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Does osteoporosis treatment increase the risk of osteonecrosis of sites other than the jaw?

Key clinical point: The use of bone-specific drugs (BSDs), especially more potent BSDs, is associated with a higher risk of osteonecrosis of sites other than the jaw; this increased risk decreases after the final dose of BSD.

Major finding: The risk of osteonecrosis was increased in BSD users (adjusted hazard ratio [HR], 4.02). The osteonecrosis risk was higher with denosumab (HR, 1.93; 95% confidence interval [95% CI], 1.33-2.79) and zoledronic acid (HR, 1.95; 95% CI, 1.31-2.91) than with other BSDs, primarily alendronate. The increased risk of osteonecrosis reduced after the end of therapy (P less than .001 for time trend).

Study details: The findings are based on 2 studies, a cohort study and a case-control study, conducted using the Swedish registry data (n = 3,523,912; aged, 50 years or older).

Disclosures: No study sponsor was identified. The authors declared no conflicts of interest.


Nordström P et al. J Bone Miner Res. 2020 May 7. doi: 10.1002/jbmr.4040.