Systematic literature review of bisphosphonates and osteonecrosis of the jaw in patients with osteoporosis.

OBJECTIVE: To systematically assess the literature related to the occurrence of osteonecrosis of the jaw (ONJ) using bisphosphonates (BP) in the treatment of osteoporosis (OP). METHODS: We conducted a systematic literature search in PubMed, EMBASE and the Cochrane Central Register of Controlled Trials up to July 2010, including terms relating to OP, ONJ, and BP (MeSH and free text). We selected meta-analysis, systematic reviews and clinical trials (CT), English or Spanish, including patients > 18 years of both sexes with OP treated with BF (intravenous and oral). Furthermore, studies should evaluate the occurrence of ONJ during treatment with BF. We excluded studies that included patients with cancer or diseases other than OP, animal studies and basic science. The selection of articles both by title and 2 independent reviewers conducted a detailed review of the abstracts. We used the modified Oxford Scale (version 2001) to assess the quality of the included studies. RESULTS: We identified 1422 articles of which we included 18 (8 systematic reviews, 8 CT and 2 meta-analysis). Most studies were of good quality and examined the use of BF in middle-aged women with OP. Frequency of ONJ was low. CONCLUSIONS: We found insufficient evidence to affirm that intravenous or oral BF used exclusively for the treatment of OP lead to a significant risk of ONJ (evidence level 2a, grade B recommendation).