Risk factors for osteonecrosis of the jaw in patients with chronic kidney disease

Lay Summary

Osteonecrosis of the jaw (ONJ) is a rare but severe condition associated with anti-resorptive medications. Information on ONJ risk in CKD patients was limited, despite the increasing use of anti-osteoporosis drugs. This study showed the incidence rate of ONJ in CKD patients (3.27 per 100 000 patient-years), no significant association between kidney functions itself and ONJ risk, and key risk factors for ONJ in CKD patients: use of anti-resorptive drugs for tumor-related disorders and oral corticosteroid use. Importantly, anti-resorptive drugs for osteoporosis and injectable corticosteroid use were not significantly associated with ONJ risk. Similarly, other relevant factors such as diabetes, liver disease, anabolic drugs, and radiation therapy did not show a significant association with ONJ risk. These findings may influence clinical practice by encouraging the appropriate use of osteoporosis medications in CKD patients after thorough fracture risk assessment, rather than avoiding them due to ONJ concerns. It also highlights the need for heightened surveillance in CKD patients receiving anti-osteoporosis drugs for tumor-related disorders or oral corticosteroid use.