title: Risk factors for osteonecrosis of the jaws: a case-control study from the CONDOR dental PBRN.
abstract: Case reports and cohort studies have linked bisphosphonate therapy and osteonecrosis of the jaws (ONJ), but neither causality nor specific risks for lesion development have been clearly established. We conducted a 1:3 case-control study with three dental Practice-based Research Networks, using dentist questionnaires and patient interviews for collection of data on bisphosphonate therapy, demographics, co-morbidities, and dental and medical treatments. Multivariable logistic regression analyses tested associations between bisphosphonate use and other risk factors with ONJ. We enrolled 191 ONJ cases and 573 controls in 119 dental practices. Bisphosphonate use was strongly associated with ONJ (odds ratios [OR] 299.5 {95%CI 70.0-1282.7} for intravenous [IV] use and OR = 12.2 {4.3-35.0} for oral use). Risk markers included local suppuration (OR = 7.8 {1.8-34.1}), dental extraction (OR = 7.6 {2.4-24.7}), and radiation therapy (OR = 24.1 {4.9-118.4}). When cancer patients (n = 143) were excluded, bisphosphonate use (OR = 7.2 {2.1-24.7}), suppuration (OR = 11.9 {2.0-69.5}), and extractions (OR = 6.6 {1.6-26.6}) remained associated with ONJ. Higher risk of ONJ began within 2 years of bisphosphonate initiation and increased four-fold after 2 years. Both IV and oral bisphosphonate use were strongly associated with ONJ. Duration of treatment > 2 years; suppuration and dental extractions were independent risk factors for ONJ.
authors.affiliation: University of Alabama School of Dentistry, SDB 111, Birmingham, AL 35294-0007, USA. abarasch@uab.edu
authors.forename: A
authors.initials: A
authors.lastname: Barasch
authors.forename: J
authors.initials: J
authors.lastname: Cunha-Cruz
authors.forename: F A
authors.initials: FA
authors.lastname: Curro
authors.forename: P
authors.initials: P
authors.lastname: Hujoel
authors.forename: A H
authors.initials: AH
authors.lastname: Sung
authors.forename: D
authors.initials: D
authors.lastname: Vena
authors.forename: A E
authors.initials: AE
authors.lastname: Voinea-Griffin
authors.forename: Steven
authors.initials: S
authors.lastname: Beadnell
authors.forename: Ronald G
authors.initials: RG
authors.lastname: Craig
authors.forename: Timothy
authors.initials: T
authors.lastname: DeRouen
authors.forename: Ananda
authors.initials: A
authors.lastname: Desaranayake
authors.forename: Ann
authors.initials: A
authors.lastname: Gilbert
authors.forename: Gregg H
authors.initials: GH
authors.lastname: Gilbert
authors.forename: Ken
authors.initials: K
authors.lastname: Goldberg
authors.forename: Richard
authors.initials: R
authors.lastname: Hauley
authors.forename: Mariko
authors.initials: M
authors.lastname: Hashimoto
authors.forename: Jon
authors.initials: J
authors.lastname: Holmes
authors.forename: Brooke
authors.initials: B
authors.lastname: Latzke
authors.forename: Brian
authors.initials: B
authors.lastname: Leroux
authors.forename: Anne
authors.initials: A
authors.lastname: Lindblad
authors.forename: Joshua
authors.initials: J
authors.lastname: Richman
authors.forename: Monika
authors.initials: M
authors.lastname: Safford
authors.forename: Jonathan
authors.initials: J
authors.lastname: Ship
authors.forename: Van P
authors.initials: VP
authors.lastname: Thompson
authors.forename: O Dale
authors.initials: OD
authors.lastname: Williams
authors.forename: Wanrong
authors.initials: W
authors.lastname: Yin
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000367:Age Factors; D000740:Anemia / Q000150:complications; D050071:Bone Density Conservation Agents / Q000008:administration & dosage / Q000009:adverse effects; D016022:Case-Control Studies; D002908:Chronic Disease; D055812:Community-Based Participatory Research; D048909:Diabetes Complications; D004164:Diphosphonates / Q000008:administration & dosage / Q000009:adverse effects; D004522:Educational Status; D005260:Female; D005884:Gingival Hemorrhage / Q000150:complications; D006801:Humans; D007182:Income; D007275:Injections, Intravenous; D007571:Jaw Diseases / Q000139:chemically induced / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications; D010020:Osteonecrosis / Q000139:chemically induced / Q000209:etiology*; D010024:Osteoporosis / Q000150:complications; D011878:Radiotherapy / Q000009:adverse effects; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects; D013492:Suppuration; D013997:Time Factors; D014081:Tooth Extraction / Q000009:adverse effects
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates