Risk factors for osteonecrosis of the jaws: a case-control study from the CONDOR dental PBRN

Journal Name: 
J Dent Res
Authors: 
Barasch,A.
Cunha-Cruz,J.
Curro,F.A.
Hujoel,P.
Sung,A.H.
Vena,D.
Voinea-Griffin,A.E.
Beadnell,S.
Craig,R.G.
DeRouen,T.
Desaranayake,A.
Gilbert,A.
Gilbert,G.H.
Goldberg,K.
Hauley,R.
Hashimoto,M.
Holmes,J.
Latzke,B.
Leroux,B.
Lindblad,A.
Richman,J.
Safford,M.
Ship,J.
Thompson,V.P.
Williams,O.D.
Yin,W.
Abstract: 
Case reports and cohort studies have linked bisphosphonate therapy and osteonecrosis of the jaws (ONJ), but neither causality nor specific risks for lesion development have been clearly established. We conducted a 1:3 case-control study with three dental Practice-based Research Networks, using dentist questionnaires and patient interviews for collection of data on bisphosphonate therapy, demographics, co-morbidities, and dental and medical treatments. Multivariable logistic regression analyses tested associations between bisphosphonate use and other risk factors with ONJ. We enrolled 191 ONJ cases and 573 controls in 119 dental practices. Bisphosphonate use was strongly associated with ONJ (odds ratios [OR] 299.5 {95%CI 70.0-1282.7} for intravenous [IV] use and OR = 12.2 {4.3-35.0} for oral use). Risk markers included local suppuration (OR = 7.8 {1.8-34.1}), dental extraction (OR = 7.6 {2.4-24.7}), and radiation therapy (OR = 24.1 {4.9-118.4}). When cancer patients (n = 143) were excluded, bisphosphonate use (OR = 7.2 {2.1-24.7}), suppuration (OR = 11.9 {2.0-69.5}), and extractions (OR = 6.6 {1.6-26.6}) remained associated with ONJ. Higher risk of ONJ began within 2 years of bisphosphonate initiation and increased four-fold after 2 years. Both IV and oral bisphosphonate use were strongly associated with ONJ. Duration of treatment > 2 years; suppuration and dental extractions were independent risk factors for ONJ
4
2011
Volume: 
90
Pages: 
439-444
Keywords: 
administration & dosage, Administration,Oral, Adult, adverse effects, Age Factors, Alabama, Anemia, Bone Density, Bone Density Conservation Agents, cancer patients, Case Report, Case-Control Studies, Causality, chemically induced, Chronic Disease, Cohort Studies, Community-Based Participatory Research, Comorbidity, Comparative Study, complications, Dentistry, Development, Diabetes Complications, Diphosphonates, Educational Status, electronic, etiology, factors, Female, Gingival Hemorrhage, Humans, Income, Injections,Intravenous, Interviews, Jaw Diseases, Male, medical, Middle Aged, Multicenter Studies, Neoplasms, Odds Ratio, Osteonecrosis, Osteoporosis, patient, Patients, Questionnaires, Radiotherapy, regression, Research, Research Support, Risk, Risk Factors, Smoking, support, Suppuration, therapy, Time Factors, Tooth Extraction, Universities