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The influence of alendronate and tooth extraction on the incidence of osteonecrosis of the jaw among osteoporotic subjects

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  • Wei-Yih Chiu
  • Wei-Shiung Yang
  • Jung-Yien Chien
  • Jang-Jaer Lee
  • Keh-Sung Tsai

Abstract

Background: Although bisphosphonate-related osteonecrosis of the jaw (ONJ) develops mainly after tooth extractions (TEs), the strength of the association between them and how the existence of the disease among bisphosphonate (BP)-treated osteoporotic patients exposed to TE remain uncertain. Methods: A nationwide retrospective cohort study investigated the influence of alendronate and TE on the development of ONJ. Results: Incidence of ONJ following long-term alendronate therapy was 262/100,000 person-years, while no event developed in the control group on raloxifene. Overall prevalence of ONJ in osteoporotic subjects receiving alendronate was estimated at 0.34% which rose to 2.16% after TE. Multiple logistic regression analysis, adjusted for the potential confounders, showed TE (adjusted odds ratio, 9.60 [4.33–21.29]), drug duration exceeding 3 years (3.00 [1.33–6.76]), and concomitant rheumatoid arthritis (4.94 [1.64–14.90]) were independent predictors of ONJ. Conclusions: This article strengthens the relationship between ONJ and BPs. Among osteoporotic patients exposed to alendronate, TE confers a 9.6-fold increased risk for ONJ and it should be performed with caution irrespective of drug duration.

Suggested Citation

  • Wei-Yih Chiu & Wei-Shiung Yang & Jung-Yien Chien & Jang-Jaer Lee & Keh-Sung Tsai, 2018. "The influence of alendronate and tooth extraction on the incidence of osteonecrosis of the jaw among osteoporotic subjects," PLOS ONE, Public Library of Science, vol. 13(4), pages 1-12, April.
    • Handle: RePEc:plo:pone00:0196419
    DOI: 10.1371/journal.pone.0196419
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