Comorbid conditions are a risk for osteonecrosis of the jaw unrelated to antiresorptive therapy.

Objective: Osteonecrosis of the jaw (ONJ) is commonly associated with antiresorptive therapy. There have been numerous reports of ONJ unrelated to antiresorptive therapy (ONJ), confounding risk assessment. This study aimed to determine if ONJ is associated with one or more particular comorbidities.

Study Design: This was a retrospective case-control study of patients with ONJ and delayed healing (DH). Each case was matched for patient age and gender, as well as location of ONJ or DH lesion to a control patient who had a history of dentoalveolar surgery with uneventful healing and no history of antiresorptive therapy. Comorbidity data included medical conditions and smoking.

Results: Of the 92 patients identified, 67 (73%) met the criteria for ONJ and 25 (27%) for DH. The most common trigger for ONJ and DH was extraction (50%). The presence of any comorbidity (i.e., at least 1) was more prevalent in ONJ than among controls (P = .04), and there were more comorbidities in patients with ONJ and DH than in controls [M(SD) = 1.94 (1.2) and 2.0 (1.3) vs 1.26 (0.89); both P < .001].

Conclusions: ONJ and DH are not limited to patients with a history of antiresorptive therapy. More comorbidities may signal increased risk for ONJ and DH.