Authors' conclusions: The relative prevalence of osteonecrosis of the jaw (ONJ) in patients treated for osteoporosis was low vs the number of prescriptions. Age >or=60 years, female sex, and previous invasive dental treatment were the most common characteristics of those who developed ONJ. However, it is not possible to draw further conclusions about the potential association between oral bisphosphonate use and ONJ in the identified studies because of incomplete reporting and the presence of confounding factors.
Methods: A narrative systematic review of 11 studies (8 case reports and 3 retrospective studies. The review aimed to elucidate the relationship between bisphosphonate use and the development of ONJ in patients receiving oral bisphosphonates for the treatment of osteoporosis. Literature search 1966-2006.
Quality of review: A reasonable attempt was made to identify relevant literature by searching several databases, some relevant organisation websites and conference abstracts and by reference list checking. However, the search was restricted to published research in the English language, which may have introduced publication and language bias. The results of the review are limited by the low level of evidence (mostly case series or reports) and poor quality of included studies. It appears that randomised controlled trials were not eligible for inclusion on the assumption that they did not report prevalence of osteonecrosis of the jaw. However, the accuracy of this assumption could not have been verified by the authors without checking potentially relevant RCTs in full text.
The review was funded by pharmaceutical company Roche Laboratories.
Results: 11 publications reporting 26 cases of ONJ in osteoporosis patients were included in the review. The most commonly affected site was the mandible (16 patients), followed by the maxilla (6 patients). Among the 23 patients whose age was reported, 18 (78%) were aged >or=60 years. Among the 23 patients whose sex was reported, only 3 (13%) were men. Of 15 patients with a history of invasive dental treatment, 12 (80%) had undergone dental surgery or experienced dental trauma at the site of ONJ. Among the 10 patients for whom treatment duration was reported, no clear relationship between the duration of bisphosphonate treatment and the development of ONJ was observed.
Citation: Pazianas M, Miller P, Blumentals WA, Bernal M, Kothawala P. A review of the literature on osteonecrosis of the jaw in patients with osteoporosis treated with oral bisphosphonates: prevalence, risk factors, and clinical characteristics. Clinical Therepeutics 2007; 29(8):1548-58.
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