title: Osteonecrosis of the jaw and nonmalignant disease: is there an association with rheumatoid arthritis?
abstract: OBJECTIVE
  To review cases of bisphosphonate-related osteonecrosis of the jaw (BRONJ) occurring in association with benign disease and to describe and compare the clinical course and outcome for patients with BRONJ and rheumatoid arthritis (RA) or osteoporosis.
  
  
  METHODS
  We retrospectively reviewed observations of all patients referred for treatment and followup for BRONJ from January 2007 to December 2011. Only patients with malignant disease were excluded. Demographic data, medical history, maxillofacial findings, BRONJ treatment, and followup were reviewed for each case.
  
  
  RESULTS
  Over a 5-year period, we diagnosed 112 patients with BRONJ. Among these patients, 15 received bisphosphonate (BP) treatment for nonmalignant disease (mean age 65.7 ± 19.8 yrs, 80% women). Patients received BP for a variety of reasons: 8 (53%) to prevent osteoporosis in association with underlying RA; 6 (40%) to prevent idiopathic osteoporosis; and 1 (7%) to treat ankle algodystrophy. The mean oral BP exposure period was 48.4 months (median 36 mo). In 13 cases (86.6%), BRONJ was diagnosed following dental extraction. Of the 8 patients with RA, 5 (62.5%) were taking prednisone at the time of the discovery of BRONJ. Major surgery, sequestrectomy, or alveolectomy was performed in 9 patients (60%), all of whom healed within 3 to 36 months (mean 11.5 mo). Comparative analysis of all the variables showed no statistically significant differences between patients with RA and others.
  
  
  CONCLUSIONS
  ONJ is a rare adverse effect of BP therapy, especially when administered orally. Within the limits of our study, we were unable to demonstrate a difference in BRONJ disease spectrum, clinical course, or outcome between patients with and those without RA.
authors.affiliation: Oral Surgery Department and the Stomatology and Maxillofacial Surgery Department, and INSERM, UMR-S 606, Hôpital Lariboisière, Pitié-Salpêtrière University Hospital, Paris Diderot University, Paris, France.
authors.forename: Géraldine
authors.initials: G
authors.lastname: Lescaille
authors.forename: Amélie E
authors.initials: AE
authors.lastname: Coudert
authors.forename: Vanessa
authors.initials: V
authors.lastname: Baaroun
authors.forename: Marie-José
authors.initials: MJ
authors.lastname: Javelot
authors.forename: Martine
authors.initials: M
authors.lastname: Cohen-Solal
authors.forename: Ariane
authors.initials: A
authors.lastname: Berdal
authors.forename: Patrick
authors.initials: P
authors.lastname: Goudot
authors.forename: Jean
authors.initials: J
authors.lastname: Azérad
authors.forename: Blandine
authors.initials: B
authors.lastname: Ruhin
authors.forename: Vianney
authors.initials: V
authors.lastname: Descroix
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001172:Arthritis, Rheumatoid / Q000150:complications* / Q000473:pathology; D059266:Bisphosphonate-Associated Osteonecrosis of the Jaw / Q000150:complications* / Q000473:pathology; D050071:Bone Density Conservation Agents / Q000009:adverse effects / Q000627:therapeutic use; D004164:Diphosphonates / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007568:Jaw / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000188:drug therapy / Q000473:pathology; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates
keywords: BISPHOSPHONATE; JAW; OSTEONECROSIS; OSTEOPOROSIS; RHEUMATOID ARTHRITIS