Is vitamin D deficiency a risk factor for osteonecrosis of the jaw in patients with cancer? A matched case-control study

Alberto Bedogni; Giordana Bettini; Giorgio Bedogni; Daniela Basso; Davide Gatti; Silvia Valisena; Antonella Brunello; Marco Sorio; Tamara Berno; Sandro Giannini; Filippo Navaglia; Mario Plebani; Pier Francesco Nocini; Stella Blandamura; Giorgia Saia; Francesco Bertoldo

doi:10.1016/j.jcms.2019.03.007

Is vitamin D deficiency a risk factor for osteonecrosis of the jaw in patients with cancer? A matched case-control study

J Craniomaxillofac Surg. 2019 Aug;47(8):1203-1208. doi: 10.1016/j.jcms.2019.03.007. Epub 2019 Mar 13.

Authors

Alberto Bedogni¹, Giordana Bettini², Giorgio Bedogni³, Daniela Basso⁴, Davide Gatti⁵, Silvia Valisena⁶, Antonella Brunello⁷, Marco Sorio⁸, Tamara Berno⁹, Sandro Giannini¹⁰, Filippo Navaglia⁴, Mario Plebani⁴, Pier Francesco Nocini¹¹, Stella Blandamura¹², Giorgia Saia², Francesco Bertoldo¹³

Affiliations

¹ Unit of Maxillofacial Surgery, Department of Neuroscience-DNS, University of Padua, Padua, Italy. Electronic address: [email protected].
² Unit of Maxillofacial Surgery, Department of Neuroscience-DNS, University of Padua, Padua, Italy.
³ Clinical Epidemiology Unit, Liver Research Center, Basovizza, Trieste, Italy.
⁴ Unit of Laboratory Medicine, Department of Medicine-DIMED, University of Padua, Padua, Italy.
⁵ Unit of Rheumatology, Department of Medicine, University of Verona, Verona, Italy.
⁶ Service of Traumatology, Orthopedics and Hand Surgery, Regional Hospital of Bellinzona, Switzerland.
⁷ Medical Oncology, Istituto Oncologico Veneto-IRCCS, Padua, Italy.
⁸ Unit of Hematology, Department of Medicine, University of Verona, Verona, Italy.
⁹ Hematology and Clinical Immunology Branch, Department of Medicine-DIMED, University of Padua, Padua, Italy.
¹⁰ Unit of Internal Medicine, Department of Medicine-DIMED, University of Padua, Padua, Italy.
¹¹ Unit of Oral and Maxillofacial Surgery, Department of Surgery, University of Verona, Verona, Italy.
¹² Department of Medicine-DIMED, University of Padua, Padua, Italy.
¹³ Unit of Internal Medicine, Department of Medicine, University of Verona, Verona, Italy.

PMID: 30929994
DOI: 10.1016/j.jcms.2019.03.007

Abstract

Purpose: A previous case-control histomorphometric study showed higher odds of osteomalacia in patients with bisphosphonate-related osteonecrosis of the jaw (BRONJ). Vitamin D deficiency causes osteomalacia and may therefore be involved in the pathogenesis of BRONJ. The present case-control study aimed at testing such hypothesis.

Materials and methods: BRONJ+ and BRONJ- patients treated with bisphosphonates were matched by sex (same) and age (within 5 years). Serum 25-hydroxy-vitamin D (25-OH-D), parathyroid hormone, bone alkaline phosphatase, total procollagen type 1 amino-terminal propeptide, carboxy-terminal collagen crosslinks, Dickkopf WNT signaling pathway inhibitor 1 and sclerostin were measured.

Results: The main outcome was vitamin D deficiency defined as 25-OH-D < 50 nmol/l. A total of 51 BRONJ+ and 73 BRONJ- patients were studied. The frequency (95% CI) of vitamin D deficiency was 59% (45%-72%) in BRONJ+ and 62% (48%-75%) in BRONJ- patients. This amounts to a difference of -3% (-22%-16%, p = 0.77) for BRONJ+ patients. Serum 25-hydroxy-vitamin D and parathyroid hormone were similar in BRONJ+ and BRONJ- patients. Among the bone metabolism markers, only sclerostin differed between the two groups, being higher in BRONJ+ patients.

Conclusion: The present matched case-control study suggests that vitamin D deficiency is not a risk factor for BRONJ.

Keywords: cancer; case-control study; osteonecrosis of the jaw; risk factor; vitamin D deficiency.

MeSH terms

Bisphosphonate-Associated Osteonecrosis of the Jaw*
Bone Density Conservation Agents / adverse effects*
Case-Control Studies
Diphosphonates
Humans
Neoplasms
Risk Factors
Vitamin D Deficiency* / drug therapy

Substances

Bone Density Conservation Agents
Diphosphonates