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

Research output: Contribution to journalArticlepeer-review


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.

Original languageEnglish
Pages (from-to)1203-1208
Number of pages6
JournalJournal of Maxillofacial Surgery
Issue number8
Publication statusPublished - Aug 2019


  • 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


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