Title	Taking Bisphosphonates For Osteoporosis Increases The Risk Of Osteonecrosis Of The Jaw Only Slightly
Clinical Question	In a patient currently taking oral bisphosphonates, what is the likelihood of bisphosphonates induced osteonecrosis after dental extractions?
Clinical Bottom Line	In patients taking oral bisphosphonates, the risk of bisphosphonate induced osteonecrosis after dental extraction is slightly increased.
Best Evidence
PubMed ID Author / Year Patient Group Study type (level of evidence) 17919538 Pazianas/2007 11 publications reporting 26 cases of ONJ in patients receiving bisphosphonates for the treatment of osteoporosis Systematic Review of: case reports, case series and observational studies Key results Characteristics like age, sex and history of dental procedures/trauma are important risks factors for the development of ONJ. The prevalence of ONJ in patients taking bisphosphonates was low. Age greater than 60 years, female sex, and previous invasive dental treatment were the most common characteristics of those who acquired ONJ. Twelve (80%) of the 15 patients for whom any history of invasive dental treatment dental was reported had undergone a dental extraction before developing ONJ. Dental extractions may be an important initiating factor in the development of ONJ. Therefore, it cannot be concluded that there is an association between oral bisphosphonate use and ONJ due to dental extractions. The reports are still to be completed and confounding issues are present.
Evidence Search	("diphosphonates"[MeSH Terms] OR "diphosphonates"[All Fields] OR "bisphosphonates"[All Fields]) AND ("osteoporosis, postmenopausal"[MeSH Terms] OR ("osteoporosis"[All Fields] AND "postmenopausal"[All Fields]) OR "postmenopausal osteoporosis"[All Fields] OR "osteoporosis"[All Fields] OR "osteoporosis"[MeSH Terms]) AND ("osteonecrosis"[MeSH Terms] OR "osteonecrosis"[All Fields]) AND ("tooth extraction"[MeSH Terms] OR ("tooth"[All Fields] AND "extraction"[All Fields]) OR "tooth extraction"[All Fields])
Comments on The Evidence	Eleven publications reporting 26 cases of ONJ in patients receiving bisphosphonates for the treatment of osteoporosis were included in this review. For inclusion in the review, published articles had to meet all the following criteria: the population consisted of adult (age>or = 18 years) male and/ or female patient with ONJ; patients received bisphosphonates for the treatment of osteoporosis only; the characteristics of bisphosphonate treatment, clinical features of ONJ, treatment protocol used to manage ONJ; and the publication involved a case report, case series or observational study. Articles got rejected if hormone replacement therapy or estrogen-receptor modulators were used in the management of osteoporosis.
Applicability	It is estimated that <1% of a dose of oral bisphosphonates is bioavailable for incorporation into the bone matrix. It is always necessary to consider the risks and benefits of any medication being prescribed. Clinicians should be aware of the benefits of bisphosphonates in significantly reducing the risk of fractures, which are a cause of marked morbidity and mortality, and should weigh this against the risk for ONJ, which is low in patients with osteoporosis. There is a need for prospective and retrospective studies in order to assess the prevalence of ONJ in bigger samples over long periods of time.
Specialty	(General Dentistry) (Oral Surgery) (Periodontics) (Dental Hygiene)
Keywords	Oral bisphosphonates, osteonecrosis, BNONJ, dental extractions, osteoporosis.
ID#	2269
Date of submission	04/26/2012
E-mail	bonillad@livemail.uthscsa.edu
Author	Diego Bonilla
Co-author(s)
Co-author(s) e-mail
Faculty mentor	Edward Ellis, III, DDS
Faculty mentor e-mail	ellise3@uthscsa.edu
Basic Science Rationale (Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?) None available
Comments and Evidence-Based Updates on the CAT (FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs) None available