Diabetes Microvascular Disease and the Risk for bisphosphonate-related Osteonecrosis of the Jaw: A Single Center Study

Context: Bisphosphonate-related osteonecrosis of the jaws (BRONJ) is a severe bone disease for which the exact pathogenesis mechanisms are not fully understood. Objective: The objective of the study is to investigate a possible contribution of diabetes and microvascular disease to the pathophysiology of BRONJ. Design: Weidentified 46 patients treated with bisphosphonates who were diagnosed with BRONJ based on their medical history during 2009 to 2012 and invited them for a dental assessment to confirm the diagnosis. Diabetes diagnosis was based on the American Diabetes Association criteria. The study group was compared to a control group of 38 patients treated with bisphosphonates without evidence of BRONJ. Setting: The study was conducted at Rambam Health Care Campus, a referral center, Haifa, Israel. Results: The results of our study showed that of the 46 patients with BRONJ, 31 (67.4%) had diabetes or impaired fasting glucose. The proportion with diabetes (37%) was higher than in the control group (26.3%; P =.009). The presence of diabetes or impaired fasting glucose increased the association with BRONJ by 2.78-fold (confidence interval 1.27-6.07, P =.009). The prevalence of microvascular disease (neuropathy, retinopathy, nephropathy) was significantly higher in the BRONJ than in the control group (P =.01). The presence of diabetic nephropathy increased the association with BRONJ by 3.9-fold (confidence interval +/- 1.1213.52, P +/-.02). Conclusions: This retrospective study suggests an association between diabetes, perhaps mediated through microvascular complications, and the development of BRONJ.