title: Oral bisphosphonate use increases the risk for inflammatory jaw disease: a cohort study.
abstract: OBJECTIVE
  The objective of this study was to address whether among people living in Denmark, those treated with medications to prevent osteoporosis have an increased risk for inflammatory jaw disease compared with those not treated.
  
  
  METHODS
  A historical cohort study was designed to compare the rate of inflammatory jaw-related events, ie, osteomyelitis, osteitis, periostitis, or sequestrum, between Danish patients who had been prescribed oral bisphosphonates (BP) and other drugs for the treatment of osteoporosis between 1996 and 2006 (the exposed group), and a random sample of the Danish population drawn from a nationwide registry who had not been prescribed oral BPs or other medications to treat osteoporosis (the nonexposed group). The nonexposed subjects were age- and gender-matched to the exposed subjects and randomly drawn from the general population at a ratio of 3 non-BP subjects to 1 BP subject. The primary explanatory variable was oral BP exposure status. Associations between BP treatment and inflammatory jaw events were ascertained using hazard ratios (HR) Cox proportional hazards models.
  
  
  RESULTS
  The study sample was composed of 103,562 index subjects and 310,683 control subjects. After adjusting for other factors, including diabetes and chemotherapy, alendronate (HR = 3.15, 95% confidence interval 1.44-6.87) and etidronate (HR = 2.23, 95% confidence interval 1.15-4.31) were associated with an increased risk for inflammatory jaw events. There was no association between oral BP dose and risk for inflammatory jaw events.
  
  
  CONCLUSIONS
  The oral BPs alendronate and etidronate were associated with an increased risk for inflammatory jaw events.
authors.affiliation: Department of Oral and Maxillofacial Surgery, Institute of Odontology, Faculty of Health Sciences, University of Copenhagen, Denmark.
authors.forename: Peter
authors.initials: P
authors.lastname: Vestergaard
authors.forename: Kristoffer
authors.initials: K
authors.lastname: Schwartz
authors.forename: Lars
authors.initials: L
authors.lastname: Rejnmark
authors.forename: Leif
authors.initials: L
authors.lastname: Mosekilde
authors.forename: Else Marie
authors.initials: EM
authors.lastname: Pinholt
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000437:Alcoholism / Q000453:epidemiology; D019386:Alendronate / Q000008:administration & dosage; D059266:Bisphosphonate-Associated Osteonecrosis of the Jaw / Q000453:epidemiology*; D050071:Bone Density Conservation Agents / Q000008:administration & dosage*; D016022:Case-Control Studies; D015331:Cohort Studies; D003718:Denmark / Q000453:epidemiology; D048909:Diabetes Complications / Q000453:epidemiology; D004164:Diphosphonates / Q000008:administration & dosage*; D004358:Drug Therapy / Q000706:statistics & numerical data; D012968:Etidronic Acid / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007571:Jaw Diseases / Q000453:epidemiology; D008297:Male; D009369:Neoplasms / Q000453:epidemiology; D009942:Organometallic Compounds / Q000008:administration & dosage; D010000:Osteitis / Q000453:epidemiology; D010019:Osteomyelitis / Q000453:epidemiology; D010024:Osteoporosis / Q000188:drug therapy; D010281:Parathyroid Hormone / Q000008:administration & dosage / Q000031:analogs & derivatives; D010522:Periostitis / Q000453:epidemiology; D011878:Radiotherapy / Q000706:statistics & numerical data; D020849:Raloxifene Hydrochloride / Q000008:administration & dosage; D012307:Risk Factors; D012859:Sjogren's Syndrome / Q000453:epidemiology; D013324:Strontium / Q000008:administration & dosage; D013876:Thiophenes / Q000008:administration & dosage
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D009942:Organometallic Compounds; D010281:Parathyroid Hormone; D013876:Thiophenes; C081587:strontium ranelate; D020849:Raloxifene Hydrochloride; D012968:Etidronic Acid; D019386:Alendronate; D013324:Strontium