bone Density Conservation Agents; D004164:Diphosphonates