Risk of osteomyelitis of the jaw induced by oral bisphosphonates in patients taking medications for osteoporosis: a hospital-based cohort study in Japan.
Risk of osteomyelitis of the jaw induced by oral bisphosphonates in patients taking medications for osteoporosis: a hospital-based cohort study in Japan.
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DOI：
10.1016/j.bone.2012.08.115
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发表时间：
2012-11
期刊：
影响因子：
4.1
通讯作者：
T. Yamazaki;M. Yamori;Keiichi Yamamoto;Kazuyuki Saito;K. Asai;Eriko Sumi;K. Goto;Katsu Takahashi-Katsu-Takahas
中科院分区：
文献类型：
--
作者：
T. Yamazaki;M. Yamori;Keiichi Yamamoto;Kazuyuki Saito;K. Asai;Eriko Sumi;K. Goto;Katsu Takahashi-Katsu-Takahas
口服双膦酸盐（BP）是预防和治疗骨质疏松症的第一线药物。然而，一些研究报告了颌骨骨坏死（ONJ），也称为颌骨骨髓炎（OMJ），作为这些药物的副作用。虽然绝对风险被认为是低的，但迄今为止关于相对风险或可归因风险的信息实际上是有限的。在这里，我们估计口服BP与其他骨质疏松症药物相比，口服BP对OMJ的骨质疏松症患者的风险。使用电子病历检索系统和手动确认OMJ，我们对2000年11月至2010年10月期间在京都大学医院服用骨质疏松症药物的患者进行了回顾性队列研究。为了评估口服BP对OMJ的相对风险，进行了logistic回归分析，并估计了比值比（OR）和95%置信区间（CI）。此外，根据分级诊断进行敏感性分析。共有4129名患者（59.6%）接受了BP治疗，而2794名患者（40.3%）接受了其他骨质疏松药物治疗。在接受口服BP的患者中，OMJ的绝对风险估计范围为0.46%至0.99%（95% CI：0.25-0.66至0.69-1.2），在接受其他骨质疏松药物的患者中，OMJ的绝对风险估计范围为0.071%至0.17%（95% CI：0-0.17至0.022-0.33）。口服BP对OMJ的归因风险估计范围为0.38%-0.81%（95% CI：0.38-0.39至0.80-0.81）。仅确诊病例经混杂因素调整后的OR（95% CI）为5.0（1.9-12.9）至6.0（1.3-26.1）。在绝对和归因风险方面，认为骨质疏松症患者口服BP对OMJ的风险小于1%。然而，与其他骨质疏松症药物治疗的患者相比，口服BP可能会增加OMJ的风险，并且应记住副作用的风险。
Oral bisphosphonates (BPs) represent the first line of prevention and treatment for osteoporosis. However, several studies have reported osteonecrosis of the jaw (ONJ), also known as osteomyelitis of the jaw (OMJ), as a side effect of these drugs. Although absolute risk is suggested to be low, information to date on the relative risk or attributable risk has in fact been limited. Here, we estimated risk of oral BPs for OMJ in osteoporosis patients taking oral BPs compared with other osteoporosis drugs. Using an electronic medical records retrieval system and manual confirmation of OMJ, we conducted a retrospective cohort study of patients taking medications for osteoporosis at Kyoto University Hospital between November 2000 and October 2010. To evaluate relative risks of oral BPs for OMJ, logistic regression analysis was performed and odds ratios (ORs) and 95% confidence interval (CIs) were estimated. In addition, sensitivity analyses were performed according to hierarchical diagnosis. A total of 4129 patients (59.6%) were prescribed BPs while 2794 (40.3%) received other osteoporosis drugs. Absolute risk for OMJ was estimated to range from 0.46% to 0.99% (95% CIs: 0.25–0.66 to 0.69–1.2) among patients receiving oral BPs and 0.071% to 0.17% (95% CIs: 0–0.17 to 0.022–0.33) among patients receiving other osteoporosis drugs. The attributable risks of oral BPs for OMJ were estimated to range from 0.38% to 0.81% (95% CIs: 0.38–0.39 to 0.80–0.81). ORs (95% CIs) adjusted for confounding factors were 5.0 (1.9–12.9) to 6.0 (1.3–26.1) for confirmed cases only. In terms of absolute and attributable risks, the risk of oral BPs for OMJ is considered to be less than 1% in patients with osteoporosis. However, oral BPs may increase the risk of OMJ compared with patients treated with other osteoporosis medications and the risk of side effects should be kept in mind.