ArticleFrontiers in endocrinology2021
Gradual, but Not Sudden, Dose-Dependent Increase of ONJ Risk With Bisphosphonate Exposure: A Nationwide Cohort Study in Women With Osteoporosis.
Article in Frontiers in endocrinology, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers.
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Who cites it
15 citing papers in PubMed, 20 citations in OpenAlex.
- The Bisphosphonate Accumulation Index (BAI): A Quantitative Metric for Cumulative Antiresorptive Exposure in Pre-Procedural Dental and Surgical Assessment.Dentistry journal · 2026Article
- The therapeutic window: timing dentoalveolar surgery to minimize MRONJ risk in denosumab-treated osteoporotic patients.JBMR plus · 2026Article
- Asia-Pacific consensus statement on medication-related osteonecrosis of the jaw in patients with osteoporosis.Osteoporosis and sarcopenia · 2026Review
- Medication-related osteonecrosis of the jaw: an evidence-based 2025 position statement from a Korean multidisciplinary task force.Journal of the Korean Association of Oral and Maxillofacial Surgeons · 2025Review
- Medication-Related Osteonecrosis of the Jaw: An Evidence-Based 2025 Position Statement from a Korean Multidisciplinary Task Force.Endocrinology and metabolism (Seoul, Korea) · 2025Article
- Time since last intravenous bisphosphonate and risk of osteonecrosis of the jaw in osteoporotic patients.Nature communications · 2025Article
- Prevalence of MRONJ in patients treated with antiresorptive agents for glucocorticoid-induced osteoporosis.Oral and maxillofacial surgery · 2025Article
- Case Report: single low-dose of denosumab as a trigger of MRONJ development in a patient with osteoporosis after bisphosphonate therapy.Frontiers in oral health · 2024Article
- Association of gamma-glutamyl transferase variability with risk of venous thrombosis.Scientific reports · 2023Article
- Association of Oral Health with Risk of Rheumatoid Arthritis: A Nationwide Cohort Study.Journal of personalized medicine · 2023Article
- Association of high estimated glomerular filtration rate with risk of atrial fibrillation: a nationwide cohort study.Frontiers in medicine · 2023Article
- Better oral hygiene is associated with a reduced risk of osteoporotic fracture: a nationwide cohort study.Frontiers in endocrinology · 2023Article
- Better Oral Hygiene Is Associated with a Decreased Risk of Meniere's Disease: A Nationwide Cohort Study.Journal of personalized medicine · 2022Article
- Improved Oral Health Status Is Associated with a Lower Risk of Venous Thromboembolism: A Nationwide Cohort Study.Journal of personalized medicine · 2022Article
- Better oral hygiene is associated with a reduced risk of cataract: A nationwide cohort study.Frontiers in medicine · 2022Article
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Authors and funding
7 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Background: A causal relationship of bisphosphonate (BP) exposure with osteonecrosis of the jaw (ONJ) has been reported; however, a definite dose-dependent risk remains to be elucidated beyond current vague recommendations of 4-year oral BP for ONJ risk increase. Objective: To identify the effect of bisphosphonate cumulative dose on ONJ development in women with osteoporosis. Methods: A retrospective cohort study was designed using the National Health Insurance Service-National Health Screening database of Korea. Females over the age of 50 were diagnosed with osteoporosis based on the International Classification of Diseases 10th revision (ICD-10) codes (M80, M81, and M82) with bisphosphonate prescriptions. The cumulative dose of bisphosphonate was calculated using defined daily doses (DDD) to provide an accurate BP cumulative effect on ONJ occurrence. Osteonecrosis of the jaw was identified using both ICD-10 codes and related procedure codes. The incidence rates of ONJ and hazard ratios were estimated according to the bisphosphonate cumulative dose. Results: Among 74,491 included subjects, 190 cases of ONJ were identified. The incidence rate substantially increased after BP cumulative dose over 1 year (25.75 for DDD < 365, which increased to 53.43 for 365 ≤ DDD < 730). Compared to subjects with a cumulative dose of DDD < 365, subjects with a cumulative dose of 365 ≤ DDD < 730 had 2.36-fold hazard for developing ONJ (p < 0.001). Conclusion: A bisphosphonate cumulative dose of more than 1 year had an increased risk of ONJ development. A gradual, but not sudden, dose-dependent increase in ONJ risk with BP exposure needs to be considered in providing the optimal BP treatment duration.
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