Study links oral bisphosphonates to ONJ

A new study in the January issue of The Journal of the American Dental Association suggests that the use of oral bisphosphonates can lead to osteonecrosis of the jaw following certain dental procedures.

The ADA has issued an e-gram on this topic that contains points and ADA resources, including a handout that dentists can give to their patients. To download a copy of the handout, please click here.

The study, “Oral bisphosphonate use and the prevalence of osteonecrosis of the jaw: An institutional inquiry,” was conducted by researchers at the University of Southern California School of Dentistry who identified 208 patients from the USC database with a history of oral bisphosphonate (alendronate) use.

The researchers determined that nine of those 208 patients developed active osteonecrosis of the jaw (ONJ) after undergoing tooth extractions or denture trauma resulting in jawbone exposure. Additionally, 4,384 patients with with no history of oral bisphosphonate use who received extractions, but no ONJ cases were reported among these patients.

Lead researcher Dr. Parish Sedghizadeh, director of the USC Center for Biofilms, hopes the study will encourage physicians and dentists to talk with patients about the oral health risks associated with the widely used drugs.

“Here at [USC], we’re getting two or three new patients a week that have bisphosphonate-related ONJ and I know we’re not the only ones seeing it,” said Dr. Sedghizadeh in a university press release.

Previously, only cancer patients being treated with intravenous bisphosphonate drugs were suspected to be at an increased risk for developing ONJ. According to Merck, a manufacturer of oral bisphosphonate drugs, the correlation was so small that the incidence was 0.7 per 100,000 persons.

“Since this problem was first identified, the ADA has been encouraging studies such as this,” said Dr. Michael Rethman, chair, ADA Council on Scientific Affairs. “While this particular study is not large, it strongly suggests that the previous or ongoing use of oral alendronate may be linked to an unexpectedly high incidence of serious jaw infections in patients who undergo tooth extractions or who wear dentures.For now, all health care providers and susceptible patients need to be made aware of these results.Additional studies are needed to better delineate the risk across the population of alendronate users.More science is also needed to better understand why some patients get ONJ and others do not鈥攁s well as what can be done to minimize the likelihood of this serious condition among susceptible patients.”

Dr. Peter Jacobsen, CSA vice chair and member of the ADA expert panel on oral bisphosphonates, added that the USC results make a significant difference in the counseling and management of patients on oral bisphosphonates.

“All health care providers and susceptible patients need to be made aware of them.” Dr. Jacobsen said. “The risk shown by this article is about two orders of magnitude higher than found in prior studies.”

In 2006, the ADA developed “Dental Management of Patients Receiving Oral Bisphosphonate Therapy: Expert Panel Recommendations” for dentists to consult, which can be viewed by clicking here.

ADA e-grams are sent to members who have provided the Association with their e-mail addresses. Currently, more than 83,000 members receive communications this way. To add your e-mail address to this list, send your request to “epubs@ada.org“.