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Originally published as JCO Early Release 10.1200/JCO.2008.16.2768 on June 23 2008

Journal of Clinical Oncology, Vol 26, No 28 (October 1), 2008: pp. 4634-4638
© 2008 American Society of Clinical Oncology.

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Bisphosphonate-Related Osteonecrosis of the Jaws: A Case-Control Study of Risk Factors in Breast Cancer Patients

Athanassios Kyrgidis, Konstantinos Vahtsevanos, Georgios Koloutsos, Charalampos Andreadis, Ioannis Boukovinas, Zisis Teleioudis, Anna Patrikidou, Stefanos Triaridis

From the Department of Oral Maxillofacial Surgery, 3rd Department of Clinical Oncology, and 2nd Department of Clinical Oncology, Theagenio Cancer Hospital; and 1st University Department of Otolaryngology, Aristotle University, AHEPA Hospital, Thessaloniki, Greece

Corresponding author: Kyrgidis Athanassios, MD, 3 Papazoli St, 546 30, Thessaloniki, Greece; e-mail: akyrgidi{at}, akyrgidi{at}

Purpose Osteonecrosis of the jaws (ONJ) was initially described in 2001 in patients receiving intravenous bisphosphonate (BP) treatment. The objective of the present study was to determine whether routine dental procedures can be considered as possible risk factors for the development of ONJ in breast cancer patients receiving BP.

Patients and Methods Twenty breast cancer patients who developed ONJ receiving BP treatment were included in group A, whereas group B consisted of 40 matched controls (breast cancer patients who did not progress to ONJ receiving BP treatment). Routine dental care, smoking habits, history of tooth extraction, use of dentures, and root canal therapy were recorded.

Results Our results indicate that history of tooth extraction during zoledronic acid treatment (adjusted odds ratio [OR] = 16.4; 95% CI, 3.4 to 79.6) and the use of dentures (adjusted OR = 4.9; 95% CI, 1.2 to 20.1) increase the risk of developing ONJ.

Conclusion The outcome of the present study suggests early referral by oncologists for dental evaluation for every patient to be treated with BP. These results raise the current American Society of Clinical Oncology Level of Evidence linking certain dental procedures with ONJ from V to III. Further studies are needed to assess other possible risk factors and also to highlight the etiopathogenesis mechanism of ONJ.

published online ahead of print at on June 23, 2008.

Authors’ disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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