title: The increase in prescriptions of bisphosphonates and the incidence proportion of osteonecrosis of the jaw after risk communication activities in Japan: a hospital-based cohort study.
abstract: OBJECTIVE
  The purpose of this study was to investigate the impact of risk communication about bisphosphonate (BP)-related osteonecrosis of the jaw (ONJ) on the number of reported cases to the Drug Adverse Reactions Reporting System and on the incidence proportion of ONJ in a hospital-based cohort study in Japan.
  
  
  METHODS
  We conducted a survey of the safety information on BP-related ONJ available from regulatory authorities, pharmaceutical manufacturers and academic associations. We also performed a trend analysis of a dataset from the Drug Adverse Reactions Reporting System and a sub-analysis, using previously constructed data from a retrospective cohort study.
  
  
  RESULTS
  Risk communication from pharmaceutical manufacturers and academic associations began within 1 year after revisions were made to the package inserts, in October 2006. Twenty times more cases of ONJ have been reported to regulatory authority since 2007, compared with the period before 2007. In our cohort, the incidence proportion of ONJ during and after 2009 was four times greater than before 2009. During this period, BPs were frequently prescribed, whereas there was no increase in the use of alternative agents, such as selective estrogen receptor modulators.
  
  
  CONCLUSIONS
  ONJ was increasingly diagnosed after risk communication efforts, but the impact of the communications was not clear. Safety notifications were diligently disseminated after the package insert was revised. However, there was no surveillance for ONJ before the revision.
authors.affiliation: Department of Clinical Innovative Medicine, Institute for Advancement of Clinical and Translational Science, Kyoto University, Kyoto, Japan.
authors.forename: Eriko
authors.initials: E
authors.lastname: Sumi
authors.forename: Toru
authors.initials: T
authors.lastname: Yamazaki
authors.forename: Shiro
authors.initials: S
authors.lastname: Tanaka
authors.forename: Keiichi
authors.initials: K
authors.lastname: Yamamoto
authors.forename: Takeo
authors.initials: T
authors.lastname: Nakayama
authors.forename: Kazuhisa
authors.initials: K
authors.lastname: Bessho
authors.forename: Masayuki
authors.initials: M
authors.lastname: Yokode
mesh_terms: D016907:Adverse Drug Reaction Reporting Systems / Q000706:statistics & numerical data; D000368:Aged; D059266:Bisphosphonate-Associated Osteonecrosis of the Jaw / Q000453:epidemiology* / Q000517:prevention & control; D050071:Bone Density Conservation Agents / Q000008:administration & dosage / Q000009:adverse effects*; D015331:Cohort Studies; D003142:Communication; D004164:Diphosphonates / Q000008:administration & dosage / Q000009:adverse effects*; D004345:Drug Industry / Q000379:methods; D006801:Humans; D015994:Incidence; D007564:Japan; D012189:Retrospective Studies; D012306:Risk
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates
keywords: oral bisphosphonates; osteonecrosis of the jaw; pharmacoepidemiology; risk communication