This Article Full Text Full Text (PDF) Submit a related Letter to the Editor Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Copyright Permission Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Khamaisi, M. Articles by Elad, S. Search for Related Content PubMed PubMed Citation Articles by Khamaisi, M. Articles by Elad, S. Pubmed/NCBI databases Medline Plus Health Information Diabetes Osteonecrosis Related Collections Calcium and Bone Metabolism Diabetes and Insulin

Possible Association between Diabetes and Bisphosphonate-Related Jaw Osteonecrosis

Department of Internal Medicine B and the Diabetes Center (M.K., E.L., I.R.), Hebrew University-Hadassah Medical Center, Departments of Oral and Maxillofacial Surgery (E.R.) and Oral Medicine (S.E.), Hebrew University-Hadassah School of Dental Medicine, and Department of Hematology (B.A., S.E.), Hadassah Medical Center, Jerusalem 91120, Israel; and Department of Oral Pathology and Oral Medicine (N.Y.), The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv 69978, Israel

Address all correspondence and requests for reprints to: Mogher Khamaisi, M.D., Ph.D., Department of Internal Medicine B and the Diabetes Center, Hebrew University-Hadassah Medical Center, Kiryat Hadassah, P.O. Box 12000, Jerusalem 91120, Israel. E-mail: murir{at}hadassah.org.il; or mogher{at}bgumail.bgu.ac.il.

Context: Bisphosphonate-related osteonecrosis (BON) of the jaws is a newly identified condition for which the exact mechanism involved in its pathogenesis remains obscure.

Objective: The objective of the study was to evaluate whether diabetes mellitus (DM) may be a contributing factor in the development of BON.

Design: From 2004 to 2006, 31 patients were diagnosed with BON. The diagnosis of BON was based on the medical and dental history of each patient as well as the observation of clinical signs and symptoms of this pathological process. DM was based on two consecutive fasting blood glucose levels above 7 mmol/liter.

Setting: The study was completed in the Hebrew University-Hadassah Hospital referral center.

Results: Of the 31 patients with BON, 18 (58%) were found to have DM or impaired fasting glucose. The proportion of diabetic patients was much higher than expected relative to the incidence of DM in the general population (14%) and compared with the proportion of diabetic patients in a control group of oncological patients treated with bisphosphonates and without BON (12%) (P = 0.00003).

Conclusions: This finding indicates that DM may be a risk factor for BON and that DM patients treated with bisphosphonates should be carefully monitored. We discuss here the bone metabolic pathways characteristic of DM patients and the way in which these pathways can augment the effects of bisphosphonates.

This article has been cited by other articles:

				A. A. KHAN, G. K.B. SANDOR, E. DORE, A. D. MORRISON, M. ALSAHLI, F. AMIN, E. PETERS, D. A. HANLEY, S. R. CHAUDRY, B. LENTLE, et al. Bisphosphonate Associated Osteonecrosis of the Jaw J Rheumatol, March 1, 2009; 36(3): 478 - 490. [Abstract] [Full Text] [PDF]

				M. Khamaisi and S. Elad Re: Intravenous Bisphosphonate Therapy and Inflammatory Conditions or Surgery of the Jaw: A Population-Based Analysis J Natl Cancer Inst, January 16, 2008; 100(2): 155 - 155. [Full Text] [PDF]

				G. S. Wilkinson, Y.-F. Kuo, J. L. Freeman, and J. S. Goodwin Response: Re: Intravenous Bisphosphonate Therapy and Inflammatory Conditions or Surgery of the Jaw: A Population-Based Analysis J Natl Cancer Inst, January 16, 2008; 100(2): 155 - 156. [Full Text] [PDF]

				J. T. Grbic, R. Landesberg, S.-Q. Lin, P. Mesenbrink, I. R. Reid, P.-C. Leung, N. Casas, C. P. Recknor, Y. Hua, P. D. Delmas, et al. Incidence of Osteonecrosis of the Jaw in Women With Postmenopausal Osteoporosis in the Health Outcomes and Reduced Incidence With Zoledronic Acid Once Yearly Pivotal Fracture Trial J Am Dent Assoc, January 1, 2008; 139(1): 32 - 40. [Abstract] [Full Text] [PDF]

				G. D. Roodman Skeletal Imaging and Management of Bone Disease Hematology, January 1, 2008; 2008(1): 313 - 319. [Abstract] [Full Text] [PDF]

				M. J. Favus Diabetes and the Risk of Osteonecrosis of the Jaw J. Clin. Endocrinol. Metab., March 1, 2007; 92(3): 817 - 818. [Full Text] [PDF]