Association between periodontal disease, tooth extraction, and medication-related osteonecrosis of the jaw in women receiving bisphosphonates: A national cohort-based study

Min Jeong Kwoen; Jung Hyun Park; Keun Suh Kim; Jae Ryun Lee; Jin Woo Kim; Hyejin Lee; Hyo Jung Lee

doi:10.1002/JPER.21-0611

Association between periodontal disease, tooth extraction, and medication-related osteonecrosis of the jaw in women receiving bisphosphonates: A national cohort-based study

Min Jeong Kwoen, Jung Hyun Park, Keun Suh Kim, Jae Ryun Lee, Jin Woo Kim, Hyejin Lee, Hyo Jung Lee

Department of Dentistry

Research output: Contribution to journal › Article › peer-review

13 Scopus citations

Abstract

Background: We investigated whether periodontal diseases contribute to the development of medication-related osteonecrosis of the jaw (MRONJ) in addition to tooth extraction, which is a major risk factor for MRONJ occurrence. Methods: This retrospective, nationwide cohort study was performed using South Korea's National Health Insurance Service database on women aged > 50 years who took bisphosphonates for at least 1 year between 2010 and 2015. MRONJ, periodontal disease, and tooth extraction were defined using the claims data. Results: Among the 27,168 patients analyzed, the incidence of confirmed MRONJ was significantly higher in the periodontal disease group (0.58%) than in the nonperiodontal disease group (0.31%). While extraction alone showed an increased risk of MRONJ development (hazard ratio [HR] = 1.61, 95% confidence interval [CI]: 0.74–3.52), periodontal disease without tooth extraction also indicated a similar risk (HR = 1.68, 95% CI: 0.86–3.28); when a history of both periodontal disease and tooth extraction was present, the HR significantly increased to 2.55 (95% CI: 1.41–4.64). Conclusions: The risk of MRONJ increased significantly when tooth extraction was performed in patients diagnosed with periodontal disease; therefore, periodontal diseases should be proactively managed in patients taking bisphosphonates.

Original language	English
Pages (from-to)	98-107
Number of pages	10
Journal	Journal of Periodontology
Volume	94
Issue number	1
DOIs	https://doi.org/10.1002/JPER.21-0611
State	Published - Jan 2023

Bibliographical note

Funding Information:
This study was analyzed using the National Health Information Database (NHIS‐2020–2‐154) created by the National Health Insurance Service (NHIS). The National Health Information Database was provided by the NHIS of South Korea. The results were not influenced by the NHIS. The authors express our gratitude for the cooperation of NHIS. This work was supported by the Seoul National University Bundang Hospital (Nos. 02‐2018‐042 and 06‐2020‐020) and National Research Foundation of Korea (NRF) grant funded by the Korean government (MSIT) (Nos. 2020R1A2C4001842 and 2021R1A2C100646611).

Funding Information:
This study was analyzed using the National Health Information Database (NHIS-2020–2-154) created by the National Health Insurance Service (NHIS). The National Health Information Database was provided by the NHIS of South Korea. The results were not influenced by the NHIS. The authors express our gratitude for the cooperation of NHIS. This work was supported by the Seoul National University Bundang Hospital (Nos. 02-2018-042 and 06-2020-020) and National Research Foundation of Korea (NRF) grant funded by the Korean government (MSIT) (Nos. 2020R1A2C4001842 and 2021R1A2C100646611).

Publisher Copyright:
© 2022 The Authors. Journal of Periodontology published by Wiley Periodicals LLC on behalf of American Academy of Periodontology.

Keywords

bisphosphonate-related osteonecrosis of the jaw
osteonecrosis
periodontal diseases
tooth extraction

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10.1002/JPER.21-0611

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@article{aff6a4621daa46ddac65be89f54b057c,

title = "Association between periodontal disease, tooth extraction, and medication-related osteonecrosis of the jaw in women receiving bisphosphonates: A national cohort-based study",

abstract = "Background: We investigated whether periodontal diseases contribute to the development of medication-related osteonecrosis of the jaw (MRONJ) in addition to tooth extraction, which is a major risk factor for MRONJ occurrence. Methods: This retrospective, nationwide cohort study was performed using South Korea's National Health Insurance Service database on women aged > 50 years who took bisphosphonates for at least 1 year between 2010 and 2015. MRONJ, periodontal disease, and tooth extraction were defined using the claims data. Results: Among the 27,168 patients analyzed, the incidence of confirmed MRONJ was significantly higher in the periodontal disease group (0.58%) than in the nonperiodontal disease group (0.31%). While extraction alone showed an increased risk of MRONJ development (hazard ratio [HR] = 1.61, 95% confidence interval [CI]: 0.74–3.52), periodontal disease without tooth extraction also indicated a similar risk (HR = 1.68, 95% CI: 0.86–3.28); when a history of both periodontal disease and tooth extraction was present, the HR significantly increased to 2.55 (95% CI: 1.41–4.64). Conclusions: The risk of MRONJ increased significantly when tooth extraction was performed in patients diagnosed with periodontal disease; therefore, periodontal diseases should be proactively managed in patients taking bisphosphonates.",

keywords = "bisphosphonate-related osteonecrosis of the jaw, osteonecrosis, periodontal diseases, tooth extraction",

author = "Kwoen, {Min Jeong} and Park, {Jung Hyun} and Kim, {Keun Suh} and Lee, {Jae Ryun} and Kim, {Jin Woo} and Hyejin Lee and Lee, {Hyo Jung}",

note = "Funding Information: This study was analyzed using the National Health Information Database (NHIS‐2020–2‐154) created by the National Health Insurance Service (NHIS). The National Health Information Database was provided by the NHIS of South Korea. The results were not influenced by the NHIS. The authors express our gratitude for the cooperation of NHIS. This work was supported by the Seoul National University Bundang Hospital (Nos. 02‐2018‐042 and 06‐2020‐020) and National Research Foundation of Korea (NRF) grant funded by the Korean government (MSIT) (Nos. 2020R1A2C4001842 and 2021R1A2C100646611). Funding Information: This study was analyzed using the National Health Information Database (NHIS-2020–2-154) created by the National Health Insurance Service (NHIS). The National Health Information Database was provided by the NHIS of South Korea. The results were not influenced by the NHIS. The authors express our gratitude for the cooperation of NHIS. This work was supported by the Seoul National University Bundang Hospital (Nos. 02-2018-042 and 06-2020-020) and National Research Foundation of Korea (NRF) grant funded by the Korean government (MSIT) (Nos. 2020R1A2C4001842 and 2021R1A2C100646611). Publisher Copyright: {\textcopyright} 2022 The Authors. Journal of Periodontology published by Wiley Periodicals LLC on behalf of American Academy of Periodontology.",

year = "2023",

month = jan,

doi = "10.1002/JPER.21-0611",

language = "English",

volume = "94",

pages = "98--107",

journal = "Journal of Periodontology",

issn = "0022-3492",

publisher = "John Wiley & Sons Inc.",

number = "1",

}

TY - JOUR

T1 - Association between periodontal disease, tooth extraction, and medication-related osteonecrosis of the jaw in women receiving bisphosphonates

T2 - A national cohort-based study

AU - Kwoen, Min Jeong

AU - Park, Jung Hyun

AU - Kim, Keun Suh

AU - Lee, Jae Ryun

AU - Kim, Jin Woo

AU - Lee, Hyejin

AU - Lee, Hyo Jung

N1 - Funding Information: This study was analyzed using the National Health Information Database (NHIS‐2020–2‐154) created by the National Health Insurance Service (NHIS). The National Health Information Database was provided by the NHIS of South Korea. The results were not influenced by the NHIS. The authors express our gratitude for the cooperation of NHIS. This work was supported by the Seoul National University Bundang Hospital (Nos. 02‐2018‐042 and 06‐2020‐020) and National Research Foundation of Korea (NRF) grant funded by the Korean government (MSIT) (Nos. 2020R1A2C4001842 and 2021R1A2C100646611). Funding Information: This study was analyzed using the National Health Information Database (NHIS-2020–2-154) created by the National Health Insurance Service (NHIS). The National Health Information Database was provided by the NHIS of South Korea. The results were not influenced by the NHIS. The authors express our gratitude for the cooperation of NHIS. This work was supported by the Seoul National University Bundang Hospital (Nos. 02-2018-042 and 06-2020-020) and National Research Foundation of Korea (NRF) grant funded by the Korean government (MSIT) (Nos. 2020R1A2C4001842 and 2021R1A2C100646611). Publisher Copyright: © 2022 The Authors. Journal of Periodontology published by Wiley Periodicals LLC on behalf of American Academy of Periodontology.

PY - 2023/1

Y1 - 2023/1

N2 - Background: We investigated whether periodontal diseases contribute to the development of medication-related osteonecrosis of the jaw (MRONJ) in addition to tooth extraction, which is a major risk factor for MRONJ occurrence. Methods: This retrospective, nationwide cohort study was performed using South Korea's National Health Insurance Service database on women aged > 50 years who took bisphosphonates for at least 1 year between 2010 and 2015. MRONJ, periodontal disease, and tooth extraction were defined using the claims data. Results: Among the 27,168 patients analyzed, the incidence of confirmed MRONJ was significantly higher in the periodontal disease group (0.58%) than in the nonperiodontal disease group (0.31%). While extraction alone showed an increased risk of MRONJ development (hazard ratio [HR] = 1.61, 95% confidence interval [CI]: 0.74–3.52), periodontal disease without tooth extraction also indicated a similar risk (HR = 1.68, 95% CI: 0.86–3.28); when a history of both periodontal disease and tooth extraction was present, the HR significantly increased to 2.55 (95% CI: 1.41–4.64). Conclusions: The risk of MRONJ increased significantly when tooth extraction was performed in patients diagnosed with periodontal disease; therefore, periodontal diseases should be proactively managed in patients taking bisphosphonates.

AB - Background: We investigated whether periodontal diseases contribute to the development of medication-related osteonecrosis of the jaw (MRONJ) in addition to tooth extraction, which is a major risk factor for MRONJ occurrence. Methods: This retrospective, nationwide cohort study was performed using South Korea's National Health Insurance Service database on women aged > 50 years who took bisphosphonates for at least 1 year between 2010 and 2015. MRONJ, periodontal disease, and tooth extraction were defined using the claims data. Results: Among the 27,168 patients analyzed, the incidence of confirmed MRONJ was significantly higher in the periodontal disease group (0.58%) than in the nonperiodontal disease group (0.31%). While extraction alone showed an increased risk of MRONJ development (hazard ratio [HR] = 1.61, 95% confidence interval [CI]: 0.74–3.52), periodontal disease without tooth extraction also indicated a similar risk (HR = 1.68, 95% CI: 0.86–3.28); when a history of both periodontal disease and tooth extraction was present, the HR significantly increased to 2.55 (95% CI: 1.41–4.64). Conclusions: The risk of MRONJ increased significantly when tooth extraction was performed in patients diagnosed with periodontal disease; therefore, periodontal diseases should be proactively managed in patients taking bisphosphonates.

KW - bisphosphonate-related osteonecrosis of the jaw

KW - osteonecrosis

KW - periodontal diseases

KW - tooth extraction

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SN - 0022-3492

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Association between periodontal disease, tooth extraction, and medication-related osteonecrosis of the jaw in women receiving bisphosphonates: A national cohort-based study

Abstract

Bibliographical note

Keywords

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