RESEARCH - Oral bisphosphonates may cut risk of jaw necrosis

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Oral bisphosphonates may cut risk of jaw necrosis

By Reuters Health

January 4, 2008

NEW YORK (Reuters Health), Jan 4 - A report in the Journal of the American

Dental Association for January clarifies the risk of jaw osteonecrosis

associated with bisphosphonates. Intravenous bisphosphonates strongly

increase the risk of adverse jaw outcomes, but oral bisphosphonates tend to

decrease the risk, the research shows.

" This is good news for the roughly 3 million Americans who take Fosamax,

Actonel, Boniva, or similar osteoporosis meds orally, " senior author Dr.

Athanasios Zavras, from Harvard School of Dental Medicine in Boston, said in

a statement.

In 2003, reports first surfaced linking intravenous bisphosphonate use with

osteonecrosis of the jaw. Oral versions of these agents were initially

thought to be safe until a report came out in May 2005 showing that seven of

63 bisphosphonate users who developed the condition had been using oral

forms.

To investigate further, the researchers analyzed medical claims from 714,217

patients with osteoporosis or cancer to determine the effect that

bisphosphonate use had on the risk of three outcomes: inflammatory

conditions of the jaw (including osteonecrosis), major jaw surgery for

necrotic indications, and jaw surgery for a malignant process.

The results showed that intravenous bisphosphonate use was associated with

odds ratios of 4.01 and 4.47 for inflammatory necrosis of the jaw among

patients with osteoporosis and cancer, respectively, and with corresponding

odds ratios of 7.80 and 6.80 for surgery for a necrotic process. No

significant effect was noted regarding the risk of surgery for a cancer

process.

By contrast, oral bisphosphonate use reduced the risk of inflammatory

necrosis of the jaw in patients with osteoporosis, with an odds ratio of

0.65. No significant effects of oral bisphosphonates were seen regarding

surgery for a necrotic process in this patient group or for any of the

adverse jaw outcomes in cancer patients.

" Our findings on intravenous bisphosphonates are consistent with the

literature, which makes me confident that our findings on oral

bisphosphonates are correct, " Dr. Zavras stated. " We're currently recruiting

patients for a clinical study to confirm them. "

Last Updated: 2008-01-03 10:16:09 -0400 (Reuters Health)

J Am Dent Assoc 2008;139:23-30.

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