Incidence of bisphosphonate-related osteonecrosis of the jaws (BRONJ) in patients taking bisphosphonates for osteoporosis treatment - a grossly underestimated risk?

Purpose: The aim of this study was to detect the incidence of bisphosphonate-related osteonecrosis of the jaws (BRONJ) in association with osteoporosis in 2009 in the rural district of Marburg-Biedenkopf, Germany. In addition, the therapeutic regimen of dentists in this area was compared to the treatment guidelines of established international associations.

Methodology: A postal survey including 129 dental offices within the named investigation area was conducted. Additionally, the dentists were asked to contribute to this study during a course of retraining. Ultimately, 107 colleagues participated in this study.

Results: A total of 37 BRONJ cases were revealed, 37.4 % of those were linked to malignant diseases, 62.6 % to osteoporosis. Noticeably, 30.1 % of the BRONJ cases linked to osteoporosis were connected with intravenous application. In total, 62.6 % of all cases were associated with intravenous and 37.4 % with oral application. Considering the estimated number of 1.014 patients using bisphosphonates for osteoporosis treatment in Marburg-Biedenkopf in 2009, the specific incidence of BRONJ could be narrowed down to about 2.27 %. In proportion to the increasing risk potential of the three patient groups, participants conducted fewer surgical interventions themselves but tended to refer patients to colleagues.

Conclusion: This study reveals the incidence of BRONJ in association with osteoporosis as being grossly underrated so far, especially in connection with intravenous bisphosphonate treatment. The therapeutic regimen of the dentists who participated correlated with the established guidelines.

Clinical Relevance: The interface between dentistry and medicine may profit from our study's results which will help to improve interdisciplinary communication. With regard to this, we wish to contribute to an informative discussion since a main focus was to ensure colleagues in their decision making, especially in case of complications after elective dentoalveolar surgery-like implantations. Besides medical there are also economic and political aspects, i.e. the financial responsibility in case of unexpected or inevitable complications, possibly leading to BRONJ, that may become part of future discussions based on this study.