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News / February 14, 2011

Osteonecrosis studies reveal definition issues

by Guy Hiscott

New research may have an important impact to the developing of better definitions for ONJ.

The International and American Associations for Dental Research’s Journal of Dental Research (JDR) has released a research report that estimates the prevalence of osteonecrosis of the jaw (ONJ), as well as containing a case-control study on bisphosphonate use and other risk factors.

These investigations represent some of the largest published studies to date on ONJ patients, with the researchers making use of the National Institute of Dental and Craniofacial Research-supported practice-based research networks.

The researchers conducted a case-control study to determine the risk associated with bisphosphonates and identified other risk factors for ONJ, including dental diseases and procedures.

Lead author Andrei Barasch and colleagues enrolled 191 ONJ cases and 573 controls from 119 dental practices. Bisphosphonate use was strongly associated with ONJ with an odds ratio of 299.5 for intravenous use and 12.2 for oral use.

In a second JDR article, led by Jeffrey Fellows, the researchers identified 572,606 health plan members, of which approximately 25,000 had a diagnosis or procedure code that suggested a necrotic bone lesion, including inflammatory jaw condition, cyst of bone, aseptic necrosis of the bone and open wound of the jaw.

Of those members’ electronic medical records, 73 suspected ONJ cases were identified, of which 16 were later confirmed by manual chart review.

An additional seven cases were indentified through oral surgeons or the Peer Review Committee for a total of 23 confirmed ONJ cases.

Patients with oral bisphosphonates were 15.5 times more likely to have ONJ than non-exposed patients. However, the number of ONJ cases limits firm conclusions and suggests absolute risks for ONJ from oral bisphosphonates is low.

‘ONJ represents a challenging clinical dilemma affecting dental and cancer patients, and communities at many levels of dentistry, notably oral/maxillofacial surgery and oral oncology are called upon to manage these cases,’ said JDR editor-in-chief William Giannobile. ‘The work underscores important clinical implications that will be of value to not only the IADR and AADR communities, but especially practicing clinicians.’

A perspective article titled Making a case for defining osteonecrosis of the jaw summarises the key implications of ONJ and the relevance in the field of the two JDR research reports. The research that was conducted may have an important impact to the developing of better definitions for ONJ.

All three of these articles are published in the Journal of Dental Research. Click here to access them.