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

Publication Type
Journal Article
Year of Publication
Barasch, A; Cunha-Cruz, J; Curro, F A; Hujoel, P; Sung, A H; Vena, D; Voinea-Griffin, A E; CONDOR Collaborative Group; Beadnell, Steven; Craig, Ronald G; DeRouen, Timothy; Desaranayake, Ananda; Gilbert, Ann; Gilbert, Gregg H; Goldberg, Ken; Hauley, Richard; Hashimoto, Mariko; Holmes, Jon; Latzke, Brooke; Leroux, Brian; Lindblad, Anne; Richman, Joshua; Safford, Monika; Ship, Jonathan; Thompson, Van P; Williams, O Dale; Yin, Wanrong
J Dent Res
Date Published
2011 Apr
Administration, Oral; Adult; Age Factors; anemia; Bone Density Conservation Agents; Case-Control Studies; chronic disease; Community-Based Participatory Research; Diabetes Complications; Diphosphonates; Educational Status; Female; Gingival Hemorrhage; Humans; Income; Injections, Intravenous; Jaw Diseases; Male; Middle Aged; Neoplasms; Osteonecrosis; Osteoporosis; Radiotherapy; Risk Factors; Smoking; Suppuration; Time Factors; Tooth Extraction

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.