Oral Health Considerations in Older Women Receiving Oral Bisphosphonate Therapy

Authors

  • Joan C. Lo MD,

    1. From the *Division of Research, Kaiser Permanente Northern California, Oakland, California; Divisions of Endocrinology and Maxillofacial Surgery, Kaiser Permanente Oakland Medical Center, Oakland, California; and Departments of §Epidemiology and Biostatistics and Medicine, University of California at San Francisco, San Francisco, California.
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  • Felice O'Ryan DDS,

    1. From the *Division of Research, Kaiser Permanente Northern California, Oakland, California; Divisions of Endocrinology and Maxillofacial Surgery, Kaiser Permanente Oakland Medical Center, Oakland, California; and Departments of §Epidemiology and Biostatistics and Medicine, University of California at San Francisco, San Francisco, California.
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  • Jingrong Yang MA,

    1. From the *Division of Research, Kaiser Permanente Northern California, Oakland, California; Divisions of Endocrinology and Maxillofacial Surgery, Kaiser Permanente Oakland Medical Center, Oakland, California; and Departments of §Epidemiology and Biostatistics and Medicine, University of California at San Francisco, San Francisco, California.
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  • Mohammad K. Hararah BA,

    1. From the *Division of Research, Kaiser Permanente Northern California, Oakland, California; Divisions of Endocrinology and Maxillofacial Surgery, Kaiser Permanente Oakland Medical Center, Oakland, California; and Departments of §Epidemiology and Biostatistics and Medicine, University of California at San Francisco, San Francisco, California.
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  • Joel R. Gonzalez BS,

    1. From the *Division of Research, Kaiser Permanente Northern California, Oakland, California; Divisions of Endocrinology and Maxillofacial Surgery, Kaiser Permanente Oakland Medical Center, Oakland, California; and Departments of §Epidemiology and Biostatistics and Medicine, University of California at San Francisco, San Francisco, California.
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  • Nancy Gordon ScD,

    1. From the *Division of Research, Kaiser Permanente Northern California, Oakland, California; Divisions of Endocrinology and Maxillofacial Surgery, Kaiser Permanente Oakland Medical Center, Oakland, California; and Departments of §Epidemiology and Biostatistics and Medicine, University of California at San Francisco, San Francisco, California.
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  • Paula Silver BA,

    1. From the *Division of Research, Kaiser Permanente Northern California, Oakland, California; Divisions of Endocrinology and Maxillofacial Surgery, Kaiser Permanente Oakland Medical Center, Oakland, California; and Departments of §Epidemiology and Biostatistics and Medicine, University of California at San Francisco, San Francisco, California.
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  • Alice Ansfield BS,

    1. From the *Division of Research, Kaiser Permanente Northern California, Oakland, California; Divisions of Endocrinology and Maxillofacial Surgery, Kaiser Permanente Oakland Medical Center, Oakland, California; and Departments of §Epidemiology and Biostatistics and Medicine, University of California at San Francisco, San Francisco, California.
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  • Benjamin Wang,

    1. From the *Division of Research, Kaiser Permanente Northern California, Oakland, California; Divisions of Endocrinology and Maxillofacial Surgery, Kaiser Permanente Oakland Medical Center, Oakland, California; and Departments of §Epidemiology and Biostatistics and Medicine, University of California at San Francisco, San Francisco, California.
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  • Alan S. Go MD

    1. From the *Division of Research, Kaiser Permanente Northern California, Oakland, California; Divisions of Endocrinology and Maxillofacial Surgery, Kaiser Permanente Oakland Medical Center, Oakland, California; and Departments of §Epidemiology and Biostatistics and Medicine, University of California at San Francisco, San Francisco, California.
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Address correspondence to Joan C. Lo, Kaiser Permanente Division of Research, 2000 Broadway, Oakland, CA 94612. E-mail: joan.c.lo@kp.org

Abstract

Recent reports of bisphosphonate-related osteonecrosis of the jaw (BRONJ) have increased awareness of oral health in patients receiving osteoporosis therapy. This study describes the demographic, oral health, and clinical characteristics of a contemporary population of women aged 50 and older undergoing oral bisphosphonate treatment who returned a mailed questionnaire pertaining to dental symptoms. The study, as previously reported, was conducted within Kaiser Permanente Northern California, a large, integrated healthcare delivery system. The cohort included 7,909 women with bisphosphonate exposure of at least 1 year, with a subset of 923 women reporting dental symptoms who underwent clinical examination. Overall, the average age was 71±9; 70% were white, and 74% had at least some college education. Nearly two-thirds had received oral bisphosphonate therapy for 3 or more years. Most reported daily tooth brushing, 85% had had a dental examination in the past year, 22% reported denture use, and 6% reported moderate to severe periodontal disease. Oral healthcare patterns varied according to age and race and ethnicity. Five hundred seven (6.4%) women reported a tooth extraction in the prior year, of whom two developed BRONJ (0.4%). Tori or exostoses were found in 28% of examined participants with dental symptoms; these were predominantly in the lingual mandible and palate, with palatal BRONJ occurring in 1.6% of symptomatic participants with palatal tori. In summary, among older women with bisphosphonate exposure, oral health varied according to patient characteristics, and BRONJ occurred more frequently after tooth extraction or on palatal tori. These data support efforts to optimize oral health and to identify risk factors for BRONJ in older individuals receiving bisphosphonate drugs.

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