title: Epidemiological study of alendronate-related osteonecrosis of the jaw in the southeast of Scotland.
abstract: We aimed to establish the incidence of alendronate-related osteonecrosis of the jaw (ONJ) in the southeast of Scotland, and to assess the effect of corticosteroids on it. We studied a prospective case series of patients between June 2004 and March 2012 separated into steroid and non-steroid groups. There were 34 cases of alendronate-related ONJ and 78732 drug patient years (DPY) of alendronate, making the overall occurrence 43.1 cases/100000 DPY. There were 12 patients in the steroid group (mean (range) age 68.2 (48-87) years) making 42.5 cases/100000 DPY, and 22 in the non-steroid group (mean (range) age 76.2 (63-91) years) making 119.6 cases/100000 DPY. The mean (range) age at presentation of alendronate-related ONJ was significantly lower in the steroid group (68.2 (48-87) compared with 76.2 (63-91) years, p=0.019) as was the duration of exposure to alendronate before it developed (28.9 (6-120) compared with 61.3 (13-168) months, p=0.03). The overall incidence seems to be higher in the southeast of Scotland than elsewhere. Concurrent use of corticosteroids is not associated with an increased incidence of alendronate-related ONJ, but it seems to reduce the duration of exposure before it develops. Age is likely to be a confounding factor.
authors.affiliation: Combined Department of Oral and Maxillofacial Surgery and Oral Medicine, Edinburgh Dental Institute, Lauriston Building, Lauriston Place, Edinburgh, EH3 9HA, Scotland - United Kingdom. Electronic address: stefsammut@gmail.com.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Sammut
authors.affiliation: Combined Department of Oral and Maxillofacial Surgery and Oral Medicine, Edinburgh Dental Institute, Lauriston Building, Lauriston Place, Edinburgh, EH3 9HA, Scotland - United Kingdom. Electronic address: nick.malden@nhslothian.scot.nhs.uk.
authors.forename: Nick
authors.initials: N
authors.lastname: Malden
authors.affiliation: Combined Department of Oral and Maxillofacial Surgery and Oral Medicine, Edinburgh Dental Institute, Lauriston Building, Lauriston Place, Edinburgh, EH3 9HA, Scotland - United Kingdom. Electronic address: vlopes@staffmail.ed.ac.uk.
authors.forename: Victor
authors.initials: V
authors.lastname: Lopes
authors.affiliation: Rheumatic Diseases Unit, School of Molecular, Genetic and Population Health Sciences, University of Edinburgh, Scotland. Electronic address: stuart.ralston@ed.ac.uk.
authors.forename: Stuart
authors.initials: S
authors.lastname: Ralston
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019386:Alendronate / Q000009:adverse effects*; D059266:Bisphosphonate-Associated Osteonecrosis of the Jaw / Q000453:epidemiology*; D050071:Bone Density Conservation Agents / Q000009:adverse effects*; D004164:Diphosphonates; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010020:Osteonecrosis; D011446:Prospective Studies; D012606:Scotland / Q000453:epidemiology
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D019386:Alendronate
keywords: Bisphosphonate; Incidence; Jaw; Osteonecrosis