El papel de apixaban en la enfermedad tromboembólica venosa y arterial

Translated title of the contribution: Osteonecrosis of the jaw in older osteoporosis patients treated with intravenous bisphosphonates

Jacques Baillargeon, Yong Fang Kuo, Yu Li Lin, Gregg S. Wilkinson, James Goodwin

Research output: Contribution to journalArticle

21 Citations (Scopus)

Abstract

BACKGROUND: Intravenous bisphosphonate therapy has been linked to osteonecrosis of the jaw among patients with cancer. Some patients with osteoporosis also receive intravenous bisphosphonates, although at lower total doses than those with cancer. OBJECTIVE: To examine the risk for jaw osteonecrosis among a population-based cohort of older adults receiving intravenous bisphosphonates for the treatment of osteoporosis. METHODS: Using a 5% national sample of Medicare beneficiaries, we identified 2296 patients treated with intravenous infusions of bisphosphonates for osteoporosis and other metabolic bone diseases between January 1, 2000, and December 31, 2007. We matched this cohort to 6865 bisphosphonate nonusers, at a 1:3 ratio, on age, race, sex, type of bone disease, and risk factors for osteonecrosis of the jaw. Patients were followed until December 31, 2007. The jaw toxicity outcomes included operations on the facial bones or jaw and diagnosis of inflammatory conditions of the jaw. RESULTS: The absolute risk at 3 years for any jaw toxicity was 0.70 events per 100 patients using bisphosphonates and 0.30 events per 100 patients not using such drugs (2-sided log rank test, p = 0.08). In multivariable survival analyses (Cox proportional hazards regression) adjusting for potential confounders, intravenous bisphosphonate use was not significantly associated with diagnoses or procedures suggestive of osteonecrosis of the jaw (p = 0.24). CONCLUSIONS: Patients with osteoporosis who are treated with intravenous bisphosphonates do not appear to have a statistically significant increase in the incidence of osteonecrosis of the jaw over 3 years compared with those who do not receive such treatment. Future studies will further contribute to our understanding of the bisphosphonate risk profile, thereby allowing patients and physicians to more rigorously assess the risk-benefit ratio of this treatment across different clinical scenarios.

Original languageSpanish
Pages (from-to)1199-1206
Number of pages8
JournalAnnals of Pharmacotherapy
Volume45
Issue number10
DOIs
StatePublished - Oct 2011

Fingerprint

Osteonecrosis
Diphosphonates
Jaw
Osteoporosis
Facial Bones
Metabolic Bone Diseases
Bone Diseases
Therapeutics
Survival Analysis
Medicare
Intravenous Infusions
Neoplasms
Odds Ratio
Physicians
Incidence

Keywords

  • Bisphosphonates
  • Older adults
  • Osteonecrosis
  • Osteoporosis

ASJC Scopus subject areas

  • Pharmacology (medical)

Cite this

El papel de apixaban en la enfermedad tromboembólica venosa y arterial. / Baillargeon, Jacques; Kuo, Yong Fang; Lin, Yu Li; Wilkinson, Gregg S.; Goodwin, James.

In: Annals of Pharmacotherapy, Vol. 45, No. 10, 10.2011, p. 1199-1206.

Research output: Contribution to journalArticle

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abstract = "BACKGROUND: Intravenous bisphosphonate therapy has been linked to osteonecrosis of the jaw among patients with cancer. Some patients with osteoporosis also receive intravenous bisphosphonates, although at lower total doses than those with cancer. OBJECTIVE: To examine the risk for jaw osteonecrosis among a population-based cohort of older adults receiving intravenous bisphosphonates for the treatment of osteoporosis. METHODS: Using a 5{\%} national sample of Medicare beneficiaries, we identified 2296 patients treated with intravenous infusions of bisphosphonates for osteoporosis and other metabolic bone diseases between January 1, 2000, and December 31, 2007. We matched this cohort to 6865 bisphosphonate nonusers, at a 1:3 ratio, on age, race, sex, type of bone disease, and risk factors for osteonecrosis of the jaw. Patients were followed until December 31, 2007. The jaw toxicity outcomes included operations on the facial bones or jaw and diagnosis of inflammatory conditions of the jaw. RESULTS: The absolute risk at 3 years for any jaw toxicity was 0.70 events per 100 patients using bisphosphonates and 0.30 events per 100 patients not using such drugs (2-sided log rank test, p = 0.08). In multivariable survival analyses (Cox proportional hazards regression) adjusting for potential confounders, intravenous bisphosphonate use was not significantly associated with diagnoses or procedures suggestive of osteonecrosis of the jaw (p = 0.24). CONCLUSIONS: Patients with osteoporosis who are treated with intravenous bisphosphonates do not appear to have a statistically significant increase in the incidence of osteonecrosis of the jaw over 3 years compared with those who do not receive such treatment. Future studies will further contribute to our understanding of the bisphosphonate risk profile, thereby allowing patients and physicians to more rigorously assess the risk-benefit ratio of this treatment across different clinical scenarios.",
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