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

Published:November 19, 2016DOI:



      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.


      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.


      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.

      Abbreviations and Acronyms:

      ICD-9-CM (International Classification of Disease, Ninth Revision, Clinical Modification), IV (intravenous)
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      Linked Article

      • Bisphosphonates and Osteonecrosis of the Jaw
        Mayo Clinic ProceedingsVol. 92Issue 7
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          In the January 2017 issue of Mayo Clinic Proceedings, Goodwin et al1 provide reassuring information on the incidence of osteonecrosis of the jaw (ONJ) in patients treated with intravenous bisphosphonates. Although the causal relationship between this class of bone antiresorptive medications and ONJ has long been known, this specific complication of osteoporosis treatment appears to be a rarity. Nevertheless, the perception among patients and some health care professionals is that ONJ is a relatively common occurrence.
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