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Bisphosphonates and the Risk of Osteonecrosis of the Jaw

Even though oral bisphosphonates are widely used, there is an inordinate concern over the risk of osteonecrosis of the jaw (ONJ).  A new UK study suggests that the risk of ONJ is elevated six fold by the use of biphosphonates.

This UK study examined ONJ amongst those hospital admission with osteonecrosis of the jaw from 521,695 Million Women Study participants.

After a mean follow-up of 8.2 years, 100 women were hospitalized with their first ONJ. One-third (29/100) of the cases had used bisphosphonates.  The absolute risk ONJ hospitalizations for those at age 70 years was 0.09 per 1000 in non-bisphosphonate exposed and 0.69 per 1000 among those who use bisphosphonates (adjusted RR = 6.09, 95% CI 3.83–9.66; p < 0.0001). Bisphosphonates had an excess ONJ risk of 0.6/1000 users over a 5 year period. 

The risk for ONJ was also increased in women with a prior cancer (RR = 3.40, 2.22–5.22, p < 0.0001). 

In this UK population of postmenopausal women, use of oral bisphosphonates was associated with a 6-fold increased risk of hospital admission with osteonecrosis of the jaw.


The author has no conflicts of interest to disclose related to this subject

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