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Comparative Study
. 2017 Jan;92(1):106-113.
doi: 10.1016/j.mayocp.2016.09.015. Epub 2016 Nov 19.

Risk of Jaw Osteonecrosis After Intravenous Bisphosphonates in Cancer Patients and Patients Without Cancer

James S Goodwin  1 , Jie Zhou  2 , Yong-Fang Kuo  3 , Jacques Baillargeon  4
Affiliations
Comparative Study

Risk of Jaw Osteonecrosis After Intravenous Bisphosphonates in Cancer Patients and Patients Without Cancer

James S Goodwin et al. Mayo Clin Proc. 2017 Jan.

Abstract

Objective: To compare the risk of jaw osteonecrosis after intravenous (IV) bisphosphonate administered to patients with cancer vs patients without cancer.

Patients and methods: We conducted a retrospective cohort study of a 5% national sample of Medicare patients administered IV bisphosphonate from January 1, 2008, through December 31, 2013, for cancer vs noncancer indications. Probable jaw osteonecrosis was estimated with an algorithm including diagnoses, surgical procedures, and imaging studies. A non-IV bisphosphonate comparison group included patients prescribed an oral bisphosphonate for 30 days or less.

Results: During follow-up, 40 (0.42%) out of 9482 patients with cancer developed probable jaw osteonecrosis compared with 8 (0.05%) out of 16,046 patients without cancer. In a Cox multivariable survival analysis controlling for patient characteristics and number of IV zoledronic infusions, patients without cancer had a hazard ratio of 0.17 (95% CI, 0.06-0.46) for developing jaw osteonecrosis compared with those with cancer. The lower rate of jaw osteonecrosis in patients without cancer was also confirmed in a number of sensitivity analyses.

Conclusion: The low rate of jaw osteonecrosis in patients with osteoporosis who receive IV bisphosphonate should be weighed against the benefit of those agents in preventing hip and other fractures.

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Conflict of interest statement

None of the authors have any conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Kaplan-Meier survival free of jaw osteonecrosis for patients receiving oral bisphosphonate <=30 days, along with cancer and non-cancer patients receiving 1-5 IV infusions of zoledronic acid. Kaplan Meier survival free of jaw osteonecrosis for three cohorts 1) Those who received 1-5 IV infusions of zoledronic acid for a cancer; 2) Those who received 1-5 IV infusions of zoledronic acid for a non-cancer indication; and 3) Those who did not receive IV bisphosphonate but received a prescription for an oral bisphosphonate and took it for 30 days or less. The numbers of patients at risk in the three cohorts over time are given below the graph.
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References

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