Non-Cochrane · aetiology · PM42683904
Association between periodontal disease severity and the risk of medication-related osteonecrosis of the jaw: a systematic review and meta-analysis by the Korean Academy of Periodontology.
Lee Jae-Hong, Kim Yun-Jeong, Song Young Woo, et al. · Journal of periodontal & implant science · 2026 · PubMed · doi:10.5051/jpis.2602140107
Findings
16 findings
| Population | ||||
|---|---|---|---|---|
| Patients receiving antiresorptive or antiangiogenic therapy | Periodontal disease (any severity) | No periodontal disease | Medication-related osteonecrosis of the jaw (MRONJ) Sensitivity: excluding Walter et al. (2014) and Kwoen et al. (2023) | Relative effect (pooled OR/RR/HR) 2.61 [1.65, 4.11] GRADE not reported 6 studies |
| Patients receiving antiresorptive or antiangiogenic therapy | Periodontal disease (any severity) | No periodontal disease | Medication-related osteonecrosis of the jaw (MRONJ) Sensitivity: excluding Estilo et al. (2008), BRONJ-era study | Relative effect (pooled OR/RR/HR) 3.24 [2.25, 4.68] GRADE not reported 7 studies |
| Patients receiving antiresorptive or antiangiogenic therapy | Periodontal disease (any severity) | No periodontal disease | Medication-related osteonecrosis of the jaw (MRONJ) Overall, 95% prediction interval | Relative effect (pooled OR/RR/HR) 3.02 [1.29, 7.04] GRADE not reported 8 studies |
| Patients receiving antiresorptive or antiangiogenic therapy | Periodontal disease (any severity) | No periodontal disease | Medication-related osteonecrosis of the jaw (MRONJ) | Relative effect (pooled OR/RR/HR) 3.02 [1.99, 4.56] GRADE not reported 8 studies |
| Patients receiving antiresorptive or antiangiogenic therapy | Periodontal disease (any severity) | No periodontal disease | Medication-related osteonecrosis of the jaw (MRONJ) Sensitivity: excluding Kos (2014), implant-related case | Relative effect (pooled OR/RR/HR) 2.97 [1.82, 4.84] GRADE not reported 7 studies |
| Patients receiving antiresorptive or antiangiogenic therapy | Periodontal disease (any severity) | No periodontal disease | Medication-related osteonecrosis of the jaw (MRONJ) Sensitivity: excluding Kwoen et al. (2023) | Relative effect (pooled OR/RR/HR) 3.24 [1.91, 5.51] GRADE not reported 7 studies |
| Patients receiving antiresorptive or antiangiogenic therapy | Periodontal disease (any severity) | No periodontal disease | Medication-related osteonecrosis of the jaw (MRONJ) Sensitivity: excluding Walter et al. (2014) | Relative effect (pooled OR/RR/HR) 2.58 [1.8, 3.71] GRADE not reported 7 studies |
| Patients receiving antiresorptive or antiangiogenic therapy | Periodontal disease (any severity) | No periodontal disease | Medication-related osteonecrosis of the jaw (MRONJ) Sensitivity: trim-and-fill adjusted (k0=0 imputed studies) | Relative effect (pooled OR/RR/HR) 3.02 [1.99, 4.56] GRADE not reported 8 studies |
| Patients receiving antiresorptive or antiangiogenic therapy | Periodontal disease (any severity) | No periodontal disease | Medication-related osteonecrosis of the jaw (MRONJ) Sensitivity: excluding Kos (2014) and Estilo et al. (2008), implant-related outcome mixing | Relative effect (pooled OR/RR/HR) 3.33 [2.11, 5.26] GRADE not reported 6 studies |
| Adults receiving medications associated with MRONJ | Periodontal disease | Clinically healthy periodontium or mild periodontal conditions | Medication-related osteonecrosis of the jaw OR-only; exclude Yamazaki 2012 and Kwoen 2023 | OR 3.29 [1.82, 5.93] GRADE not reported 6 studies |
| Patients receiving antiresorptive or antiangiogenic therapy | Severe/procedure-linked periodontal disease | No periodontal disease | Medication-related osteonecrosis of the jaw (MRONJ) Sensitivity within severe/procedure-linked group: excluding Walter et al. (2014) and Kwoen et al. (2023) | Relative effect (pooled OR/RR/HR) 4.0 [1.31, 12.28] GRADE not reported 2 studies |
| Patients receiving antiresorptive or antiangiogenic therapy | Severe/procedure-linked periodontal disease | No periodontal disease | Medication-related osteonecrosis of the jaw (MRONJ) Sensitivity within severe/procedure-linked group: excluding Walter et al. (2014) | Relative effect (pooled OR/RR/HR) 2.82 [1.66, 4.77] GRADE not reported 3 studies |
| Patients receiving antiresorptive or antiangiogenic therapy | Severe/procedure-linked periodontal disease | No periodontal disease | Medication-related osteonecrosis of the jaw (MRONJ) Sensitivity within severe/procedure-linked group: excluding Kwoen et al. (2023) | Relative effect (pooled OR/RR/HR) 6.67 [2.93, 15.21] GRADE not reported 3 studies |
| Patients receiving antiresorptive or antiangiogenic therapy | Severe/procedure-linked periodontal disease | No periodontal disease | Medication-related osteonecrosis of the jaw (MRONJ) Severity subgroup: severe/procedure-linked group | Relative effect (pooled OR/RR/HR) 4.26 [1.96, 9.24] GRADE not reported 4 studies |
| Patients receiving antiresorptive or antiangiogenic therapy | Moderate-to-mixed periodontal disease | No periodontal disease | Medication-related osteonecrosis of the jaw (MRONJ) Severity subgroup: moderate-to-mixed group | Relative effect (pooled OR/RR/HR) 2.39 [1.45, 3.94] GRADE not reported 4 studies |
| Patients receiving antiresorptive or antiangiogenic therapy | Moderate-to-mixed periodontal disease | No periodontal disease | Medication-related osteonecrosis of the jaw (MRONJ) Sensitivity within moderate-to-mixed group: excluding Estilo et al. (2008) | Relative effect (pooled OR/RR/HR) 2.88 [1.64, 5.04] GRADE not reported 3 studies |
Included primary studies 8
Open in Studies| Study | Year | Also included by | Outcomes it informs here | Trial data |
|---|---|---|---|---|
| Estilo 2008 Osteonecrosis of the Maxilla and Mandible in Patients with Advanced Cancer Treated with Bisphosphonate Therapy DOI:10.1634/theoncologist.2008-0091 | 2008 | this review only | not stated | not extracted yet |
| Kos 2014 Association of dental and periodontal status with bisphosphonate-related osteonecrosis of the jaws. A retrospective case controlled study. PMID:24701224 | 2014 | this review only | not stated | not extracted yet |
| Kwoen 2023 Association between periodontal disease, tooth extraction, and medication‐related osteonecrosis of the jaw in women receiving… DOI:10.1002/jper.21-0611 | 2022 | this review only | not stated | not extracted yet |
| Manfredi 2017 A 5-year retrospective longitudinal study on the incidence and the risk factors of osteonecrosis of the jaws in patients treated with… PMID:28390132 | 2017 | this review only | not stated | not extracted yet |
| Tsao 2013 Oral Health Risk Factors for Bisphosphonate-Associated Jaw Osteonecrosis DOI:10.1016/j.joms.2013.02.016 | 2013 | this review only | not stated | not extracted yet |
| Walter 2014 Radiologic bone loss in patients with bisphosphonate-associated osteonecrosis of the jaws: a case–control study DOI:10.1007/s00784-013-0974-7 | 2013 | this review only | not stated | not extracted yet |
| Wick 2022 Risk factors associated with onset of medication-related osteonecrosis of the jaw in patients treated with denosumab DOI:10.1007/s00784-021-04261-4 | 2021 | this review only | not stated | not extracted yet |
| Yamazaki 2012 Increased incidence of osteonecrosis of the jaw after tooth extraction in patients treated with bisphosphonates: a cohort study DOI:10.1016/j.ijom.2012.06.020 | 2012 | this review only | not stated | not extracted yet |
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Patients receiving antiresorptive or antiangiogenic therapy | Patients receiving bisphosphonates, denosumab or other antiresorptive/antiangiogenic therapy (8 studies) |
| Intervention | Periodontal disease (exposure) with reproducible clinical, radiographic, guideline-based or administrative-code definition | Periodontal disease: severe/procedure-linked (n=4 studies) and moderate-to-mixed (n=4 studies) |
| Comparison | Not specified (patients without periodontal disease implied) | No periodontal disease |
| Outcomes | Medication-related osteonecrosis of the jaw | MRONJ (n=8 studies) |
| Study designs | Observational studies; case reports, case series n<10, reviews, animal studies excluded | Observational studies (3 case-control, 5 retrospective cohort; n=8) |
| Timing | Not specified | Not specified |