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, 16 (1), 121-32

Quality of Life Implications of Bisphosphonate-Associated Osteonecrosis of the Jaw


Quality of Life Implications of Bisphosphonate-Associated Osteonecrosis of the Jaw

Rebecca Anne Miksad et al. Oncologist.


Purpose: Potentially debilitating, osteonecrosis of the jaw (ONJ) is an emerging complication of bisphosphonates. However, its effect on quality of life (QoL) is unknown. We determined the ONJ-related QoL decline in a cancer patient cohort.

Patients and methods: Thirty-four cancer patients with bisphosphonate-associated ONJ completed a telephone survey (October 2007 through May 2008). The Oral Health Impact Profile 14 (OHIP) retrospectively assessed participant oral health-related QoL before and after ONJ. Standardized ONJ descriptions were developed in a multidisciplinary, iterative process and were evaluated with three frequently used preference-based QoL measurement methods on a 0 (death) to 1 (perfect health) scale: Visual Analogue Scale (VAS), Time Trade-Off (TTO), and EQ-5D.

Results: ONJ significantly (p < .001) increased OHIP scores (worse QoL) for additive (3.56-16.53) and weighted (7.0-17.5) methods. Seven individual OHIP items significantly increased (Bonferroni correction p < .0035): pain, eating discomfort, self-consciousness, unsatisfactory diet, interrupted meals, irritability, and decreased life satisfaction. Mean preference-based QoL values significantly decreased (p < .001) with worsening ONJ stage (VAS, TTO, and EQ-5D): no ONJ (0.76, 0.86, 0.82), ONJ stage 1 (0.69, 0.82, 0.78), ONJ stage 2 (0.51, 0.67, 0.55), and ONJ stage 3 (0.37, 0.61, 0.32). As ONJ worsened, EQ-5D domain scores significantly increased (p < .001). Pain/discomfort and anxiety/depression contributed most to declining QoL.

Conclusions: ONJ significantly affects QoL, a detriment that increases with worsening ONJ. QoL impairments for ONJ stages 2 and 3 are similar to other treatment side effects that influence decision-making. Bisphosphonate-associated ONJ QoL is an important consideration for patients, clinicians, and policy makers.

Conflict of interest statement

Disclosures: Rebecca Anne Miksad: None; Kuan-Chi Lai: None; Thomas Benton Dodson: None; Sook-Bin Woo: None; Nathaniel Simon Treister: None; Omosalewa Akinyemi: None; Marian Bihrle: None; Guy Maytal: None; Meredith August: None; G. Scott Gazelle: None; J. Shannon Swan: None.

The content of this article has been reviewed by independent peer reviewers to ensure that it is balanced, objective, and free from commercial bias. No financial relationships relevant to the content of this article have been disclosed by the authors or independent peer reviewers.


Figure 1.
Figure 1.
Enrollment of patients.
Figure 2.
Figure 2.
Preference-based QoL assessment. (A): Mean (SD) utility value for ONJ health states. (B): ONJ utility decrement by stage. (C): Mean scores of EQ-5D domains (numbers listed in supplemental online Table 1). Abbreviations: ONJ, osteonecrosis of the jaw; QoL, quality of life; TTO, Time Trade-off; VAS, Visual Analogue Scale.

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