title: Nationwide survey for bisphosphonate-related osteonecrosis of the jaws in Japan.
abstract: OBJECTIVE
  A nationwide retrospective cohort study was conducted by the Japanese Society of Oral and Maxillofacial Surgeons to assess the occurrence of bisphosphonate (BP)-related osteonecrosis of the jaws (BRONJ) during 2006 to 2008 and to elucidate the outcome and factors associated with remission of BRONJ.
  
  
  METHODS
  A written questionnaire, including the clinical characteristics, management, and outcome of patients with BRONJ, was sent to 248 institutions certified as training facilities by the Japanese Society of Oral and Maxillofacial Surgeons in 2008.
  
  
  RESULTS
  A total of 568 patients with BRONJ, including suspicious cases, were registered. Of these 568 patients, 263, including the maxilla in 81, the mandible in 160, and both in 22, met the working definition of BRONJ proposed by the American Association of Oral and Maxillofacial Surgeons. The patients included 219 women (83.3%) and 44 men (16.7%). Of these patients, 152 (57.8%) had received intravenous BPs, 104 (39.5%) had received oral BPs, and 7 (2.7%) had received both. The mean duration of administration until onset of BRONJ was 23.6 months for intravenous BPs and 33.2 months for oral BPs. BRONJ was stage 1 in 42 patients (16.0%), stage 2 in 187 (71.1%), stage 3 in 32 (12.2%), and unknown in 2. Of these patients, 34.2% had remission of BRONJ, 46.0% had persistent or progressive disease, and 19.7% died of malignancy or were lost to follow-up. Statistical analysis revealed that surgical treatment, including tooth extraction, sequestrectomy, and segmental mandibulectomy, contributed to the remission of BRONJ. In contrast, conservative treatment, concurrent anticancer drugs, poor oral hygiene, and the use of intravenous BPs did not.
  
  
  CONCLUSIONS
  The relative ratio of BRONJ related to the use of oral BPs was greater in Japan than in the United States and European Union. Surgical treatment contributed to remission of BRONJ, and conservative treatment, concurrent anticancer drugs, poor oral hygiene, and intravenous BPs did not.
authors.affiliation: Department of Oral and Maxillofacial Surgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan. uradem@hyo-med.ac.jp
authors.forename: Masahiro
authors.initials: M
authors.lastname: Urade
authors.forename: Noriaki
authors.initials: N
authors.lastname: Tanaka
authors.forename: Kiyofumi
authors.initials: K
authors.lastname: Furusawa
authors.forename: Jun
authors.initials: J
authors.lastname: Shimada
authors.forename: Takanori
authors.initials: T
authors.lastname: Shibata
authors.forename: Tadaaki
authors.initials: T
authors.lastname: Kirita
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Yamamoto
authors.forename: Tetsuro
authors.initials: T
authors.lastname: Ikebe
authors.forename: Yoshimasa
authors.initials: Y
authors.lastname: Kitagawa
authors.forename: Jinichi
authors.initials: J
authors.lastname: Fukuta
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use; D050071:Bone Density Conservation Agents / Q000008:administration & dosage / Q000009:adverse effects*; D015331:Cohort Studies; D004164:Diphosphonates / Q000008:administration & dosage / Q000009:adverse effects*; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007275:Injections, Intravenous; D007564:Japan / Q000453:epidemiology; D007571:Jaw Diseases / Q000139:chemically induced / Q000453:epidemiology* / Q000628:therapy; D008297:Male; D008336:Mandibular Diseases / Q000139:chemically induced / Q000453:epidemiology / Q000628:therapy; D008439:Maxillary Diseases / Q000139:chemically induced / Q000453:epidemiology / Q000628:therapy; D008875:Middle Aged; D009369:Neoplasms / Q000401:mortality; D009910:Oral Hygiene; D010020:Osteonecrosis / Q000139:chemically induced / Q000453:epidemiology* / Q000628:therapy; D010027:Osteotomy / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014081:Tooth Extraction / Q000706:statistics & numerical data; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D050071:Bone Density Conservation Agents; D004164:Diphosphonates