Endocrine Abstracts (2017) 50 P055 | DOI: 10.1530/endoabs.50.P055

The incidence of Bisphosphonate related Osteonecrosis of the Jaw (BONJ) in patients treated with oral bisphosphonates for osteoporosis

Fergus MacLean1, Rebecca Mason2, Jeff Downie2, Iain Watt3, Andrew Gallagher4, Stephen Gallacher4 & John Hinnie4


1Dept Endocrinology, Queen Elizabeth University Hospital, 1345 Glasgow Road, G51 4TF, Glasgow, UK; 2Dept of Oral and Maxillofacial Surgery, Forth Valley Royal Hospital, Stirling Road, FK5 4WR, Larbert, UK; 3Prescribing Support Team, Pharmacy Services, NHS Forth Valley, Falkirk Community Hospital, Westburn Avenue, FK1 5QE, Falkirk, UK; 4Dept of Endocrinology, Queen Elizabeth University Hospital, 1345 Glasgow Road, G51 4TF, Glasgow, UK.


Introduction: BONJ is a recognised complication of bisphosphonate treatment (both oral and intravenous). Data are sparse with the reported incidence of BONJ in the oral treatment of osteoporosis between 0.01% to 0.067% or alternatively described as 1.04 to 69 per 100,000 patient-years. This study aimed to estimate the incidence of BONJ in patients taking oral bisphosphonates as a treatment for osteoporosis.

Methods: Forth Valley Health Board (GP Practice population 317,641, Forth Valley Health Board data, 1/10/16) has one treatment centre for BONJ at Forth Valley Royal Hospital. From September 2015 to September 2016 all cases of BONJ were recorded. Data on prescriptions for bisphosphonates dispensed in the community were extracted from NHS Scotland’s Prescribing Information System for the period September 2015 to September 2016 inclusive.

Results: In 2015–16, 4978 individuals in Forth Valley had oral bisphosphonate prescriptions dispensed in the community. In 2015–16 there were 8 cases of BONJ. 3 cases were receiving intravenous bisphosphonates (cancer therapy) and were excluded. 5 individuals, with post code addresses in Forth Valley, were taking oral bisphosphonates for osteoporosis treatment (4 female, 1 male, age range 51–90 years with a median of 84 years, average 73 years). They were receiving oral alendronic acid (70 mg weekly) with a range of elapsed treatment time to BONJ of 29 to 117 months (median 47, average 60.2). Tooth extraction appeared to be the precipitating factor in 4 of the 5 cases. In our study there were no recorded cases of osteonecrosis of the jaw without the use of bisphosphonates.

The incidence of BONJ for those treated with oral bisphosphonates for osteoporosis was 0.1%.

Conclusion: Studies have shown a significant variation in the incidence of BONJ. This study suggests an incidence, in our population, higher than previously reported. The reason for this is not clear.

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