title: Osteonecrosis of the jaw in older osteoporosis patients treated with intravenous bisphosphonates.
abstract: BACKGROUND
  Intravenous bisphosphonate therapy has been linked to osteo-necrosis of the jaw among patients with cancer. Some patients with osteoporosis also receive intravenous bisphosphonates, although at lower total doses than those with cancer.
  
  
  OBJECTIVE
  To examine the risk for jaw osteonecrosis among a population-based cohort of older adults receiving intravenous bisphosphonates for the treatment of osteoporosis.
  
  
  METHODS
  Using a 5% national sample of Medicare beneficiaries, we identified 2296 patients treated with intravenous infusions of bisphosphonates for osteoporosis and other metabolic bone diseases between January 1, 2000, and December 31, 2007. We matched this cohort to 6865 bisphosphonate nonusers, at a 1:3 ratio, on age, race, sex, type of bone disease, and risk factors for osteonecrosis of the jaw. Patients were followed until December 31, 2007. The jaw toxicity outcomes included operations on the facial bones or jaw and diagnosis of inflammatory conditions of the jaw.
  
  
  RESULTS
  The absolute risk at 3 years for any jaw toxicity was 0.70 events per 100 patients using bisphosphonates and 0.30 events per 100 patients not using such drugs (2-sided log rank test, p = 0.08). In multivariable survival analyses (Cox proportional hazards regression) adjusting for potential confounders, intravenous bisphosphonate use was not significantly associated with diagnoses or procedures suggestive of osteonecrosis of the jaw (p = 0.24).
  
  
  CONCLUSIONS
  Patients with osteoporosis who are treated with intravenous bisphosphonates do not appear to have a statistically significant increase in the incidence of osteonecrosis of the jaw over 3 years compared with those who do not receive such treatment. Future studies will further contribute to our understanding of the bisphosphonate risk profile, thereby allowing patients and physicians to more rigorously assess the risk-benefit ratio of this treatment across different clinical scenarios.
authors.affiliation: Sealy Center on Aging, Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, TX, USA. jbaillar@utmb.edu
authors.forename: Jacques
authors.initials: J
authors.lastname: Baillargeon
authors.forename: Yong Fang
authors.initials: YF
authors.lastname: Kuo
authors.forename: Yu-Li
authors.initials: YL
authors.lastname: Lin
authors.forename: Gregg S
authors.initials: GS
authors.lastname: Wilkinson
authors.forename: James S
authors.initials: JS
authors.lastname: Goodwin
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D050071:Bone Density Conservation Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D001851:Bone Diseases, Metabolic / Q000188:drug therapy; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D004164:Diphosphonates / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D015994:Incidence; D007262:Infusions, Intravenous; D007571:Jaw Diseases / Q000139:chemically induced* / Q000453:epidemiology; D008297:Male; D006278:Medicare; D008875:Middle Aged; D010020:Osteonecrosis / Q000139:chemically induced* / Q000453:epidemiology; D010024:Osteoporosis / Q000188:drug therapy*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D014481:United States / Q000453:epidemiology
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates