title: Quality of life implications of bisphosphonate-associated osteonecrosis of the jaw.
abstract: OBJECTIVE
  Potentially debilitating, osteonecrosis of the jaw (ONJ) is an emerging complication of bisphosphonates. However, its effect on quality of life (QoL) is unknown. We determined the ONJ-related QoL decline in a cancer patient cohort.
  
  
  METHODS
  Thirty-four cancer patients with bisphosphonate-associated ONJ completed a telephone survey (October 2007 through May 2008). The Oral Health Impact Profile 14 (OHIP) retrospectively assessed participant oral health-related QoL before and after ONJ. Standardized ONJ descriptions were developed in a multidisciplinary, iterative process and were evaluated with three frequently used preference-based QoL measurement methods on a 0 (death) to 1 (perfect health) scale: Visual Analogue Scale (VAS), Time Trade-Off (TTO), and EQ-5D.
  
  
  RESULTS
  ONJ significantly (p < .001) increased OHIP scores (worse QoL) for additive (3.56-16.53) and weighted (7.0-17.5) methods. Seven individual OHIP items significantly increased (Bonferroni correction p < .0035): pain, eating discomfort, self-consciousness, unsatisfactory diet, interrupted meals, irritability, and decreased life satisfaction. Mean preference-based QoL values significantly decreased (p < .001) with worsening ONJ stage (VAS, TTO, and EQ-5D): no ONJ (0.76, 0.86, 0.82), ONJ stage 1 (0.69, 0.82, 0.78), ONJ stage 2 (0.51, 0.67, 0.55), and ONJ stage 3 (0.37, 0.61, 0.32). As ONJ worsened, EQ-5D domain scores significantly increased (p < .001). Pain/discomfort and anxiety/depression contributed most to declining QoL.
  
  
  CONCLUSIONS
  ONJ significantly affects QoL, a detriment that increases with worsening ONJ. QoL impairments for ONJ stages 2 and 3 are similar to other treatment side effects that influence decision-making. Bisphosphonate-associated ONJ QoL is an important consideration for patients, clinicians, and policy makers.
authors.affiliation: Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Shapiro 9, Boston, Massachusetts 02215, USA. rmiksad@bidmc.harvard.edu
authors.forename: Rebecca Anne
authors.initials: RA
authors.lastname: Miksad
authors.forename: Kuan-Chi
authors.initials: KC
authors.lastname: Lai
authors.forename: Thomas Benton
authors.initials: TB
authors.lastname: Dodson
authors.forename: Sook-Bin
authors.initials: SB
authors.lastname: Woo
authors.forename: Nathaniel Simon
authors.initials: NS
authors.lastname: Treister
authors.forename: Omosalewa
authors.initials: O
authors.lastname: Akinyemi
authors.forename: Marian
authors.initials: M
authors.lastname: Bihrle
authors.forename: Guy
authors.initials: G
authors.lastname: Maytal
authors.forename: Meredith
authors.initials: M
authors.lastname: August
authors.forename: G Scott
authors.initials: GS
authors.lastname: Gazelle
authors.forename: J Shannon
authors.initials: JS
authors.lastname: Swan
mesh_terms: D050071:Bone Density Conservation Agents / Q000009:adverse effects*; D015331:Cohort Studies; D004164:Diphosphonates / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007568:Jaw / Q000187:drug effects* / Q000473:pathology; D007571:Jaw Diseases / Q000139:chemically induced* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D010020:Osteonecrosis / Q000139:chemically induced* / Q000473:pathology; D011788:Quality of Life
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates