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Osteoporosis International

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01-01-2013 | Original Article

Defining the epidemiology of bisphosphonate-associated osteonecrosis of the jaw: prior work and current challenges

Authors: D. H. Solomon, E. Mercer, S. B. Woo, J. Avorn, S. Schneeweiss, N. Treister

Published in: Osteoporosis International | Issue 1/2013

Abstract

Summary

Bisphosphonate-related osteonecrosis of the jaw (BONJ) is an adverse effect of bisphosphonate use with a poorly described epidemiology in osteoporosis patients. We examined the literature and two new cohorts for BONJ. The literature suggests an incidence rate of 0.028 % to 4.3 %. Our cohort studies found an incidence of 0.02 % (95 % CI 0.004 %–0.11 %).

Introduction

We examined the epidemiology of BONJ associated with osteoporosis dosing of bisphosphonates.

Methods

First, we systematically searched the literature about osteoporosis BONJ. Identified studies were abstracted by two authors. Second, we attempted to estimate the relative risk of BONJ among bisphosphonate users with osteoporosis. Two different large insurance databases, one from 2005–2007 and another from 2007–2010, combined with medical record review, were searched. The older dataset did not include the International Classification of Diagnoses (ICD) diagnosis code for osteonecrosis of the jaw (ONJ; ICD 733.45). Incidence rates and relative risks were estimated using Cox regression.

Results

The literature review produced nine studies of varying quality. The incidence rates for BONJ among osteoporosis patients varied from 0.028 % to 4.3 %. Two prior studies estimated the relative risk of ONJ related to bisphosphonates and found odds ratios of 7.2 and 9.2. Our attempts to estimate the incidence rate of BONJ encompassed 41,957 in the dataset from 2005–2007 and 466,645 in a separate dataset from 2007–2010. From the older dataset, we found 51 potential cases of BONJ using a broad definition of possible ONJ. One case was confirmed by a dentist for a prevalence of 0.02 % (95 % CI 0.004 %–0.11 %) among bisphosphonate users. From the newer dataset, we found 13 possible cases, but none could be confirmed. Most subjects with the ONJ diagnosis code appeared to have had an osteoporosis-related fracture and not ONJ.

Conclusions

The literature suggests a broad range of possible values for the prevalence of BONJ; our estimate fell within the range from prior literature.

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Title: Defining the epidemiology of bisphosphonate-associated osteonecrosis of the jaw: prior work and current challenges
Authors: D. H. Solomon
E. Mercer
S. B. Woo
J. Avorn
S. Schneeweiss
N. Treister
Publication date: 01-01-2013
Publisher: Springer-Verlag
Published in: Osteoporosis International / Issue 1/2013
Print ISSN: 0937-941X
Electronic ISSN: 1433-2965
DOI: https://doi.org/10.1007/s00198-012-2042-6

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Defining the epidemiology of bisphosphonate-associated osteonecrosis of the jaw: prior work and current challenges

Abstract

Summary

Introduction

Methods

Results

Conclusions

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Summary

Introduction

Methods

Results

Conclusions

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