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Rheumatology 2008 47(3):383-384; doi:10.1093/rheumatology/kem388
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© The Author 2008. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Comment on: Bisphosphonates and osteonecrosis of the jaw: reply

N. G. Shenker1 and A. S. M. Jawad2

1Department of Rheumatology, Addenbrooke's Hospital, Cambridge University NHS Foundation Trust, Hills Road, Cambridge and 2Department of Rheumatology, The Royal London Hospital, Bancroft Road, London, UK

Correspondence to: N. G. Shenker, Department of Rheumatology, Addenbrooke's, Cambridge University Hospitals, Hills Road, Cambridge CB2 0QQ, UK. E-mail: nicholas.shenker{at}addenbroookes.nhs.uk; mpxns{at}bath.ac.uk

SIR, We thank Bianchi et al. [1] in highlighting the increasing number of children being exposed to relatively high doses of aminobisphosphonates for a variety of conditions and for noting the likely increased risk for osteonecrosis of the jaw (ONJ) consequent to their poor dental health. We are reassured by their negative findings although it must be emphasized that their study would need at least 100 times the number of patients to be adequately powered to detect ONJ at an incidence of 1 in 10 000, a rough estimate of its prevalence [2]. We are aware of another series of paediatric patients exposed to high doses of i.v. bisphosphonates for the treatment of osteogenesis imperfecta [3]. Sixty-four patients underwent a total of 38 procedures and after long-term follow-up none of these patients had developed ONJ. More work is needed but the incidence of ONJ is very low and the benefits of treatment are well-recognized. We are unsure of the value of screening all the patients radiographically. Finally, we would reiterate that the risk–benefit analysis is clearly in favour of treatment although vigilance is required and larger studies are needed to more precisely estimate where the right balance lies.

Disclosure statement: The authors have declared no conflicts of interest.


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  1. Bianchi M, Limonta C, Frasunkiewicz J, et al. Comment on: Bisphosphonates and osteonecrosis of the jaw. Rheumatology (2008) 47:383.[Free Full Text]
  2. Shenker NG, Jawad ASM. Bisphosphonates and osteonecrosis of the jaw. Rheumatology (2007) 46:1049–51.[Free Full Text]
  3. Malmgren B, Astrom E, Soderhall S. No osteonecrosis in jaws of young patients with osteogenesis imperfecta treated with bisphosphonates. J Oral Pathol Med (2007) (Online Early Articles) doi:10.1111/j.1600-0714.2007.00607.x.
Accepted 20 December 2007


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