{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T05:45:27Z","timestamp":1792043127931,"version":"4.4.0"},"reference-count":37,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T00:00:00Z","timestamp":1791936000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T00:00:00Z","timestamp":1791936000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100000049","name":"National Institute on Aging","doi-asserted-by":"publisher","award":["R01AG079118"],"award-info":[{"award-number":["R01AG079118"]}],"id":[{"id":"10.13039\/100000049","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["acrjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Arthritis Care &amp;amp; Research"],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Medication\u2010related osteonecrosis of the jaw (MRONJ) is a rare complication of antiresorptive therapy for osteoporosis, with risk potentially influenced by \u201cdrug holidays\u201d around dentoalveolar procedures. MRONJ risk is higher in rheumatic diseases. Epidemiologic studies are limited by poor administrative code performance for MRONJ identification and lack of structured pharmacy data capturing drug holidays. We developed and validated a natural language processing (NLP) algorithm to classify MRONJ and detect drug holidays from free\u2010text clinical notes in electronic health records (EHRs).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Using US Veterans Health Administration EHRs, we identified adults aged \u226550 years old with at least one filled prescription for a bisphosphonate or denosumab for fracture prevention (October 1, 1999, to December 31, 2022). An NLP codebook defined 11 targets with 16 attributes. Two annotators independently labeled notes to create a reference set (n\u00a0=\u00a0870; 200 held out for validation) and an independent validation set (n\u00a0=\u00a0100) for performance assessment (precision, recall, and F\u2010measure). A decision tree\u2013based machine\u2010learning model used NLP\u2010extracted features to classify MRONJ. Drug holiday was an NLP target directly.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The reference set included 6,421 annotations, informing a curated vocabulary of &gt;1,350 terms. For MRONJ classification excluding unclassifiable outputs across all validation notes, precision was 1.00 (95% confidence interval [CI] 0.86\u20131.00), recall 0.96 (95% CI 0.80\u20131.00), and F\u2010measure 0.95 (95% CI 0.88\u20131.00). For drug holiday detection in the held\u2010out validation set, precision was 0.90 (95% CI 0.83\u20130.95), recall 0.98 (95% CI 0.93\u20131.00), and F\u2010measure 0.94.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>We developed an NLP algorithm that is sufficiently accurate in classifying MRONJ and detecting drug holidays to be a promising tool for future studies, including in people with rheumatic diseases.<\/jats:p>\n                    <jats:p>\n                      <jats:boxed-text content-type=\"graphic\" position=\"anchor\">\n                        <jats:graphic xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" mimetype=\"image\/png\" position=\"anchor\" specific-use=\"enlarged-web-image\" xlink:href=\"graphic\/acr80173-gra-0001-m.png\">\n                          <jats:alt-text>image<\/jats:alt-text>\n                        <\/jats:graphic>\n                      <\/jats:boxed-text>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/acr.80173","type":"journal-article","created":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T07:07:36Z","timestamp":1791011256000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Identifying Incident Medication\u2010Related Osteonecrosis of the Jaw and Antiresorptive Drug Holidays Using Natural Language Processing on Clinical Notes in Men and Women Prescribed Bisphosphonates or Denosumab for Fracture Prevention"],"prefix":"10.1002","author":[{"given":"Emily","family":"Budde","sequence":"first","affiliation":[{"name":"Edward Hines Jr. Veterans Affairs Hospital  Hines Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9927-6063","authenticated-orcid":false,"given":"Rachel E.","family":"Elam","sequence":"additional","affiliation":[{"name":"Edward Hines Jr. 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