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Yang G, Williams R, Wang L, Farhadfar N, Chen Y, Loiacono AT, Bian J, Holliday LS, Katz J, Gong Y. Medication-Related Osteonecrosis of the Jaw in Cancer Patients: Result from the OneFlorida Clinical Research Consortium. J Bone Miner Res 2022; 37:2466-2471. [PMID: 36151778 PMCID: PMC9772085 DOI: 10.1002/jbmr.4708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 08/12/2022] [Accepted: 09/17/2022] [Indexed: 01/22/2023]
Abstract
Medication-related osteonecrosis of the jaw (MRONJ) is a rare but severely debilitating drug-induced bone disorder in the jawbone region. The first MRONJ was reported in 2003 after bisphosphonate (BP) exposure. Recently, other drugs, such as receptor activator of NF-κB ligand (RANKL) inhibitor denosumab and antiangiogenic agents, were also associated with MRONJ. The purpose of this study was to evaluate the incidence and risk factors for MRONJ related to BPs or denosumab in cancer patients in real-world clinical settings using data from the OneFlorida Clinical Research Consortium. We queried the electronic health records of participants with prescriptions of intravenous (IV) BPs or denosumab between January 1, 2012, and September 1, 2021, in the OneFlorida Consortium. Time to MRONJ diagnosis was evaluated using the Kaplan-Meier method, and Cox regression analysis was performed to estimate the adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for MRONJ. A total of 5689 participants had one or more prescriptions of IV BP or denosumab within this study period and were included in this study. Among these participants, 52 (0.9%) had a diagnosis of MRONJ. The overall rate of MRONJ was 0.73%, 0.86%, and 3.50% in the cancer patients treated with IV BPs, denosumab, and sequential IV BPs and denosumab, respectively. The risk of MRONJ was similar in participants treated with denosumab alone compared to those treated with IV BPs alone (HR: 1.25, 95% CI: 0.66-2.34, p = .49). Patients with sequential prescription of IV BP and denosumab were at much higher risk for MRONJ, with an adjusted HR of 4.49, 95% CI of 1.96-10.28, p = .0004. In conclusion, in real-world clinical settings, the rates of MRONJ associated with IV BPs and denosumab were similar, while the sequential treatment of these two drug classes was associated with a much higher risk of MRONJ. © 2022 American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Guang Yang
- Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics and Precision Medicine, College of Pharmacy, University of Florida, Gainesville, FL, USA
- Department of Pharmacology, Northwestern University, Chicago IL, USA
| | - Roy Williams
- Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics and Precision Medicine, College of Pharmacy, University of Florida, Gainesville, FL, USA
| | - Lishu Wang
- Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics and Precision Medicine, College of Pharmacy, University of Florida, Gainesville, FL, USA
| | - Nosha Farhadfar
- Division of Hematology/Oncology, University of Florida College of Medicine, Gainesville FL, USA
| | - Yiqing Chen
- Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics and Precision Medicine, College of Pharmacy, University of Florida, Gainesville, FL, USA
- Department of Biostatistics and Data Science, School of Public Health, University of Texas Health Science Center in Houston
| | - Alexander T. Loiacono
- Department of Health Outcomes & Biomedical Informatics, College of Medicine, University of Florida, Gainesville FL, USA
| | - Jiang Bian
- Department of Health Outcomes & Biomedical Informatics, College of Medicine, University of Florida, Gainesville FL, USA
| | - L. Shannon Holliday
- Department of Orthodontics, College of Dentistry, University of Florida, Gainesville, Florida, USA
| | - Joseph Katz
- Department of Oral Medicine, College of Dentistry, University of Florida, Gainesville FL, USA
| | - Yan Gong
- Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics and Precision Medicine, College of Pharmacy, University of Florida, Gainesville, FL, USA
- University of Florida Health Cancer Center, University of Florida, Gainesville FL, USA
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Osteonecrosis of the jaw among cancer patients in Denmark: risk and prognosis. Int J Oral Maxillofac Surg 2022; 51:1424-1430. [DOI: 10.1016/j.ijom.2022.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 12/23/2021] [Accepted: 02/21/2022] [Indexed: 11/23/2022]
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Stevens LAS, Spangler L, Yochum L, Ding Y, Wang FT. Assessment of a Claims-Based ICD-9 and ICD-10 Medication-Related Osteonecrosis of the Jaw Algorithm in the United States. Clin Epidemiol 2021; 13:1019-1026. [PMID: 34737646 PMCID: PMC8560083 DOI: 10.2147/clep.s325080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 09/27/2021] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Medication-related osteonecrosis of jaw (MRONJ) is associated with certain drug therapies. Pharmacoepidemiologic studies often rely on electronic healthcare data to assess adverse events following drug exposure. Few studies have developed and validated claims-based MRONJ identification algorithms. This study assessed the performance of claims-based MRONJ algorithms by chart review of potential cases among postmenopausal (PM) women and women with postmenopausal osteoporosis (PMO). METHODS Among PM and PMO women sourced from a large US commercial health insurance database affiliated with Optum, potential cases were identified by International Classification of Diseases, 9th and 10th Revisions (ICD-9, ICD-10) diagnosis codes; 200 were selected for chart retrieval, with the goal of obtaining 100 charts in each coding era. Procured charts were redacted and then reviewed by an oral surgeon who determined case status. Positive predictive values (PPV) and 95% confidence intervals (CI) were calculated overall, by cohorts, and coding eras. Baseline characteristics were assessed. Two potential algorithm refinements were explored: using a restricted set of ICD codes; requiring antibiotic use after MRONJ diagnosis. RESULTS A total of 1273 potential cases were identified. Of the 200 potential cases selected, 104 (52%) were procured, and six cases were confirmed (PPV 5.8%, 95% CI 2.2, 12.1). Baseline characteristics were largely similar across all strata. Potential algorithm refinements yielded marginal PPV improvement. CONCLUSION This study identified a small number of confirmed cases, and the resulting PPVs were low, but consistent with reported studies. Potential algorithm refinements yielded minimal improvements. To our knowledge, this study is the first to report on the identification of MRONJ using ICD-10 codes in the US.
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Affiliation(s)
| | - Leslie Spangler
- Center for Observational Research, Amgen, Inc., Thousand Oaks, CA, USA
| | | | - Yan Ding
- Optum Epidemiology, Optum, Boston, MA, USA
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Wotton CJ, Green J, Brown A, Armstrong MEG, Floud S, Beral V, Reeves GK. Use of oral bisphosphonates and risk of hospital admission with osteonecrosis of the jaw: Large prospective cohort study in UK women. Bone 2019; 124:69-74. [PMID: 30959190 DOI: 10.1016/j.bone.2019.04.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 03/19/2019] [Accepted: 04/04/2019] [Indexed: 11/21/2022]
Abstract
About 1 in 10 postmenopausal UK women are currently prescribed oral bisphosphonates, but there are concerns about their adverse effects. Osteonecrosis of the jaw is a recognised uncommon but important side effect of intravenous bisphosphonates, but epidemiological evidence on risk of osteonecrosis of the jaw associated with oral bisphosphonate use is less conclusive. The incidence of hospital admission with osteonecrosis of the jaw was examined among 521,695 Million Women Study participants, aged 64.7 years at baseline. Cox proportional hazards regression was used to estimate adjusted relative risks (RRs) and 95% confidence intervals (CIs) associated with use of oral bisphosphonates in postmenopausal women followed-up by record-linkage to National Health Service hospital admission databases. During mean follow-up of 8.2 years per woman, 100 women were admitted to hospital with first recorded osteonecrosis of the jaw, at mean age 72.4 years. Almost a third (29/100) of the cases had ever-used oral bisphosphonates. Ever-users had a six-fold increased risk of hospital admission for osteonecrosis of the jaw, when compared with never-users (adjusted RR = 6.09, 95% CI 3.83-9.66; p < 0.0001). The relative risk for osteonecrosis of the jaw in never-users of oral bisphosphonates was increased in women with prior cancer (RR = 3.40, 2.22-5.22, p < 0.0001). The estimated absolute risk of hospital admission for osteonecrosis of the jaw over a 5-year period from age 70 to 74 in women without prior cancer was 0.09 per 1000 in never-users and 0.69 per 1000 in ever-users of oral bisphosphonates. In this UK population of postmenopausal women, use of oral bisphosphonates was associated with a 6-fold increased risk of hospital admission with osteonecrosis of the jaw, accounting for around one-third of cases, with an excess risk of about 0.6/1000 users over 5 years.
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Affiliation(s)
- Clare J Wotton
- Cancer Epidemiology Unit, University of Oxford, Richard Doll Building, Old Road Campus, Oxford OX3 7LF, UK.
| | - Jane Green
- Cancer Epidemiology Unit, University of Oxford, Richard Doll Building, Old Road Campus, Oxford OX3 7LF, UK
| | - Anna Brown
- Cancer Epidemiology Unit, University of Oxford, Richard Doll Building, Old Road Campus, Oxford OX3 7LF, UK
| | | | - Sarah Floud
- Cancer Epidemiology Unit, University of Oxford, Richard Doll Building, Old Road Campus, Oxford OX3 7LF, UK
| | - Valerie Beral
- Cancer Epidemiology Unit, University of Oxford, Richard Doll Building, Old Road Campus, Oxford OX3 7LF, UK
| | - Gillian K Reeves
- Cancer Epidemiology Unit, University of Oxford, Richard Doll Building, Old Road Campus, Oxford OX3 7LF, UK
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Eiken PA, Prieto-Alhambra D, Eastell R, Abrahamsen B. Surgically treated osteonecrosis and osteomyelitis of the jaw and oral cavity in patients highly adherent to alendronate treatment: a nationwide user-only cohort study including over 60,000 alendronate users. Osteoporos Int 2017; 28:2921-2928. [PMID: 28664276 DOI: 10.1007/s00198-017-4132-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 06/16/2017] [Indexed: 10/19/2022]
Abstract
UNLABELLED Osteonecrosis of the jaw (ONJ) is rare (2.53/10,000 person-years) among alendronate users, but long-term and compliant use are associated with an increased risk of surgically treated ONJ. Risk of surgically treated ONJ is higher in patients with rheumatoid diseases and use of proton pump inhibitors. INTRODUCTION ONJ is a rare event in users of oral bisphosphonates. Our aims were to evaluate if the risk of surgically treated ONJ increases with longer or more compliant treatment with alendronate for osteoporosis and to identify risk factors for surgically treated ONJ. METHODS Open nationwide register-based cohort study containing one nested case-control study. Patients were treatment-naïve incident users of alendronate 1996-2007 in Denmark, both genders, aged 50-94 at the time of beginning treatment (N = 61,990). Participants were followed to 31 December 2013. RESULTS Over a mean of 6.8 years, 107 patients received surgery for ONJ or related conditions corresponding to an incidence rate of 2.53 (95% confidence interval (CI) 2.08 to 3.05) per 10,000 patient years. Recent use was associated with an adjusted odds ratio (OR) 4.13 (95% CI 1.94 to 8.79) compared to past use. Similarly, adherent users (medication possession ratio (MPR) >50%) were at two to threefold increased risk of ONJ compared to low adherence (MPR <50%), and long-term (>5 years) use was related with higher risk (adjusted OR 2.31 (95% CI (1.14 to 4.67)) than shorter-term use. History of rheumatoid disorders and use of proton pump inhibitors were independently associated with surgically treated ONJ. CONCLUSIONS Our data suggest that recent, long-term, and compliant uses of alendronate are associated with an increased risk of surgically treated ONJ. Nevertheless, the rates remain low, even in long-term adherent users. ONJ risk appears higher in patients with conditions likely to indirectly affect the oral mucosa.
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Affiliation(s)
- P A Eiken
- Department of Cardiology, Nephrology and Endocrinology, North Zealand Hospital, Hillerød, Dyrehavevej 29, 3400, Hillerød, Denmark.
- Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen, Denmark.
| | - D Prieto-Alhambra
- Musculoskeletal Pharmaco and Device Epidemiology, Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Botnar Research Centre, Windmill Road, Oxford, OX3 7LD, UK
- GREMPAL Research Group and CIBERFes, Idiap Jordi Gol, Universitat Autònoma de Barcelona and Instituto Carlos III (FEDER Research Funds), Av Gran Via Corts Catalanes 185, 08003, Barcelona, Spain
| | - R Eastell
- Academic Unit of Bone Metabolism (AUBM), University of Sheffield, Herries Road, Sheffield, S5 7AU, UK
| | - B Abrahamsen
- Department of Clinical Research, Odense Patient Data Explorative Network, University of Southern Denmark, J.B. Winsløws Vej 9 A, 3. Sal, 5000, Odense, Denmark
- Department of Medicine, Holbæk Hospital, Smedelundsgade 60, 4300, Holbæk, Denmark
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Di Fede O, Bedogni A, Giancola F, Saia G, Bettini G, Toia F, D'Alessandro N, Firenze A, Matranga D, Fedele S, Campisi G. BRONJ in patients with rheumatoid arthritis: a multicenter case series. Oral Dis 2016; 22:543-8. [DOI: 10.1111/odi.12490] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Revised: 03/15/2016] [Accepted: 04/02/2016] [Indexed: 12/30/2022]
Affiliation(s)
- O Di Fede
- Department of Surgical, Oncological and Oral Sciences; University of Palermo; Palermo Italy
| | - A Bedogni
- Department of Neurosciences; University of Padua; Padua Italy
| | - F Giancola
- Department of Surgical, Oncological and Oral Sciences; University of Palermo; Palermo Italy
| | - G Saia
- Department of Neurosciences; University of Padua; Padua Italy
| | - G Bettini
- Department of Maxillofacial Surgery; University Hospital of Padua; Padua Italy
| | - F Toia
- Department of Surgical, Oncological and Oral Sciences; University of Palermo; Palermo Italy
| | - N D'Alessandro
- Clinical Pharmacology Unit; Azienda Ospedaliera Universitaria Policlinico ‘P. Giaccone’; Palermo Italy
| | - A Firenze
- Department of Sciences for Health Promotion and Mother and Child Care ‘G. D'Alessandro’; University of Palermo; Palermo Italy
| | - D Matranga
- Department of Sciences for Health Promotion and Mother and Child Care ‘G. D'Alessandro’; University of Palermo; Palermo Italy
| | - S Fedele
- UCL Eastman Dental Institute; University College London; London UK
- NIHR University College London Hospitals Biomedical Research Centre; London UK
| | - G Campisi
- Department of Surgical, Oncological and Oral Sciences; University of Palermo; Palermo Italy
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Schmidt M, Schmidt SAJ, Sandegaard JL, Ehrenstein V, Pedersen L, Sørensen HT. The Danish National Patient Registry: a review of content, data quality, and research potential. Clin Epidemiol 2015; 7:449-90. [PMID: 26604824 PMCID: PMC4655913 DOI: 10.2147/clep.s91125] [Citation(s) in RCA: 2932] [Impact Index Per Article: 325.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background The Danish National Patient Registry (DNPR) is one of the world’s oldest nationwide hospital registries and is used extensively for research. Many studies have validated algorithms for identifying health events in the DNPR, but the reports are fragmented and no overview exists. Objectives To review the content, data quality, and research potential of the DNPR. Methods We examined the setting, history, aims, content, and classification systems of the DNPR. We searched PubMed and the Danish Medical Journal to create a bibliography of validation studies. We included also studies that were referenced in retrieved papers or known to us beforehand. Methodological considerations related to DNPR data were reviewed. Results During 1977–2012, the DNPR registered 8,085,603 persons, accounting for 7,268,857 inpatient, 5,953,405 outpatient, and 5,097,300 emergency department contacts. The DNPR provides nationwide longitudinal registration of detailed administrative and clinical data. It has recorded information on all patients discharged from Danish nonpsychiatric hospitals since 1977 and on psychiatric inpatients and emergency department and outpatient specialty clinic contacts since 1995. For each patient contact, one primary and optional secondary diagnoses are recorded according to the International Classification of Diseases. The DNPR provides a data source to identify diseases, examinations, certain in-hospital medical treatments, and surgical procedures. Long-term temporal trends in hospitalization and treatment rates can be studied. The positive predictive values of diseases and treatments vary widely (<15%–100%). The DNPR data are linkable at the patient level with data from other Danish administrative registries, clinical registries, randomized controlled trials, population surveys, and epidemiologic field studies – enabling researchers to reconstruct individual life and health trajectories for an entire population. Conclusion The DNPR is a valuable tool for epidemiological research. However, both its strengths and limitations must be considered when interpreting research results, and continuous validation of its clinical data is essential.
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Affiliation(s)
- Morten Schmidt
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | | | | | - Vera Ehrenstein
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Lars Pedersen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
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The Validity of Claims-Based Algorithms to Identify Serious Hypersensitivity Reactions and Osteonecrosis of the Jaw. PLoS One 2015; 10:e0131601. [PMID: 26161858 PMCID: PMC4498926 DOI: 10.1371/journal.pone.0131601] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 06/03/2015] [Indexed: 11/19/2022] Open
Abstract
Validation of claims-based algorithms to identify serious hypersensitivity reactions and osteonecrosis of the jaw has not been performed in large osteoporosis populations. The objective of this project is to estimate the positive predictive value of the claims-based algorithms in older women with osteoporosis enrolled in Medicare. Using the 2006-2008 Medicare 5% sample data, we identified potential hypersensitivity and osteonecrosis of the jaw cases based on ICD-9 diagnosis codes. Potential hypersensitivity cases had a 995.0, 995.2, or 995.3 diagnosis code on emergency department or inpatient claims. Potential osteonecrosis of the jaw cases had ≥1 inpatient or outpatient physician claim with a 522.7, 526.4, 526.5, or 733.45 diagnosis code or ≥2 claims of any type with a 526.9 diagnosis code. All retrieved records were redacted and reviewed by experts to determine case status: confirmed, not confirmed, or insufficient information. We calculated the positive predictive value as the number of confirmed cases divided by the total number of retrieved records with sufficient information. We requested 412 potential hypersensitivity and 304 potential osteonecrosis of the jaw records and received 174 (42%) and 84 (28%) records respectively. Of 84 potential osteonecrosis of the jaw cases, 6 were confirmed, resulting in a positive predictive value (95% CI) of 7.1% (2.7, 14.9). Of 174 retrieved potential hypersensitivity records, 95 were confirmed. After exclusion of 25 records with insufficient information for case determination, the overall positive predictive value (95% CI) for hypersensitivity reactions was 76.0% (67.5, 83.2). In a random sample of Medicare data, a claim-based algorithm to identify serious hypersensitivity reactions performed well. An algorithm for osteonecrosis of the jaw did not, partly due to the inclusion of diagnosis codes that are not specific for osteoporosis of the jaw.
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Ehrenstein V, Gammelager H, Schiødt M, Nørholt SE, Neumann-Jensen B, Folkmar TB, Pedersen L, Svaerke C, Sørensen HT, Ma H, Acquavella J. Evaluation of an ICD-10 algorithm to detect osteonecrosis of the jaw among cancer patients in the Danish National Registry of Patients. Pharmacoepidemiol Drug Saf 2015; 24:693-700. [PMID: 25974710 DOI: 10.1002/pds.3786] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Revised: 03/05/2015] [Accepted: 03/17/2015] [Indexed: 11/08/2022]
Abstract
PURPOSE This study aimed to validate a predefined algorithm for osteonecrosis of the jaw (ONJ) among cancer patients in the Danish National Registry of Patients and to assess the nature of clinical information recorded in medical charts of ONJ patients. METHODS We identified potential ONJ cases recorded in 2005-2010 among cancer patients at the hospital Departments of Oral and Maxillofacial Surgery (DOMS) in three Danish regions, using a set of codes from the International Classification of Diseases, 10th revision (ICD-10). We abstracted DOMS charts of the potential cases, had the ONJ status adjudicated by an expert ONJ adjudication committee (ONJAC), and computed positive predictive values. For patients with ONJAC-confirmed ONJ, we abstracted the charts for information on ONJ clinical course. Sensitivity of the algorithm was computed using a separate sample of 101 known ONJ cases accrued in 2005-2011. RESULTS We identified 212 potential ONJ cases, of which 197 (93%) had charts available for abstraction. Eighty-three potential cases were confirmed by ONJAC, with a positive predictive value of 42% (95% confidence interval [CI] 35%-49%). DOMS charts of these 83 cases contained complete information on ONJ clinical course. Information about antiresorptive treatment was recorded for 84% of the patients. Among the 101 known ONJ cases, 74 had at least one prespecified ICD-10 code recorded in the Danish National Registry of Patients within ±90 days of the ONJ diagnosis (sensitivity 73%; 95%CI [64%-81%]). CONCLUSIONS The predefined algorithm is not adequate for monitoring ONJ in pharmacovigilance studies. Additional case-finding approaches, coupled with adjudication, are necessary to estimate ONJ incidence accurately.
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Affiliation(s)
- Vera Ehrenstein
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Henrik Gammelager
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.,Department of Anesthesiology and Intensive Care Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Morten Schiødt
- Department of Oral and Maxillofacial Surgery, Rigshospitalet, Copenhagen Ø, Denmark
| | - Sven Erik Nørholt
- Department of Oral and Maxillofacial Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Bjarne Neumann-Jensen
- Department of Oral and Maxillofacial Surgery, Aalborg University Hospital, Aalborg, Denmark
| | - Troels Bille Folkmar
- Department of Oral and Maxillofacial Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Lars Pedersen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Claus Svaerke
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Haijun Ma
- Global Biostatistical Science, Amgen Inc., Thousand Oaks, CA, USA
| | - John Acquavella
- Center for Observational Research, Amgen Inc., Thousand Oaks, CA, USA
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Schiodt M, Larsson Wexell C, Herlofson BB, Giltvedt KM, Norholt SE, Ehrenstein V. Existing data sources for clinical epidemiology: Scandinavian Cohort for osteonecrosis of the jaw - work in progress and challenges. Clin Epidemiol 2015; 7:107-16. [PMID: 25657594 PMCID: PMC4315392 DOI: 10.2147/clep.s71796] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Osteonecrosis of the jaw (ONJ) is a severe side effect associated with antiresorptive treatment. Monitoring of ONJ using routine databases in Scandinavian countries is a challenge owing to lack of valid algorithms and to heterogeneous referral practices. The aim of this paper is to describe the process of establishing a Scandinavian ONJ Cohort enrolling all ONJ cases related to antiresorptive treatment arising in Denmark, Norway, and Sweden between 2011 and 2019. The initial purpose of the cohort is to support an ongoing pharmacovigilance study of denosumab and zoledronic acid in Denmark, Norway, and Sweden. The three countries, with their 199 clinics, departments, and units of oral and maxillofacial surgery, both hospital-based and freestanding, differ somewhat in referral practices of the ONJ patients. By directly contacting all providers of care to ONJ patients in the three countries, we established a network for reporting incident cases to each country's research database directly or through a member of the Scandinavian ONJ task force as a liaison. The task force includes a Scandinavian coordinator and three national coordinators collaborating directly with the clinics. A uniform ONJ registration form has been developed, and the relevant medical community has been informed either directly or through presentations at professional meetings. A website with study information is published in each country, and data entry is ongoing. This large-scale systematic uniform registration of ONJ cases in Denmark, Norway, and Sweden, with an underlying total population of more than 20 million people, merged into the Scandinavian ONJ Cohort, will contribute to better knowledge and understanding of this challenging group of patients, and ultimately, help improve patient care. The Scandinavian ONJ Cohort as a whole and its component national ONJ research databases may offer the potential for large-scale multinational intervention and safety studies in the future.
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Affiliation(s)
- Morten Schiodt
- Department of Oral and Maxillofacial Surgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Cecilia Larsson Wexell
- Department of Oral and Maxillofacial Surgery, Södra Älvsborg Hospital, Region Västra Götaland, Borås, Sweden ; Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Bente Brokstad Herlofson
- Department of Oral Surgery and Oral Medicine, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Karen Marie Giltvedt
- Department of Oral Surgery and Oral Medicine, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Sven Erik Norholt
- Department of Oral and Maxillofacial Surgery, Aarhus University and University Hospital, Aarhus, Denmark
| | - Vera Ehrenstein
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
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Ehrenstein V, Christiansen CF, Schmidt M, Sørensen HT. Non-Experimental Comparative Effectiveness Research: How to Plan and Conduct a Good Study. CURR EPIDEMIOL REP 2014. [DOI: 10.1007/s40471-014-0021-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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