Journal of the National Cancer Institute Advance Access originally published online on January 8, 2008
JNCI Journal of the National Cancer Institute 2008 100(2):155-156; doi:10.1093/jnci/djm262
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© The Author 2008. Published by Oxford University Press.
CORRESPONDENCE |
Response: Re: Intravenous Bisphosphonate Therapy and Inflammatory Conditions or Surgery of the Jaw: A Population-Based Analysis
Affiliations of authors: Departments of Preventive Medicine and Community Health (GSW, YFK, JLF, JSG), Family Medicine (GSW), and Internal Medicine (YFK, JLF, JSG) and SEALY Center on Aging (GSW, YFK, JLF, JSG), University of Texas Medical Branch, Galveston, TX
Correspondence to: Gregg S. Wilkinson, PhD, Department of Preventive Medicine and Community Health, University of Texas Medical Branch, 301 University Blvd, Galveston, TX 77555-1153 (e-mail: gswilkin{at}utmb.edu).
We thank Khamaisi and Elad for providing us with the opportunity to further investigate and report on a risk factor that may be associated with bisphosphonate-related inflammatory conditions (including osteonecrosis) of the jaw. Khamaisi and Elad note that in a hospital-based comparison of 31 case patients with osteonecrosis of the jaw who had been treated with intravenous bisphosphonates with 33 control patients who had been treated with bisphosphonates but were not diagnosed with osteonecrosis of the jaw, they observed (1) that 58% of the case patients but only 12% of the control patients had a concomitant diagnosis of diabetes (risk ratio = 5.2, 95% confidence interval = 2.0 to 13.6; P < .001, two-sided paired t test).
In response to the request by Khamaisi and Elad, we reanalyzed a portion of our data by removing diabetes from the risk factor index, including diabetes as a separate risk factor and all previously included covariates in the Cox regression models reported in table 4 of Wilkinson et al. (2). In this new analysis, we found little evidence of an association between diabetes and the jaw toxic effects that we investigated (Table 1). All hazard ratios for any diagnosis of diabetes were less than 1.0, and the upper confidence interval, 1.44, was well below the risk ratio found in the smaller study by Khamaisi and Elad. For a diagnosis of diabetes with complications, however, we observed hazard ratios that were more than 1.0, which were based on very few patients and had very wide confidence intervals. Our study, however, relied on Medicare claims data that do not contain the detailed clinical information that Khamaisi and Elad suggest should be considered.
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In summary, in a multivariable quantitative reanalysis of our data, we found no evidence of an association between diabetes and osteonecrosis of the jaw among bisphosphonate users.
REFERENCES
1. Khamaisi M, Regev E, Yarom N, et al. Possible association between diabetes and bisphosphonate-related jaw osteonecrosis. J Clin Endocrinol Metab. (2007) 92:1172–1175.
2. Wilkinson GS, Kuo YF, Freeman JL, Goodwin JS. Intravenous bisphosphonate therapy and inflammatory conditions or surgery of the jaw: a population-based analysis. J Natl Cancer Inst. (2007) 99:1016–1024.
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J Natl Cancer Inst 2007 99: 1016-1024.
J Natl Cancer Inst 2008 100: 155.
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