You are here

  • Home
  • Archive
  • Volume 9, Issue 2
  • Increased risk of bisphosphonate-related osteonecrosis of the jaw in patients with Sjögren’s syndrome: nationwide population-based cohort study

Article Text

Article menu

Download PDFPDF

XML
Rheumatology
Research
Increased risk of bisphosphonate-related osteonecrosis of the jaw in patients with Sjögren’s syndrome: nationwide population-based cohort study
  1. Min-Tser Liao1,2,
  2. Wu-Chien Chien3,4,5,
  3. Jen-Chun Wang6,
  4. Chi-Hsiang Chung3,4,7,
  5. Shi-Jye Chu8,
  6. Shih-Hung Tsai6,9
  1. 1 Department of Pediatrics, Taoyuan Armed Forces General Hospital, Taoyuan, Taiwan
  2. 2 Department of Pediatrics, Tri-Service General Hospital, National Defense MedicalCenter, Taipei, Taiwan
  3. 3 Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
  4. 4 School of Public Health, National Defense Medical Center, Taipei, Taiwan
  5. 5 Taiwanese Injury Prevention and Safety Promotion Association, Taipei, Taiwan
  6. 6 Department of Emergency Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
  7. 7 Taiwanese Injury Prevention and Safety Promotion Association, Taipei, Taiwan
  8. 8 Division of Rheumatology, Immunology and Allergy, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
  9. 9 Department of Physiology and Biophysics, Graduate Institute of Physiology, NationalDefense Medical Center, Taipei, Taiwan.
  1. Correspondence to Dr Shih-Hung Tsai; tsaishihung{at}yahoo.com.tw, tsaishihung{at}gmail.com

Abstract

Objective The aim of this study was to explore whether patients with Sjögren’s syndrome (SS) were susceptible to bisphosphonate (BP)-related osteonecrosis of the jaw (BRONJ) after tooth extraction in the entire population of Taiwan.

Design A nationwide population-based retrospective cohort study.

Setting Data were extracted from Taiwan’s National Health Insurance Research Database (NHIRD).

Methodology Medical conditions for both the study and control group were categorised using the International Classification of Diseases, 9th Revision. ORs and 95% CIs for associations between SS and osteonecrosis of the jaw (ONJ) were estimated using Cox regression.

Results Overall, 13 398 patients diagnosed with SS were identified from the NHIRD. An additional 53 592 matched patients formed the control group. At the 3-year follow-up, patients with SS started to exhibit a significantly increased cumulative risk of developing BRONJ compared with that of patients without SS (log rank test <0.001). At the end of the follow-up period, patients with SS exhibited a significantly increased incidence of ONJ compared with that of the controls (0.08%vs0.03%, p=0.017). The Cox regression model showed that patients with SS also exhibited a significantly increased risk of developing BRONJ compared with that of the patients without SS (adjusted HR=7.869, 95% CI 3.235 to 19.141, p<0.001).

Conclusion Patients with SS exhibit an increased risk of developing BRONJ after tooth extraction. BPs should be used with caution in patients with SS.

  • sjögren’s syndrome
  • bisphosphonate
  • osteonecrosis of the jaw
  • national health insurance

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjopen-2018-024655

Statistics from Altmetric.com

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    View Full Text

    Footnotes

    • Patient consent for publication Not required.

    • Contributors M-TL and S-HT wrote the manuscript. J-CW and S-HT conceived and designed the study. W-CC and C-HC provided the materials and analysis tools for the study. C-HC and S-JC analysed the data. All the authors approved the manuscript.

    • Funding This study was supported by grants from the Taoyuan Armed Forces General Hospital (AFTYGH-10706 and 10707), the Tri-Service General Hospital of the National Defense Medical Center in Taipei, Taiwan (TSGH-C107-004, TSGHC107- 045, TSGH-C107-047) and the Ministry of Science and Technology (MOST 106-2314-B-016-031 and MOST 106-2314-B-016-008-MY3).

    • Competing interests None declared.

    • Ethics approval This study protocol was approved and carried out by the Institutional Review Board of the Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement No additional unpublished data from the study.