title: Patients Receiving Parenteral Bisphosphonates for Malignant Disease and Having Developed an Atypical Femoral Fracture Are at Risk of Concomitant Osteonecrosis of the Jaw: An Evidence-Based Review.
abstract: OBJECTIVE
  The risk of developing concomitant medication-related osteonecrosis of the jaw (MRONJ) in patients who have sustained an atypical femoral fracture (AFF) in association with parental administration of a bisphosphonate osteoclastic inhibitor medication for malignant disease is unclear. Published data were searched to determine the prevalence of these concomitant adverse medication events, if any.
  
  
  METHODS
  A systematic review of published case series in the PubMed database was undertaken to ascertain the prevalence of patients having a concomitant history of AFF and MRONJ. The data were analyzed to provide prevalence rates of these events from the literature.
  
  
  RESULTS
  Two case series were identified that delineated the risk (25 and 33%, respectively) of concomitant development of MRONJ and AFF in recipients of parenteral bisphosphonate medication administered for malignant disease.
  
  
  CONCLUSIONS
  The published data suggest that approximately 30% of patients receiving parenteral bisphosphonates and having sustained an AFF could develop comorbid MRONJ.
authors.affiliation: Research Fellow, Oral and Maxillofacial Surgery/Dental Service, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA.
authors.forename: Lindsay L
authors.initials: LL
authors.lastname: Graves
authors.affiliation: Associate Clinical Professor, Department of Orthopaedic Surgery, UCLA Medical Center, Los Angeles, CA.
authors.forename: Susan V
authors.initials: SV
authors.lastname: Bukata
authors.affiliation: Research Fellow, Oral and Maxillofacial Surgery/Dental Service, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA.
authors.forename: Nona
authors.initials: N
authors.lastname: Aghazadehsanai
authors.affiliation: Director, Research Fellowship and Inpatient Oral and Maxillofacial Surgery, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles; Instructor, Department of Oral and Maxillofacial Surgery, UCLA School of Dentistry, Los Angeles, CA.
authors.forename: Tina I
authors.initials: TI
authors.lastname: Chang
authors.affiliation: Professor Emeritus, Division of Advanced Prosthodontics, UCLA School of Dentistry, Los Angeles, CA.
authors.forename: Neal R
authors.initials: NR
authors.lastname: Garrett
authors.affiliation: Director, Graduate Medical Education, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles; Professor in Residence, Department of Oral and Maxillofacial Surgery, UCLA School of Dentistry, Los Angeles; Director, Quality Assurance, Hospital Dental Service, Ronald Reagan UCLA Medical Center, Los Angeles, CA. Electronic address: Arthur.Friedlander@va.gov.
authors.forename: Arthur H
authors.initials: AH
authors.lastname: Friedlander
mesh_terms: D059266:Bisphosphonate-Associated Osteonecrosis of the Jaw / Q000453:epidemiology / Q000209:etiology*; D050071:Bone Density Conservation Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001859:Bone Neoplasms / Q000188:drug therapy*; D004164:Diphosphonates / Q000009:adverse effects* / Q000627:therapeutic use; D005264:Femoral Fractures / Q000139:chemically induced* / Q000150:complications; D005598:Fractures, Spontaneous / Q000139:chemically induced* / Q000150:complications; D006801:Humans; D007275:Injections, Intravenous; D015995:Prevalence; D012307:Risk Factors
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates