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Risk of osteonecrosis in patients taking bisphosphonates for prevention of osteoporosis: a systematic review and meta-analysis

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Abstract

Summary

We aimed to systematically review observational studies evaluating use of bisphosphonates (BPs) and risk of osteonecrosis of jaw (ONJ) or other sites among non-cancer patients.

Introduction

PubMed, EMBASE, and Cochrane Library were screened from database inception to Dec 2012.

Methods

Two reviewers independently identified cohort and case–control studies evaluating the use of oral or intravenous (IV) BPs and the risk of ONJ and extracted the characteristics of the studies and risk estimates. Pooled estimates of odds ratios and 95 % confidence intervals (CI) were derived by random effects meta-analysis. Subgroup analyses were carried according to patients’ characteristics and route of BP use.

Results

We identified 12 studies, including 2,652 cases and 1,571,997 controls. Use of BPs was associated with a significantly increased risk of ONJ or ON of other sites [odds ratio (OR) 2.32; 95 % CI 1.38–3.91; I 2 = 91 %]. The summary OR was 2.91 (95 % CI 1.62–5.22; I 2 = 85.9 %) for adjusted studies. Use of BPs were associated with higher risk on ONJ (OR 2.57; 95 % CI 1.37–4.84; I 2 = 92.2 %) than ON of other sites (OR 1.79; 95 % CI 0.71–4.47; I 2 = 83.3 %). Meta-regression analysis did not find design characteristics or outcome definitions to be significant sources of heterogeneity.

Conclusion

The available evidence suggests that use of BPs in cancer patients is associated with a substantial risk for ONJ. Patients receiving IV BP are at highest risk.

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Acknowledgment

This work was supported by the National Science Council NSC 100-2341-B-002-138-MY3NSC grant.

Conflicts of interest

None

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Authors and Affiliations

  1. Department of Rehabilitation and Physical Medicine, Taipei Veteran General Hospital, Taipei, Taiwan

    S.-H. Lee & R.-C. Chan

  2. Department of Rehabilitation and Physical Medicine, National Yang-Ming University, Taipei, Taiwan

    S.-H. Lee & R.-C. Chan

  3. Department of Family Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan

    S.-S. Chang

  4. Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan

    S.-S. Chang

  5. Department of Emergency Medicine, National Taiwan University Hospital Yunlin Branch, No 579 Sec 2 Yunlin Road, Douliou, 640, Taiwan

    C.-C. Lee

  6. Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA

    C.-C. Lee

  7. Medical Wisdom Consultants, Houston, TX, USA

    M. Lee

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  1. S.-H. Lee
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  2. S.-S. Chang
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Correspondence to C.-C. Lee.

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Lee, SH., Chang, SS., Lee, M. et al. Risk of osteonecrosis in patients taking bisphosphonates for prevention of osteoporosis: a systematic review and meta-analysis. Osteoporos Int 25, 1131–1139 (2014). https://doi.org/10.1007/s00198-013-2575-3

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  • DOI: https://doi.org/10.1007/s00198-013-2575-3

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