Frequency of osteonecrosis in bisphosphonate users submitted to dental procedures: A systematic review

Objective To determine the frequency of osteonecrosis of the jaw in bisphosphonate users submitted to dental procedures. Methods This systematic review searched the sources: MEDLINE, EMBASE, Web of Science, Scopus, and Virtual Health Library, with no restriction on language or publication date. Revi...

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Published in:	Oral diseases Vol. 29; no. 1; pp. 75 - 99
Main Authors:	Martins, Lucio Henrique Ives, Ferreira, Delaine Cristina, Silva, Marcus Tolentino, Motta, Rogério Heládio Lopes, Franquez, Reginaldo Tavares, Bergamaschi, Cristiane de Cássia
Format:	Journal Article
Language:	English
Published:	Denmark Wiley Subscription Services, Inc 01-01-2023
Subjects:	Alendronic acid Bisphosphonate-Associated Osteonecrosis of the Jaw - epidemiology Bisphosphonate-Associated Osteonecrosis of the Jaw - etiology Bisphosphonate-Associated Osteonecrosis of the Jaw - therapy Bisphosphonates Bone Density Conservation Agents - adverse effects Diphosphonates - adverse effects Humans Intravenous administration Jaw Meta-analysis Necrosis Osteonecrosis Osteonecrosis - chemically induced Osteonecrosis - epidemiology Osteonecrosis - therapy Osteoporosis Osteoporosis - drug therapy Systematic review Zoledronic acid Zoledronic Acid - adverse effects jaw bisphosphonates osteonecrosis systematic review
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Summary:	Objective To determine the frequency of osteonecrosis of the jaw in bisphosphonate users submitted to dental procedures. Methods This systematic review searched the sources: MEDLINE, EMBASE, Web of Science, Scopus, and Virtual Health Library, with no restriction on language or publication date. Reviewers, in pairs and independently, selected the studies, extracted their data, and assessed the risk of bias. Meta‐analyses were pooled using the DerSimonian and Laird random effects model. Results A total of 27 studies (5391 participants) were included. The most reported bisphosphonates were zoledronate (n = 17 studies) and alendronate (n = 19) for treating cancers (n = 11) and osteoporosis (n = 16), respectively. Twelve studies were of low methodological quality. The frequency of osteonecrosis was 2.7% (95% CI: 0.9–5.2%) and proved higher for intravenous [6.9% (0.7–17.3%)] than oral [0.2% (0.9–5.2%)] bisphosphonate use. No association between longer treatment duration and greater frequency of osteonecrosis was observed. Conclusions Higher frequency of osteonecrosis was observed in intravenous bisphosphonate users submitted to dental extraction. Further studies collecting more detailed information on the bisphosphonates used and of greater methodological rigor are warranted to confirm these findings and better inform prescribers, dental surgeons, and other professionals on risks of bisphosphonate use in this patient group.
Bibliography:	ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Feature-3 content type line 23 ObjectType-Review-1 ObjectType-Undefined-4
ISSN:	1354-523X 1601-0825
DOI:	10.1111/odi.14003