Osteoporosis International

, Volume 24, Issue 1, pp 237–244

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

  • D. H. Solomon
  • E. Mercer
  • S. B. Woo
  • J. Avorn
  • S. Schneeweiss
  • N. Treister
Original Article

DOI: 10.1007/s00198-012-2042-6

Cite this article as:
Solomon, D.H., Mercer, E., Woo, S.B. et al. Osteoporos Int (2013) 24: 237. doi:10.1007/s00198-012-2042-6

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.

Keywords

BisphosphonateEpidemiologyOsteonecrosis of the jawOsteoporosis

Supplementary material

198_2012_2042_MOESM1_ESM.doc (42 kb)
ESM 1(DOC 41 kb)

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2012

Authors and Affiliations

  • D. H. Solomon
    • 1
    • 2
  • E. Mercer
    • 2
  • S. B. Woo
    • 3
    • 4
  • J. Avorn
    • 1
  • S. Schneeweiss
    • 1
  • N. Treister
    • 3
    • 4
  1. 1.Division of PharmacoepidemiologyBrigham and Women’s HospitalBostonUSA
  2. 2.Division of RheumatologyBrigham and Women’s HospitalBostonUSA
  3. 3.Department of MedicineBrigham and Women’s HospitalBostonUSA
  4. 4.Department of Oral MedicineBrigham and Women’s HospitalBostonUSA