title: Risk of Jaw Osteonecrosis After Intravenous Bisphosphonates in Cancer Patients and Patients Without Cancer.
abstract: OBJECTIVE
  To compare the risk of jaw osteonecrosis after intravenous (IV) bisphosphonate administered to patients with cancer vs patients without cancer.
  
  
  METHODS
  We conducted a retrospective cohort study of a 5% national sample of Medicare patients administered IV bisphosphonate from January 1, 2008, through December 31, 2013, for cancer vs noncancer indications. Probable jaw osteonecrosis was estimated with an algorithm including diagnoses, surgical procedures, and imaging studies. A non-IV bisphosphonate comparison group included patients prescribed an oral bisphosphonate for 30 days or less.
  
  
  RESULTS
  During follow-up, 40 (0.42%) out of 9482 patients with cancer developed probable jaw osteonecrosis compared with 8 (0.05%) out of 16,046 patients without cancer. In a Cox multivariable survival analysis controlling for patient characteristics and number of IV zoledronic infusions, patients without cancer had a hazard ratio of 0.17 (95% CI, 0.06-0.46) for developing jaw osteonecrosis compared with those with cancer. The lower rate of jaw osteonecrosis in patients without cancer was also confirmed in a number of sensitivity analyses.
  
  
  CONCLUSIONS
  The low rate of jaw osteonecrosis in patients with osteoporosis who receive IV bisphosphonate should be weighed against the benefit of those agents in preventing hip and other fractures.
authors.affiliation: Department of Medicine, University of Texas Medical Branch, Galveston, Texas. Electronic address: jsgoodwi@utmb.edu.
authors.forename: James S
authors.initials: JS
authors.lastname: Goodwin
authors.affiliation: Sealy Center on Aging, University of Texas Medical Branch, Galveston, Texas.
authors.forename: Jie
authors.initials: J
authors.lastname: Zhou
authors.affiliation: Department of Medicine, University of Texas Medical Branch, Galveston, Texas; Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, Texas; Sealy Center on Aging, University of Texas Medical Branch, Galveston, Texas.
authors.forename: Yong-Fang
authors.initials: YF
authors.lastname: Kuo
authors.affiliation: Sealy Center on Aging, University of Texas Medical Branch, Galveston, Texas; Institute for Translational Sciences, University of Texas Medical Branch, Galveston, Texas.
authors.forename: Jacques
authors.initials: J
authors.lastname: Baillargeon
mesh_terms: D061605:Administration, Intravenous; D000284:Administration, Oral; D000368:Aged; D000369:Aged, 80 and over; D059266:Bisphosphonate-Associated Osteonecrosis of the Jaw / Q000453:epidemiology / Q000209:etiology*; D050071:Bone Density Conservation Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D004164:Diphosphonates / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data; D009369:Neoplasms / Q000150:complications / Q000188:drug therapy*; D010024:Osteoporosis / Q000150:complications / Q000188:drug therapy*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D014481:United States
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates