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Oral Dis. 2019 Mar;25(2):471-480. doi: 10.1111/odi.12966. Epub 2018 Sep 17.

Drug holiday patterns and bisphosphonate-related osteonecrosis of the jaw.

Author information

1
College of Pharmacy, Chung-Ang University, Seoul, South Korea.
2
College of Pharmacy, Pusan National University, Pusan, South Korea.
3
College of Natural Science, Kyungpook National University, Daegu, South Korea.
4
College of Pharmacy and Research Institute of Pharmaceutical Sciences, Kyungpook National University, Daegu, South Korea.

Abstract

OBJECTIVES:

There is limited evidence regarding the appropriate length of a bisphosphonate (BP) holiday to reduce the risk of osteonecrosis of the jaw (ONJ). In this cross-sectional study, we investigated the population-based patterns of the gaps between BP discontinuation and ONJ diagnosis.

SUBJECTS AND METHODS:

We used the claims database of the National Health Insurance Service in Korea. Among BP users between 2006 and 2015, incident ONJ cases during 2010-2015 with no history of ONJ in the last 4 years were identified. We assessed the time gap from the last BP administration to ONJ diagnosis.

RESULTS:

Among 1,569 incident ONJ cases, 836 (53.3%) occurred after BP discontinuation. The cumulative proportions of ONJ occurrence within 1 month, 3 months, 1 year, 2 years, and 3 years after discontinuation were 58.9%, 70.8%, 87.0%, 93.2%, and 96.1%, respectively. The length of drug holidays showed no significant difference between patients with or without comorbid cancer and diabetes mellitus (p-value, 0.12 and 0.52, respectively). However, the use of injectable BP formulations significantly affected ONJ incidence (p < 0.01).

CONCLUSIONS:

Most ONJ cases occurred within 3 years from BP suspension, with a higher prevalence among BP injection users with 1 year or lesser BP holiday.

KEYWORDS:

adverse reactions; alveolar bone loss; bisphosphonate; drug therapy; osteonecrosis of the jaw; pharmacoepidemiology

PMID:
30153366
DOI:
10.1111/odi.12966

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