Increased risk of bisphosphonate-related osteonecrosis of the jaw in patients with Sjogren's syndrome: nationwide population-based cohort study

Objective The aim of this study was to explore whether patients with Sjogren's syndrome (SS) were susceptible to bisphosphonate (BP)-related osteonecrosis of the jaw (BRONJ) after tooth extraction in the entire population of Taiwan. Design A nationwide population-based retrospective cohort study. Setting Data were extracted from Taiwan's National Health Insurance Research Database (NHIRD). Methodology Medical conditions for both the study and control group were categorised using the International Classification of Diseases, 9th Revision. ORs and 95% CIs for associations between SS and osteonecrosis of the jaw (ONJ) were estimated using Cox regression. Results Overall, 13 398 patients diagnosed with SS were identified from the NHIRD. An additional 53 592 matched patients formed the control group. At the 3-year follow-up, patients with SS started to exhibit a significantly increased cumulative risk of developing BRONJ compared with that of patients without SS (log rank test < 0.001). At the end of the follow-up period, patients with SS exhibited a significantly increased incidence of ONJ compared with that of the controls (0.08% vs0.03%, p=0.017). The Cox regression model showed that patients with SS also exhibited a significantly increased risk of developing BRONJ compared with that of the patients without SS (adjusted HR=7.869, 95% CI 3.235 to 19.141, p<0.001). Conclusion Patients with SS exhibit an increased risk of developing BRONJ after tooth extraction. BPs should be used with caution in patients with SS.