Use of bisphosphonates and the risk of osteonecrosis among cancer patients

A systemic review and meta-analysis of the observational studies

Si Huei Lee, Rai Chi Chan, Shy Shin Chang, Yin Ling Tan, Kai Hsiang Chang, Matthew C. Lee, Huai En Chang, Chien Chang Lee

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Purpose: This study aims to systematically review observational studies evaluating the use of bisphosphonates (BPs) and risk of osteonecrosis of the jaw (ONJ) among cancer patients. Methods: PubMed, Embase, and Cochrane Library were screened from database inception to Aug 2012. 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 were derived by random effects meta-analysis. Subgroup analyses were carried out according to patients' characteristics and route of BP use. Results: We identified eight studies, including 1,389 cases and 569,620 controls. Use of BPs was associated with a significantly increased risk of ONJ (odds ratio (OR) 4.25; 95% confidence interval (CI) 3.67-5.36; I 2=0%). The summary OR was 4.22 (95% CI 3.21-5.54; I2=0%) for adjusted studies. IV BPs were associated with higher risk (OR 4.27; 95% CI 3.38-5.40; I2=0%) than oral BPs (OR 1.18; 95% CI 0.89-1.56; I 2=0%). Hospital-based studies were associated with higher risk estimates than population-based studies. 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 the highest risk. It is important to assess oral health before initiating therapy and to avoid dental procedures during the active phase of intravenous BP therapy.

Original languageEnglish
Pages (from-to)533-560
Number of pages28
JournalSupportive Care in Cancer
Volume22
Issue number2
DOIs
Publication statusPublished - Jan 1 2014
Externally publishedYes

Fingerprint

Bisphosphonate-Associated Osteonecrosis of the Jaw
Diphosphonates
Observational Studies
Meta-Analysis
Odds Ratio
Confidence Intervals
Jaw
Neoplasms
Osteonecrosis
Jaw Neoplasms
Oral Health
PubMed
Libraries
Case-Control Studies
Tooth
Databases
Therapeutics

Keywords

  • Bisphosphonate
  • Cancer
  • Meta-analysis
  • Osteonecrosis

ASJC Scopus subject areas

  • Oncology

Cite this

Use of bisphosphonates and the risk of osteonecrosis among cancer patients : A systemic review and meta-analysis of the observational studies. / Lee, Si Huei; Chan, Rai Chi; Chang, Shy Shin; Tan, Yin Ling; Chang, Kai Hsiang; Lee, Matthew C.; Chang, Huai En; Lee, Chien Chang.

In: Supportive Care in Cancer, Vol. 22, No. 2, 01.01.2014, p. 533-560.

Research output: Contribution to journalArticle

Lee, Si Huei ; Chan, Rai Chi ; Chang, Shy Shin ; Tan, Yin Ling ; Chang, Kai Hsiang ; Lee, Matthew C. ; Chang, Huai En ; Lee, Chien Chang. / Use of bisphosphonates and the risk of osteonecrosis among cancer patients : A systemic review and meta-analysis of the observational studies. In: Supportive Care in Cancer. 2014 ; Vol. 22, No. 2. pp. 533-560.
@article{adbd82df9ba34831b5ee4eed0ad3e5bb,
title = "Use of bisphosphonates and the risk of osteonecrosis among cancer patients: A systemic review and meta-analysis of the observational studies",
abstract = "Purpose: This study aims to systematically review observational studies evaluating the use of bisphosphonates (BPs) and risk of osteonecrosis of the jaw (ONJ) among cancer patients. Methods: PubMed, Embase, and Cochrane Library were screened from database inception to Aug 2012. 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 were derived by random effects meta-analysis. Subgroup analyses were carried out according to patients' characteristics and route of BP use. Results: We identified eight studies, including 1,389 cases and 569,620 controls. Use of BPs was associated with a significantly increased risk of ONJ (odds ratio (OR) 4.25; 95{\%} confidence interval (CI) 3.67-5.36; I 2=0{\%}). The summary OR was 4.22 (95{\%} CI 3.21-5.54; I2=0{\%}) for adjusted studies. IV BPs were associated with higher risk (OR 4.27; 95{\%} CI 3.38-5.40; I2=0{\%}) than oral BPs (OR 1.18; 95{\%} CI 0.89-1.56; I 2=0{\%}). Hospital-based studies were associated with higher risk estimates than population-based studies. 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 the highest risk. It is important to assess oral health before initiating therapy and to avoid dental procedures during the active phase of intravenous BP therapy.",
keywords = "Bisphosphonate, Cancer, Meta-analysis, Osteonecrosis",
author = "Lee, {Si Huei} and Chan, {Rai Chi} and Chang, {Shy Shin} and Tan, {Yin Ling} and Chang, {Kai Hsiang} and Lee, {Matthew C.} and Chang, {Huai En} and Lee, {Chien Chang}",
year = "2014",
month = "1",
day = "1",
doi = "10.1007/s00520-013-2017-y",
language = "English",
volume = "22",
pages = "533--560",
journal = "Supportive Care in Cancer",
issn = "0941-4355",
publisher = "Springer Verlag",
number = "2",

}

TY - JOUR

T1 - Use of bisphosphonates and the risk of osteonecrosis among cancer patients

T2 - A systemic review and meta-analysis of the observational studies

AU - Lee, Si Huei

AU - Chan, Rai Chi

AU - Chang, Shy Shin

AU - Tan, Yin Ling

AU - Chang, Kai Hsiang

AU - Lee, Matthew C.

AU - Chang, Huai En

AU - Lee, Chien Chang

PY - 2014/1/1

Y1 - 2014/1/1

N2 - Purpose: This study aims to systematically review observational studies evaluating the use of bisphosphonates (BPs) and risk of osteonecrosis of the jaw (ONJ) among cancer patients. Methods: PubMed, Embase, and Cochrane Library were screened from database inception to Aug 2012. 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 were derived by random effects meta-analysis. Subgroup analyses were carried out according to patients' characteristics and route of BP use. Results: We identified eight studies, including 1,389 cases and 569,620 controls. Use of BPs was associated with a significantly increased risk of ONJ (odds ratio (OR) 4.25; 95% confidence interval (CI) 3.67-5.36; I 2=0%). The summary OR was 4.22 (95% CI 3.21-5.54; I2=0%) for adjusted studies. IV BPs were associated with higher risk (OR 4.27; 95% CI 3.38-5.40; I2=0%) than oral BPs (OR 1.18; 95% CI 0.89-1.56; I 2=0%). Hospital-based studies were associated with higher risk estimates than population-based studies. 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 the highest risk. It is important to assess oral health before initiating therapy and to avoid dental procedures during the active phase of intravenous BP therapy.

AB - Purpose: This study aims to systematically review observational studies evaluating the use of bisphosphonates (BPs) and risk of osteonecrosis of the jaw (ONJ) among cancer patients. Methods: PubMed, Embase, and Cochrane Library were screened from database inception to Aug 2012. 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 were derived by random effects meta-analysis. Subgroup analyses were carried out according to patients' characteristics and route of BP use. Results: We identified eight studies, including 1,389 cases and 569,620 controls. Use of BPs was associated with a significantly increased risk of ONJ (odds ratio (OR) 4.25; 95% confidence interval (CI) 3.67-5.36; I 2=0%). The summary OR was 4.22 (95% CI 3.21-5.54; I2=0%) for adjusted studies. IV BPs were associated with higher risk (OR 4.27; 95% CI 3.38-5.40; I2=0%) than oral BPs (OR 1.18; 95% CI 0.89-1.56; I 2=0%). Hospital-based studies were associated with higher risk estimates than population-based studies. 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 the highest risk. It is important to assess oral health before initiating therapy and to avoid dental procedures during the active phase of intravenous BP therapy.

KW - Bisphosphonate

KW - Cancer

KW - Meta-analysis

KW - Osteonecrosis

UR - http://www.scopus.com/inward/record.url?scp=84896052890&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84896052890&partnerID=8YFLogxK

U2 - 10.1007/s00520-013-2017-y

DO - 10.1007/s00520-013-2017-y

M3 - Article

VL - 22

SP - 533

EP - 560

JO - Supportive Care in Cancer

JF - Supportive Care in Cancer

SN - 0941-4355

IS - 2

ER -