Risk of bisphosphonate-related osteonecrosis of the jaw in implants vs. extractions: a nationwide population-based study

Abstract

ObjectivesThis study aimed to investigate the incidence of and factors associated with bisphosphonate-related osteonecrosis of the jaw (BRONJ) after dental procedures in South Korean patients with osteoporosis who use bisphosphonates, using a nationwide population-based approach.Materials and methodsThe study utilised the National Health Insurance Service- National Health Information Database (NHIS-NHID), which covers the entire South Korean population. Patients diagnosed with osteoporosis between 2010 and 2018 were included, excluding those with malignant neoplasms, Paget's disease, or multiple myeloma. BRONJ cases were identified based on diagnostic codes, multiple outpatient visits or hospitalisation, and ONJ-specific treatments. Variables included age, sex, medications, and dental-related clinical information. Multiple logistic regression was used to determine the odds ratios for BRONJ incidence after dental treatment.ResultsAmong 57,572 patients, 250 developed BRONJ after dental treatment. The overall BRONJ incidence was 0.43%, with an incidence of 0.85% in extraction, 0.27% in periodontal treatment, and 0.13% in implant surgery. Implant surgeries (odds ratio = 0.15) and periodontal treatments (odds ratio = 0.32) had a significantly lower association with BRONJ compared to tooth extraction. Increasing age and longer duration of bisphosphonate use were associated with a higher incidence of BRONJ, but longer drug holidays were associated with a lower incidence of BRONJ.ConclusionImplant surgeries and periodontal treatments had a lower association with BRONJ compared to extraction. A longer bisphosphonate medication duration showed a higher association with possible BRONJ.Clinical relevanceThis study suggests that tooth extraction is more strongly associated with BRONJ compared to implant surgery or periodontal treatment. To minimise the incidence of BRONJ, it is important to consider patient age and duration of bisphosphonate treatment.