Gas-Phase Ion-Molecule Reactions of Copper Hydride Anions [CuH2]- and [Cu2H3].

Gas-phase reactivity of the copper hydride anions [CuH2]- and [Cu2H3]- toward a range of neutral reagents has been examined via multistage mass spectrometry experiments in a linear ion trap mass spectrometer in conjunction with isotope labeling studies and Density Functional Theory (DFT) calculations. [CuH2]- is more reactive than [Cu2H3]-, consistent with DFT calculations, which show it has a higher energy HOMO. Experimentally, [CuH2]- was found to react with CS2 via hydride transfer to give thioformate (HCS2-) in competition with the formation of the organometallic [CuCS2]- ion via liberation of hydrogen; CO2 via insertion to produce [HCuO2CH]-; methyl iodide and allyl iodide to give I- and [CuHI]-; and 2,2,2-trifluoroethanol and 1-butanethiol via protonation to give hydrogen and the product anions [CuH(OCH2CF3)]- and [CuH(SBu)]-. In contrast, the weaker acid methanol was found to be unreactive. DFT calculations reveal that the differences in reactivity between CS2 and CO2 are due to the lower lying π* orbital of the former, which allows it to accept electron density from the Cu center to form the initial three-membered ring complex intermediate, [H2Cu(η2-CS2)]-. In contrast, CO2 undergoes the barrierless side-on hydride transfer promoted by the high electronegativity of the oxygen atoms. Side-on SN2 mechanisms for reactions of [CuH2]- with methyl iodide and allyl iodide are favored on the basis of DFT calculations. Finally, the DFT calculated barriers for protonation of [CuH2]- by methanol, 2,2,2-trifluoroethanol, and 1-butanethiol correlate with their gas-phase acidities, suggesting that reactivity is mainly controlled by the acidity of the substrate.

Non-Aqueous Microwave-Assisted Syntheses of Deca- and Hexa-Molybdovanadates.

We report a new approach for the synthesis of heterohexa- and heterodecametalates via the use of non-aqueous, microwave-assisted reaction conditions. The two novel molybdovanadates have been isolated and characterized in the solid and solution states using single-crystal X-ray diffraction, FT-IR, UV/Vis, multinuclear NMR spectroscopy, and ESI-MS. The relative stabilities of the possible structural isomers were probed using dispersion-corrected DFT calculations for both polyoxometalate systems.

Blue 'turn-on' fluorescent probes for the direct detection of free radicals and nitric oxide in Pseudomonas aeruginosa biofilms.

Two novel cell-permeable and bacteria-compatible 'turn-on' fluorescent probes, designed to be compatible in a multi-dye system and to fluoresce in the blue region exhibiting emission maxima of 440-490 nm, were synthesized. The profluorescent nitroxide probe (11) was developed to visualize and quantify free radical and redox processes, and the Cu(II)-complexed coumarin-based probe (16a) was developed for NO detection. Confocal laser-scanning microscopy and subsequent digital analysis of Pseudomonas aeruginosa biofilms stained with 11 or 16a determined that free radical and redox processes and NO generation occur predominantly in live cells during normal biofilm growth.

Economic crisis, austerity and unmet healthcare needs: the case of Greece.

BACKGROUND: The programme for fiscal consolidation in Greece has led to income decrease and several changes in health policy. In this context, this study aims to assess how economic crisis affected unmet healthcare needs in Greece. METHODS: Time series analysis was performed for the years 2004 through 2011 using the EU-SILC database. The dependent variable was the percentage of people who had medical needs but did not use healthcare services. Median income, unemployment and time period were used as independent variables. We also compared self-reported unmet healthcare needs drawn from a national survey conducted in pre-crisis 2006 with a similar survey from 2011 (after the onset of the crisis). A common questionnaire was used in both years to assess unmet healthcare needs, including year of survey, gender, age, health status, chronic disease, educational level, income, employment, health insurance status, and prefecture. The outcome of interest was unmet healthcare needs due to financial reasons. Ordinary least squares, as well as logistic regression analysis were conducted to analyze the results. RESULTS: Unmet healthcare needs increased after the enactment of austerity measures, while the year of participation in the survey was significantly associated with unmet healthcare needs. Income, educational level, employment status, and having insurance, private or public, were also significant determinants of unmet healthcare needs due to financial reasons. CONCLUSIONS: The adverse economic environment has significantly affected unmet health needs. Therefore health policy actions and social policy measures are essential in order to mitigate the negative impact on access to healthcare services and health status.

A Survey of Oral Cancer Screening Insurance Coverage in New York City.

Clinical studies show that fewer than 25% of people who visit a dentist regularly are screened for oral cancer, and that the majority of oral cancers present at an advanced stage, when cure rates are already abysmal. This study explores the current status of oral cancer screening coverage among a variety of insurance providers in New York City. The study focuses on determining the coverage and frequency of the cluster of salient CDT (dental) codes surrounding oral cancer screenings.

Bisphosphonates, Osteoporosis, and Osteonecrosis of the Jaw: A Critical Review of a Large Nested Case-Control Study.

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: A large national cohort study of the association between bisphosphonates and osteonecrosis of the jaw in patients with osteoporosis: A nested case-control study. Kwon JW, Park EJ, Jung SY, Sohn HS, Ryu H, Suh HS. JDR Clin Res Suppl 2015;94(9) Suppl 2:213S-9S. SOURCE OF FUNDING: 2014 Pusan National University Research Grant TYPE OF STUDY/DESIGN: Nested matched case-control study.

Decomposition of nitroimidazole ions: experiment and theory.

Nitroimidazoles are important compounds with chemotherapeutic applications as antibacterial drugs or as radiosensitizers in radiotherapy. Despite their use in biological applications, little is known about the fundamental properties of these compounds. Understanding the ionization reactions of these compounds is crucial in evaluating the radiosensitization potential and in developing new and more effective drugs. Thus, the present study investigates the decomposition of negative and positive ions of 2-nitroimidazole and 4(5)-nitroimidazole using low- and high-energy Collision-Induced Dissociation (CID) and Electron-Induced Dissociation (EID) by two different mass spectrometry techniques and is supported by quantum chemistry calculations. EID of [M+H](+) leads to more extensive fragmentation than CID and involves many radical cleavages including loss of H˙ leading to the formation of the radical cation, M˙(+). The stability (metastable decay) and the fragmentation (high-energy CID) of the radical cation M˙(+) have been probed in a crossed-beam experiment involving primary electron ionization of the neutral nitroimidazole. Thus, fragments in the EID spectra of [M+H](+) that come from further dissociation of radical cation M˙(+) have been highlighted. The loss of NO˙ radical from M˙(+) is associated with a high Kinetic Energy Release (KER) of 0.98 eV. EID of [M-H](-) also leads to additional fragments compared to CID, however, with much lower cross section. Only EID of [M+H](+) leads to a slight difference in the decomposition of 2-nitroimidazole and 4(5)-nitroimidazole.

Gas-phase VUV photoionisation and photofragmentation of the silver deuteride nanocluster [Ag10D8L6](2+) (L = bis(diphenylphosphino)methane). A joint experimental and theoretical study.

The bis(diphenylphosphino)methane (L = Ph2PCH2PPh2) ligated silver deuteride nanocluster dication, [Ag10D8L6](2+), has been synthesised in the condensed phase via the reaction of bis(diphenylphosphino)methane, silver nitrate and sodium borodeuteride in the methanol : chloroform (1 : 1) mixed solvent system. The photoionisation and photofragmentation of this mass-selected cluster were studied using a linear ion trap coupled to the DESIRS VUV beamline of the SOLEIL Synchrotron. At 15.5 eV the main ionic products observed are [Ag10D8L5](2+), [Ag10D8L4](2+), [Ag10D8L6](3+)˙, [Ag9D8L4](2+)˙, and [AgL2](+). The later two products arise from fragmentation of [Ag10D8L6](3+)˙. An analysis of the yields of these product ions as a function of the photon energy reveals the onset for the formation of [AgL2](+) and [Ag9D8L4](2+)˙ is around 2 eV higher than that for ionisation to produce [Ag10D8L5](3+)˙. The onset of ionisation energy of [Ag10D8L6](2+) was determined to be 9.3 ± 0.3 eV from a fit of the yield of the product ion, [Ag10D8L6](3+)˙, as a function of the VUV photon energy. DFT calculations at the RI-PBE/RECP-def2-SVP level of theory were carried out to search for a possible structure of the cluster and to estimate its vertical and adiabatic ionisation energies. The calculated lowest energy structure of the [Ag10D8L6](2+) nanocluster contains a symmetrical bicapped square antiprism as a silver core in which hydrides are located as a mix of triangular faces and edges. Four of the bisphosphines bind to the edges of the cluster core as bidentate ligands, the remaining two bisphosphines bind via a single phosphorus donor atom to each of the apical silver atoms. The DFT calculated adiabatic ionisation energy for this structure is 8.54 eV, in satisfactory agreement with experiment.

Formation and characterisation of the silver hydride nanocluster cation [Ag3H2((Ph2 P)2CH2)](+) and its release of hydrogen.

Multistage mass spectrometry and density functional theory (DFT) were used to characterise the small silver hydride nanocluster, [Ag3 H2 L](+) (where L=(Ph2 P)2 CH2 ) and its gas-phase unimolecular chemistry. Collision-induced dissociation (CID) yields [Ag2 HL](+) as the major product while laser-induced dissociation (LID) proceeds via H2 formation and subsequent release from [Ag3 H2 L](+) , giving rise to [Ag3 L](+) as the major product. Deuterium labelling studies on [Ag3 D2 L](+) prove that the source of H2 is from the hydrides and not from the ligand. Comparison of TD-DFT absorption patterns obtained for the optimised structures with action spectroscopy results, allows assignment of the measured features to structures of precursors and products. Molecular dynamics "on the fly" reveal that AgH loss is favoured in the ground state, but H2 formation and loss is preferred in the first excited state S1 , in agreement with CID and LID experimental findings. This indicates favourable photo-induced formation of H2 and subsequent release from [Ag3 H2 L](+) , an important finding in context of metal hydrides as a hydrogen storage medium, which can subsequently be released by heating or irradiation with light.

Modular molecules: site-selective metal substitution, photoreduction, and chirality in polyoxometalate hybrids.

The first members of a promising new family of hybrid amino acid-polyoxometalates have emerged from a search for modular functional molecules. Incorporation of glycine (Gly) or norleucine (Nle) ligands into an yttrium-tungstoarsenate structural backbone, followed by crystallization with p-methylbenzylammonium (p-MeBzNH3(+)) cations, affords (p-MeBzNH3)6K2(GlyH)[As(III)4(Y(III)W(VI)3)W(VI)44Y(III)4O159(Gly)8(H2O)14]⋅47 H2O (1) and enantiomorphs (p-MeBzNH3)15(NleH)3[As(III)4(Mo(V)2Mo(VI)2)W(VI)44Y(III)4O160(Nle)9(H2O)11][As(III)4(Mo(VI)2W(VI)2)W(VI)44Y(III)4O160(Nle)9(H2O)11] (generically designated 2: L-Nle, 2 a; D-Nle, 2 b). An intensive structural, spectroscopic, electrochemical, magnetochemical and theoretical investigation has allowed the elucidation of site-selective metal substitution and photoreduction of the tetranuclear core of the hybrid polyanions. In the solid state, markedly different crystal packing is evident for the compounds, which indicates the role of noncovalent interactions involving the amino acid ligands. In solution, mass spectrometric and small-angle X-ray scattering studies confirm maintenance of the structure of the polyanions of 2, while circular dichroism demonstrates that the chirality is also maintained. The combination of all of these features in a single modular family emphasizes the potential of such hybrid polyoxometalates to provide nanoscale molecular materials with tunable properties.

Synthesis, structural characterization, and gas-phase unimolecular reactivity of the silver hydride nanocluster [Ag3((PPh2)2CH2)3(µ3-H)](BF4)2.

A bis(diphenylphosphino)methane-ligated trinuclear silver hydride nanocluster, [Ag3((Ph2P)2CH2)3(µ3-H)](BF4)2, featuring three silver(I) ions coordinated to a µ3-hydride, and its deuteride analogue, [Ag3((Ph2P)2CH2)3(µ3-D)](BF4)2, have been isolated and structurally characterized using electrospray ionization mass spectrometry (ESI-MS), X-ray crystallography, NMR and IR spectroscopy. The position of the deuteride in [Ag3((Ph2P)2CH2)3(µ3-D)](BF4)2 was determined by neutron diffraction. ESI-MS of [Ag3L3(µ3-H/D)](BF4)2 [L = ((Ph2P)2CH2)2] produces [Ag3L3(µ3-H/D)](2+) and [Ag3L3(µ3-H/D)(BF4)](+). A rich gas-phase ion chemistry of [Ag3L3(µ3-H/D)](2+) is observed under conditions of collision-induced dissociation (CID) and electron-capture dissociation (ECD). CID gives rise to the following complementary ion pairs: [Ag3L2](+) and [L+(H/D)](+); [Ag2(H/D)L2](+) and [AgL](+); [Ag2(H/D)L](+) and [AgL2](+). ECD gives rise to a number of dissociation channels including loss of the bis(phosphine) ligand, fragmentation of a coordinated bis(phosphine) ligand via C-P bond activation, and loss of a hydrogen (deuterium) atom with concomitant formation of [Ag3L3](+). Under CID conditions, [Ag3L3(µ3-H/D)(BF4)](+) fragments via ligand loss, the combined loss of a ligand and [H,B,F4], and cluster fragmentation to give [Ag2(BF4)L2](+) and [Ag2(L-H)L](+) [where (L-H) = (Ph2P)2CH(-)].

Bridging gaps: Transforming dental public health training for modern job market demands.

OBJECTIVES: To create optimal oral and overall community health, dental public health (DPH) specialists must be competent and appropriately skilled to deal with contemporary and emergent public health issues. This study aims to evaluate the current job market demands related to the DPH profession and suggest contemporary skills and qualities that would enable DPH professionals to address emerging issues more effectively in their field. METHODS: A multimethod qualitative study was conducted involving two distinct groups: employers and potential employees. Interviews of stakeholders (employers) representing different job market domains, and a survey was administered to recent DPH residency graduates (employees). Qualitative analysis was applied to the data collected. RESULTS: Employers identified the following skills as crucial for future DPH employees: proficiency in care delivery systems, health informatics, clinical training, leadership, and professional and grant writing skills. Many employers assumed the presence of a clinical component in the residency program. DPH residency graduates emphasized that the most significant barrier to securing positions is the lack of clinical experience within the residency program. CONCLUSIONS: This research highlights skills currently valued by the DPH job market and proposes that DPH specialty training may consider revising its curriculum to include these skills. Implementing such updates would ensure that graduates are well equipped and competitive, thus significantly contributing to the broader objective of attaining optimal oral health and overall well-being of the community.

American Board of Dental Public Health diplomate survey, 2021: Competency domains and practice.

OBJECTIVE: To describe current Dental Public Health diplomates and list the competency domains that diplomates considered either essential or optional elements of their practice. METHODS: The American Board of Dental Public Health administered an electronic survey to active and life member diplomates during September 2021. The survey included 101 items in three sections: (1) Education and Work Experience; (2) Dental Public Health Tasks; and (3) Demographics. The Dental Public Health Tasks section asked individuals how essential work-related tasks were to their current practice. Descriptive analyses were conducted using SAS. RESULTS: The overall response rate was 82.6% (157 eligible of 190 returned). Most respondents were women, 35 to 54 years of age, and either non-Hispanic white or non-Hispanic Asian. Twice as many had DDS or DMD degrees than BDS degrees. The vast majority completed a Dental Public Health residency and received masters level training from an accredited program. About three-fourths worked in the United States and held a U.S. license. More than 37% reported a second doctoral degree and 70% worked in academia. Responses to questions about tasks closely aligned with working in academia and less so with positions related to advocacy, regulation, and program evaluation. CONCLUSIONS: Current diplomates are concentrated in academia. If this trend continues, it may be necessary to restructure the competencies, so training and skills acquisition remain timely and relevant. The specialty may also need to encourage future generations to consider non-academic positions so Dental Public Health remains an impactful component of the public health care system.

Genomewide pharmacogenetics of bisphosphonate-induced osteonecrosis of the jaw: the role of RBMS3.

UNLABELLED: Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a serious adverse drug reaction. We conducted a genomewide association study to search for genetic variants with a large effect size that increase the risk for BRONJ. METHODS: We ascertained BRONJ cases according to the diagnostic criteria of the American Association of Oral and Maxillofacial Surgeons. We genotyped cases and a set of treatment-matched controls using Illumina Human Omni Express 12v1 chip (733,202 markers). To maximize the power of the study, we expanded the initial control set by including population and treatment-tolerant controls from publicly available sources. Imputation at the whole-genome level was performed to increase the number of single nucleotide polymorphisms (SNPs) investigated. Tests of association were carried out by logistic regression, adjusting for population structure. We also examined a list of candidate genes comprising genes potentially involved in the pathogenesis of BRONJ and genes related to drug absorption, distribution, metabolism, and excretion. RESULTS: Based on principal component analysis, we initially analyzed 30 white cases and 17 treatment-tolerant controls. We subsequently expanded the control set to include 60 genetically matched controls per case. Association testing identified a significant marker in the RBMS3 gene, rs17024608 (p-value < 7 × 10(-8)); individuals positive for the SNP were 5.8× more likely to develop BRONJ (odds ratio, 5.8; 95% confidence interval, 3.1-11.1). Candidate gene analysis further identified SNPs in IGFBP7 and ABCC4 as potentially implicated in BRONJ risk. CONCLUSION: Our findings suggest that genetic susceptibility plays a role in the pathophysiology of BRONJ, with RBMS3 having a significant effect in the risk.

Incidence of osteonecrosis of the jaw among users of bisphosphonates with selected cancers or osteoporosis.

PURPOSE: To quantify the incidence of osteonecrosis of the jaw (ONJ) by bisphosphonate exposure among two cohorts of patients. METHODS: In a retrospective cohort study, we identified cohort members via health insurance claim diagnosis codes and identified potential cases of ONJ that were confirmed with medical record review. One cohort included patients aged ≥40 years with breast or prostate cancer or multiple myeloma; the other cohort included men aged ≥60 years and women ≥50 years with osteoporosis. For each cohort, we calculated sex- and age-standardized incidence of ONJ by exposure to oral bisphosphonates and intravenous bisphosphonates. RESULTS: In the cancer cohort (n = 46 542), sex- and age-standardized incidence of ONJ (n = 26 probable or possible cases) adjusted for abstraction proportion was 0.29 per 1000 person-years (95% confidence interval [CI], 0.07-0.52) among those unexposed to bisphosphonates and 5.3 (95%CI, 1.9-8.7) after intravenous bisphosphonate use. Controlling for covariates, the rate ratio for intravenous use versus no use was 8.8 (95%CI, 2.0-38). Patients with multiple myeloma had a rate 4.5 times that of patients with breast cancer. In the osteoporosis cohort (n = 31 244), sex- and age-standardized ONJ (n = 11 probable or possible cases) incidence was 0.26 per 1000 person-years (95%CI, 0.06-0.47) among those unexposed to bisphosphonate and 0.15 (95%CI, 0.00-0.36) after oral bisphosphonate use. CONCLUSION: Among patients with selected cancers, incidence of ONJ was higher among those with multiple myeloma and users of intravenous bisphosphonates.

Antiretroviral prophylaxis and the risk of cleft lip and palate: preliminary signal detection in the food and drug administration's adverse events reporting system database.

OBJECTIVE: Antiretroviral prophylaxis has been found to be effective in preventing vertical HIV transmission to the offspring of infected mothers. Because medicine and the art of public health require benefits to outweigh any plausible risks, our study aimed to explore and quantify preliminary associations between antiretroviral medications and clefting. METHODS: We analyzed 5 years of available data from the Food and Drug Administration's Adverse Events Reporting System (Medwatch program) and calculated reporting odds ratios (RORs) and their associated 95% confidence intervals (CIs). RESULTS: The medications with the highest effects were efavirenz with an ROR of 196 (95% CI, 86 to 447), lamivudine with an ROR of 60.2 (95% CI, 14.25 to 148), the combination abacavir sulfate/lamivudine/zidovudine with an ROR of 59.3, and nelfinavir with and ROR of 50.5, followed by nevirapine, lopinavir/ritonavir, and lamivudine/zidovudine. CONCLUSION: Given the multifactorial etiology of cleft lip and palate, further studies are needed to assess the relative safety of antiretroviral prophylaxis and the specific conditions or potential synergies that might lead to the development of this defect.

Bisphosphonates and time to osteonecrosis development.

Bisphosphonate-associated osteonecrosis of the jaw (BONJ) is a complication of long-term bisphosphonate (BP) use. Given the beneficial effects of BP on bone quality in patients with cancer or osteoporosis, it is of great importance to understand the risk as it relates to time to event or cumulative dose until the onset of disease. Because there is no information on the lowest toxic dose from clinical trials, here we report on a review of 71 case series published since 2003. We calculated the weighted mean time to event, as well as the minimum reported time and dose for zoledronate, pamidronate, and oral bisphosphonates. The mean time to BONJ after zoledronate treatment was calculated at 1.8 years and the minimum was 10 months; after pamidronate, the mean time was 2.8 years and the minimum was 1.5 years; and after oral BP therapy, the mean time was 4.6 years and the minimum was 3 years. Zoledronic acid seems to be the most potent among the nitrogen-containing BPs. Factors that seem to affect BONJ and time to event were invasive dental procedures and other comorbid factors such as advanced age, rheumatoid arthritis, diabetes, use of corticosteroids, vitamin D deficiency, and more. Understanding the pathophysiology of the disease requires further research.

The 3' UTR IGF2R-A2/B2 variant is associated with increased tumor growth and advanced stages in non-small cell lung cancer.

Normal function of insulin-like growth factor II receptor (IGF2R) gene has been associated with negative control of tumor growth in vivo and in vitro. Rare alleles at a 3' UTR short tandem repeat polymorphism of IGF2R are known to decrease transcript stability. One such allele (A2/B2) increases significantly the risk of oral squamous cell carcinoma and non-small cell lung carcinoma (NSCLC) in Caucasians. To determine potential association(s) between A2/B2 presence and development and/or progression of disease, we examined in 103 NSCLC patients, free of IGF2R allelic imbalance aberrations, the 3' UTR allelic status in relation to tumor kinetic parameters (proliferation index-PI and apoptotic index-AI) and clinicopathological data. PCR and automated sequence analyses were employed to genotype the IGF2R 3' UTR polymorphism. Given that, oncogenic mitogens, which escape degradation by IGF2R, can also activate p53 through a DNA damage response, the patterns between p53 status and IGF2R genetic constitution were also evaluated in relation to the above parameters. The A2/B2 variant was significantly more common (p=0.005, chi2-test) in lung cancer patients (25% vs 15%). Its presence was accompanied by high cellular proliferation (p=0.028, t-test) along with increased tumor cell growth (GI=PI/AI) (p=0.022, t-test) and it was significantly found in advanced stages. Also, patients carrying the A2/B2 in their genetic constitution that exhibit aberrant p53 expression have faster growing tumors and progress more rapidly to advanced stages. In conclusion, the IGF2R-A2/B2 variant probably provides a selective advantage for NSCLC progression through increased tumor growth.

Zoledronate, smoking, and obesity are strong risk factors for osteonecrosis of the jaw: a case-control study.

PURPOSE: Bisphosphonates (BPs) effectively treat metastatic bone disease, hypercalcemia, and osteoporosis. BP exposure, however, may be associated with osteonecrosis of the jaw (ONJ). The aim of the present study was to estimate the magnitude of the association between intravenous (IV) BP exposure and ONJ, and to identify potential confounders. MATERIALS AND METHODS: Using a case-control study design, the investigators identified and adjudicated a sample of cases with ONJ and matched them randomly with 5 controls per case. The controls were matched to cases on age, gender, cancer type, and date of cancer diagnosis. The medical records were abstracted and data on BP exposure, cancer therapy, and comorbidities were recorded. Statistical analyses were carried out using conditional logistic regression in Stata 9.0 (Stata Corp, College Station, TX). RESULTS: Thirty cases of ONJ were identified at Massachusetts General Hospital from February 2003 through February 2007. Zoledronate was found to confer significant risk toward development of ONJ (adjusted odds ratio = 31.8, P < .05). Although a trend toward increased risk was noted for pamidronate, this association was not significant after controlling for zoledronate. Obesity and smoking were associated significantly with ONJ development, whereas oral BPs had no effect. CONCLUSION: In this study, cancer patients who had received zoledronate exhibited a significant 30-fold increase in their risk to develop ONJ. More studies are needed to elucidate the exact role of obesity and smoking in the development of ONJ, and the complex interactions of IV BPs with other chemotherapies during cancer treatment.

Bisphosphonate use and the risk of adverse jaw outcomes: a medical claims study of 714,217 people.

BACKGROUND: While osteonecrosis of the jaw (ONJ) has been associated with the prolonged use of bisphosphonates (BPs), there is limited information about the risk of ONJ among users of oral BPs or about the magnitude of the risk among users of intravenous (IV) BPs. METHODS: The authors studied medical claims data from 714,217 people with osteoporosis or cancer to identify diagnostic codes or procedure codes for three outcomes: inflammatory conditions of the jaws, including osteonecrosis; major jaw surgery necessitated by necrotic or inflammatory indications; and jaw surgeries necessitated by a malignant process. The authors calculated stratified odds ratios and 95 percent confidence intervals. RESULTS: The results indicate that oral administration of BPs decreases the risk of adverse bone outcomes. In contrast, IV administration strongly and significantly increases the risk (P < .05) of adverse jaw outcomes or surgery. Across both osteoporosis and cancer, patients receiving IV BPs had a fourfold increased risk of having inflammatory jaw conditions and a greater than sixfold increased risk of having undergone major surgical resection in the jaw. CONCLUSIONS: Mode of bisphosphonate use results in different risk profiles for adverse jaw outcomes. While the authors documented an increased risk of inflammatory conditions and surgical procedures of the jaw for users of IV BPs, they did not find these observed increases for users of oral BPs. CLINICAL IMPLICATIONS: Physicians and dentists must be aware of the higher frequency of adverse jaw effects in patients receiving IV BPs, especially osteonecrosis of the jaw. While the authors' results have internal consistency, more clinical studies are needed to replicate and clarify the observed associations over long follow-up periods.