Risk Factors for Bisphosphonate Bone Complications Save

Rare reports of bisphosphonate associated atypical femoral fractures (AFF) and osteonecrosis of the jaw (ONJ) have raised concerns about the chronic use of bisphosphonates. The risk of AFF and ONJ was assessed in an analysis of the Swedish national database.  

They found a lack of overlap in AFF and ONJ risk factors. The only risk factor for AFF was long-term bisphosphonate use. ONJ risk factors identified included intravenous bisphosphonate use, invasive dental procedures and dental prostheses, cancer (especially multiple myeloma), and possibly, long-term bisphosphonate treatment and rheumatoid arthritis.

They found 167 cases of ONJ and 55 AFF amoung those taking bisphosphonates. For ONJ versus controls, significant differences were seen for time to onset (1240 vs 111 days), intravenous administration (40% vs 20%), dental procedures (49% vs 0.2%) and prostheses (5% vs 0%), cancer disease (44% vs 12%), multiple myeloma (21% vs 1%), rheumatoid arthritis (14% vs 5%), and treatment with antineoplastic agents and oxycodone.