Multicenter prospective study on the development of bisphosphonate-related osteonecrosis of the jaw after tooth extraction in patients treated with bisphosphonates (complete translation)

This study aimed to determine the frequency of bisphosphonate-related osteonecrosis of the jaw (BRONJ) after tooth extraction in patients treated with bisphosphonates (BPs) and to assess the efficacy of preventive BPs discontinuation in reducing BRONJ risk. A 26-center prospective study was conducted on 1323 patients with current or past BPs treatment (2013–2016). Patients underwent tooth extraction under a standardized protocol, and the incidence of BRONJ and adverse events were evaluated. Among 1323 cases (2371 teeth extracted), 808 were in the preventive BPs discontinuation group, and 515 were in the BPs continuation group. The overall BRONJ incidence was 1.74%, with rates of 1.73% and 1.75% in the discontinuation and continuation groups, respectively (P = 1.000). The incidence rates of BRONJ in the osteoporosis and malignancy groups were 1.23% and 28.00%, respectively (P < 0.001). Factors associated with BRONJ development included sex, BPs indications, oral hygiene, tooth extraction site, and denosumab use. Propensity score analysis using the inverse probability weighting method showed no significant association between BRONJ development and preventive BPs discontinuation (P = 0.834; odds ratio: 1.131, 95% confidence interval: 0.36–3.57). No fragility fractures occurred in the discontinuation group. The incidence of BRONJ after tooth extraction in patients receiving BPs was 1.74%, with no preventive effect of BPs discontinuation in the osteoporosis group. Significant risk factors included sex, denosumab use, BPs indication, oral hygiene, and extraction site.