Risk of Osteonecrosis of the Jaw in Patients Treated with Zoledronic or Alendronic Acid: A Systematic Review
<i>Background and Objectives:</i> Bisphosphonates (BP) like zoledronic acid (ZA) and alendronic acid (AA) are used for osteoporosis (OP) or other bone-related conditions as well as to prevent the spread of metastases and in rheumatoid arthritis treatment. However, they have been associat...
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2025-06-01
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| author | Aine Jakonyte Egle Gustainyte Zygimantas Petronis Aviad Hafizov Audra Janovskiene Dainius Razukevicius |
| author_facet | Aine Jakonyte Egle Gustainyte Zygimantas Petronis Aviad Hafizov Audra Janovskiene Dainius Razukevicius |
| author_sort | Aine Jakonyte |
| collection | DOAJ |
| description | <i>Background and Objectives:</i> Bisphosphonates (BP) like zoledronic acid (ZA) and alendronic acid (AA) are used for osteoporosis (OP) or other bone-related conditions as well as to prevent the spread of metastases and in rheumatoid arthritis treatment. However, they have been associated with an increased risk of osteonecrosis of the jaw (ONJ). This systematic review aimed to assess the incidence and risk of ONJ in osteoporotic patients treated with ZA or AA and evaluate the impact of treatment duration. <i>Material and Methods:</i> The systematic literature review was conducted following PRISMA guidelines. The keywords “Zoledronic acid,” “Alendronic acid,” “Osteoporosis,” and “Osteonecrosis” were searched in PubMed and ScienceDirect databases. Selection criteria included studies on humans written in English, published from 2014. The systematic review protocol was registered in the PROSPERO register under the following number: CRD42024587046. <i>Results:</i> A total of 7 studies with 98,717 osteoporotic patients met the criteria, showing a higher ONJ incidence with ZA than AA. Six studies linked longer BP use to increased ONJ risk, which quadrupled after 5 years of AA use. A positive correlation was found between BP use (≥3 years) and ONJ in OP patients, primarily affecting females over 60. ONJ appeared after 1 year with AA, increasing over time, while ZA-related ONJ emerged as early as 5 months with a higher overall incidence. <i>Conclusions:</i> ZA poses a higher ONJ risk and incidence and earlier onset than AA, occurring within 5 months versus 1 year for AA. These findings emphasize the need for careful monitoring, especially in long-term BP therapy with additional risk factors. |
| format | Article |
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| institution | Kabale University |
| issn | 1010-660X 1648-9144 |
| language | English |
| publishDate | 2025-06-01 |
| publisher | MDPI AG |
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| series | Medicina |
| spelling | doaj-art-703df4f680864ab4ac12efc703f0d4812025-08-20T03:35:38ZengMDPI AGMedicina1010-660X1648-91442025-06-01617115910.3390/medicina61071159Risk of Osteonecrosis of the Jaw in Patients Treated with Zoledronic or Alendronic Acid: A Systematic ReviewAine Jakonyte0Egle Gustainyte1Zygimantas Petronis2Aviad Hafizov3Audra Janovskiene4Dainius Razukevicius5Department of Odontology, Lithuanian University of Health Sciences (LSMU), LT-50161 Kaunas, LithuaniaDepartment of Odontology, Lithuanian University of Health Sciences (LSMU), LT-50161 Kaunas, LithuaniaDepartment of Maxillofacial Surgery, Faculty of Odontology, Medical Academy, Lithuanian University of Health Sciences (LSMU), LT-50161 Kaunas, LithuaniaDepartment of Odontology, Lithuanian University of Health Sciences (LSMU), LT-50161 Kaunas, LithuaniaDepartment of Maxillofacial Surgery, Faculty of Odontology, Medical Academy, Lithuanian University of Health Sciences (LSMU), LT-50161 Kaunas, LithuaniaDepartment of Maxillofacial Surgery, Faculty of Odontology, Medical Academy, Lithuanian University of Health Sciences (LSMU), LT-50161 Kaunas, Lithuania<i>Background and Objectives:</i> Bisphosphonates (BP) like zoledronic acid (ZA) and alendronic acid (AA) are used for osteoporosis (OP) or other bone-related conditions as well as to prevent the spread of metastases and in rheumatoid arthritis treatment. However, they have been associated with an increased risk of osteonecrosis of the jaw (ONJ). This systematic review aimed to assess the incidence and risk of ONJ in osteoporotic patients treated with ZA or AA and evaluate the impact of treatment duration. <i>Material and Methods:</i> The systematic literature review was conducted following PRISMA guidelines. The keywords “Zoledronic acid,” “Alendronic acid,” “Osteoporosis,” and “Osteonecrosis” were searched in PubMed and ScienceDirect databases. Selection criteria included studies on humans written in English, published from 2014. The systematic review protocol was registered in the PROSPERO register under the following number: CRD42024587046. <i>Results:</i> A total of 7 studies with 98,717 osteoporotic patients met the criteria, showing a higher ONJ incidence with ZA than AA. Six studies linked longer BP use to increased ONJ risk, which quadrupled after 5 years of AA use. A positive correlation was found between BP use (≥3 years) and ONJ in OP patients, primarily affecting females over 60. ONJ appeared after 1 year with AA, increasing over time, while ZA-related ONJ emerged as early as 5 months with a higher overall incidence. <i>Conclusions:</i> ZA poses a higher ONJ risk and incidence and earlier onset than AA, occurring within 5 months versus 1 year for AA. These findings emphasize the need for careful monitoring, especially in long-term BP therapy with additional risk factors.https://www.mdpi.com/1648-9144/61/7/1159alendronatebisphosphonate-associated osteonecrosis of the jawosteoporosiszoledronic acid |
| spellingShingle | Aine Jakonyte Egle Gustainyte Zygimantas Petronis Aviad Hafizov Audra Janovskiene Dainius Razukevicius Risk of Osteonecrosis of the Jaw in Patients Treated with Zoledronic or Alendronic Acid: A Systematic Review Medicina alendronate bisphosphonate-associated osteonecrosis of the jaw osteoporosis zoledronic acid |
| title | Risk of Osteonecrosis of the Jaw in Patients Treated with Zoledronic or Alendronic Acid: A Systematic Review |
| title_full | Risk of Osteonecrosis of the Jaw in Patients Treated with Zoledronic or Alendronic Acid: A Systematic Review |
| title_fullStr | Risk of Osteonecrosis of the Jaw in Patients Treated with Zoledronic or Alendronic Acid: A Systematic Review |
| title_full_unstemmed | Risk of Osteonecrosis of the Jaw in Patients Treated with Zoledronic or Alendronic Acid: A Systematic Review |
| title_short | Risk of Osteonecrosis of the Jaw in Patients Treated with Zoledronic or Alendronic Acid: A Systematic Review |
| title_sort | risk of osteonecrosis of the jaw in patients treated with zoledronic or alendronic acid a systematic review |
| topic | alendronate bisphosphonate-associated osteonecrosis of the jaw osteoporosis zoledronic acid |
| url | https://www.mdpi.com/1648-9144/61/7/1159 |
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