{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,28]],"date-time":"2026-02-28T02:01:30Z","timestamp":1772244090917,"version":"3.50.1"},"reference-count":29,"publisher":"National Institute for Health and Care Research","license":[{"start":{"date-parts":[[2022,12,13]],"date-time":"2022-12-13T00:00:00Z","timestamp":1670889600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100009128","name":"Research for Patient Benefit Programme","doi-asserted-by":"publisher","award":["PB-PG-1216-20017"],"award-info":[{"award-number":["PB-PG-1216-20017"]}],"id":[{"id":"10.13039\/501100009128","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001262","name":"Baily Thomas Charitable Fund","doi-asserted-by":"publisher","award":["SG5354-8380"],"award-info":[{"award-number":["SG5354-8380"]}],"id":[{"id":"10.13039\/501100001262","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["openresearch.nihr.ac.uk"],"crossmark-restriction":false},"short-container-title":["NIHR Open Res"],"abstract":"<ns3:p>Background: Recent studies show that adults with intellectual disabilities (ID) have high incidence of major osteoporotic fracture, especially hip fracture. In those \u2265 50 years, women and men with ID have an approximately two and four times higher rate of hip fracture than women and men without ID. Increased awareness of osteoporotic fracture risk in ID may lead to wider use of antiresorptive drugs (bisphosphonates and denosumab) in this population. We aimed to compare, between people with and without ID, the incidence of 1) major side effects, namely medication related osteoporosis of the jaw (ONJ) and oesophagitis; 2) oral pathology, which can be a risk factor for ONJ. Methods: Exploratory study investigating safety of first line osteoporosis medication within the population of a previous study comparing fracture incidence in people with and without ID in the GOLD database of the Clinical Practice Research Datalink 1998\u20132017. Results: The percentage of people on antiresorptive drugs was identical in the ID and non ID group (1.4%). The number of individuals who developed ONJ and oesophagitis during the study was too low to allow an accurate estimate of incidence of the events and a comparison between the two groups. The incidence of any oral pathology was 119.31 vs 64.68\/10000 person year in the ID vs non ID group. Conclusions: Medication related ONJ and oesophagitis are rare in people with and without ID. There is no reason based on our findings to use antiresorptives differently in people with ID as in the rest of the population. However, the potential for side effects of antiresorptives will inherently increase with wider use of these drugs. Given the higher incidence of oral pathology in people with ID, which could put them at higher risk of ONJ, precautions should be taken to prevent this complication by attention to oral health.<\/ns3:p>","DOI":"10.3310\/nihropenres.13352.1","type":"journal-article","created":{"date-parts":[[2022,12,13]],"date-time":"2022-12-13T07:25:09Z","timestamp":1670916309000},"page":"61","update-policy":"https:\/\/doi.org\/10.3310\/nihropenres.crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Use and risk of side effects of antiresorptive medication in people with intellectual disabilities"],"prefix":"10.3310","volume":"2","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8177-8778","authenticated-orcid":false,"given":"Valeria","family":"Frighi","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Margaret","family":"Smith","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tim A.","family":"Holt","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"6221","published-online":{"date-parts":[[2022,12,13]]},"reference":[{"key":"ref-1","doi-asserted-by":"publisher","first-page":"101656","DOI":"10.1016\/j.eclinm.2022.101656","article-title":"Incidence of fractures in people with intellectual disabilities over the life course: a retrospective matched cohort study.","volume":"52","author":"V Frighi","year":"2022","journal-title":"EClinicalMedicine."},{"key":"ref-2","doi-asserted-by":"publisher","first-page":"115080","DOI":"10.1016\/j.bone.2019.115080","article-title":"Elevated fracture risk for adults with neurodevelopmental disabilities.","volume":"130","author":"D Whitney","year":"2020","journal-title":"Bone."},{"key":"ref-3","doi-asserted-by":"publisher","first-page":"727-32","DOI":"10.1007\/s00198-016-3740-2","article-title":"Low-trauma fractures and bone mineral density testing in adults with and without intellectual and developmental disabilities: a population study.","volume":"28","author":"R Balogh","year":"2017","journal-title":"Osteoporos Int."},{"key":"ref-4","doi-asserted-by":"publisher","first-page":"369-75","DOI":"10.1007\/s00198-016-3733-1","article-title":"Fracture risk in people with developmental disabilities: results of a large claims data analysis.","volume":"28","author":"G B\u00fcchele","year":"2017","journal-title":"Osteoporos Int."},{"key":"ref-5","article-title":"Osteoporosis- prevention of fragility fractures"},{"key":"ref-6","article-title":"Management of osteoporosis and the prevention of fragility fractures"},{"key":"ref-7","article-title":"Clinical guideline for the prevention and treatment of osteoporosis"},{"key":"ref-8","doi-asserted-by":"publisher","first-page":"920-943","DOI":"10.1016\/j.joms.2022.02.008","article-title":"American Association of Oral and Maxillofacial Surgeons' Position Paper on Medication-Related Osteonecrosis of the Jaws-2022 Update.","volume":"80","author":"S Ruggiero","year":"2022","journal-title":"J Oral Maxillofac Surg."},{"key":"ref-9","doi-asserted-by":"publisher","first-page":"1396-402","DOI":"10.3899\/jrheum.100221","article-title":"Bisphosphonate-associated osteonecrosis of the jaw in Ontario: a survey of oral and maxillofacial surgeons.","volume":"38","author":"A Khan","year":"2011","journal-title":"J Rheumatol."},{"key":"ref-10","doi-asserted-by":"publisher","first-page":"2921-2928","DOI":"10.1007\/s00198-017-4132-y","article-title":"Surgically treated osteonecrosis and osteomyelitis of the jaw and oral cavity in patients highly adherent to alendronate treatment: a nationwide user-only cohort study including over 60,000 alendronate users.","volume":"28","author":"P Eiken","year":"2017","journal-title":"Osteoporos Int."},{"key":"ref-11","doi-asserted-by":"publisher","first-page":"115650","DOI":"10.1016\/j.bone.2020.115650","article-title":"Incidence of and risk for osteonecrosis of the jaw in Korean osteoporosis patients treated with bisphosphonates: A nationwide cohort-study.","volume":"143","author":"S Kim","year":"2021","journal-title":"Bone."},{"key":"ref-12","doi-asserted-by":"publisher","first-page":"714-727","DOI":"10.1016\/j.joms.2021.12.007","article-title":"Prevalence, Incidence Rate, and Risk Factors of Medication-Related Osteonecrosis of the Jaw in Patients With Osteoporosis and Cancer: A Nationwide Population-Based Study in Japan.","volume":"80","author":"M Ishimaru","year":"2022","journal-title":"J Oral Maxillofac Surg."},{"key":"ref-13","doi-asserted-by":"publisher","first-page":"616-24","DOI":"10.1177\/1060028016649368","article-title":"Identification of risk factors for bisphosphonate-associated atypical femoral fractures and osteonecrosis of the jaw in a pharmacovigilance database.","volume":"50","author":"R Bejhed","year":"2016","journal-title":"Ann Pharmacother."},{"key":"ref-14","doi-asserted-by":"publisher","first-page":"2443-2452","DOI":"10.1210\/jc.2018-01965","article-title":"Invasive Oral Procedures and Events in Postmenopausal Women With Osteoporosis Treated With Denosumab for Up to 10 Years.","volume":"104","author":"N Watts","year":"2019","journal-title":"J Clin Endocrinol Metab."},{"key":"ref-15","doi-asserted-by":"publisher","first-page":"e0196419","DOI":"10.1371\/journal.pone.0196419","article-title":"The influence of alendronate and tooth extraction on the incidence of osteonecrosis of the jaw among osteoporotic subjects.","volume":"13","author":"W Chiu","year":"2018","journal-title":"PLoS One."},{"key":"ref-16","doi-asserted-by":"publisher","first-page":"1359-1378","DOI":"10.1111\/jir.12632","article-title":"Oral health of adults with intellectual disabilities: a systematic review.","volume":"63","author":"L Ward","year":"2019","journal-title":"J Intellect Disabil Res."},{"key":"ref-17","doi-asserted-by":"publisher","first-page":"1475-81","DOI":"10.1111\/jir.12628","article-title":"Prevalence of factors associated with edentulousness (no natural teeth) in adults with intellectual disabilities.","volume":"63","author":"D Kinnear","year":"2019","journal-title":"J Intellect Disabil Res."},{"key":"ref-18","doi-asserted-by":"publisher","first-page":"1228-34","DOI":"10.1016\/j.clinthera.2015.03.018","article-title":"Gastrointestinal events among patients initiating osteoporosis therapy: a retrospective administrative claims database analysis.","volume":"37","author":"A Modi","year":"2015","journal-title":"Clin Ther."},{"key":"ref-19","article-title":"CPRD."},{"key":"ref-20","doi-asserted-by":"publisher","first-page":"827-36","DOI":"10.1093\/ije\/dyv098","article-title":"Data Resource Profile: Clinical Practice Research Datalink (CPRD).","volume":"44","author":"E Herrett","year":"2015","journal-title":"Int J Epidemiol."},{"key":"ref-21","article-title":"Stata Statistical Software: Release 16.","year":"2019"},{"key":"ref-22","doi-asserted-by":"publisher","first-page":"1115-7","DOI":"10.1016\/s0278-2391(03)00720-1","article-title":"Pamidronate (Aredia) and zoledronate (Zometa) induced avascular necrosis of the jaws: a growing epidemic.","volume":"61","author":"R Marx","year":"2003","journal-title":"J Oral Maxillofac Surg."},{"key":"ref-23","article-title":"Oral Health Management of Patients at Risk of Medication-related Osteonecrosis of the Jaw","year":"2017"},{"key":"ref-24","doi-asserted-by":"publisher","first-page":"CD012432","DOI":"10.1002\/14651858.CD012432.pub3","article-title":"Interventions for managing medication-related osteonecrosis of the jaw.","volume":"7","author":"N Beth-Tasdogan","year":"2022","journal-title":"Cochrane Database Syst Rev."},{"key":"ref-25","doi-asserted-by":"publisher","first-page":"9924","DOI":"10.3390\/ijerph18189924","article-title":"Evaluation of preventive treatment protocols for patients under antiresorptive therapy undergoing tooth extraction at a swiss university clinic.","volume":"18","author":"E Pick","year":"2021","journal-title":"Int J Environ Res Public Health."},{"key":"ref-26","doi-asserted-by":"publisher","first-page":"616-621","DOI":"10.1016\/j.jormas.2022.03.020","article-title":"Incidence and risk factors associated to Medication-Related Osteo Necrosis of the Jaw (MRONJ) in patients with osteoporosis after tooth extractions. A 12-months observational cohort study.","volume":"123","author":"A Cuozzo","year":"2022","journal-title":"J Stomatol Oral Maxillofac Surg."},{"key":"ref-27","article-title":"Read codes and CPRD GOLD codes for intellectual disabilities.","author":"V Frighi","year":"2022","journal-title":"figshare."},{"key":"ref-28","article-title":"Read codes and CPRD Gold codes for oral pathology.","author":"V Frighi","year":"2022","journal-title":"figshare."},{"key":"ref-29","article-title":"STROBE checklist for Use and risk of side effects of antiresorptive medication in people with intellectual disabilities.","author":"T Holt","year":"2022","journal-title":"figshare."}],"container-title":["NIHR Open Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/openresearch.nihr.ac.uk\/articles\/2-61\/v1\/xml","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/openresearch.nihr.ac.uk\/articles\/2-61\/v1\/pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/openresearch.nihr.ac.uk\/articles\/2-61\/v1\/iparadigms","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,11,17]],"date-time":"2023-11-17T07:35:15Z","timestamp":1700206515000},"score":1,"resource":{"primary":{"URL":"https:\/\/openresearch.nihr.ac.uk\/articles\/2-61\/v1"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,12,13]]},"references-count":29,"URL":"https:\/\/doi.org\/10.3310\/nihropenres.13352.1","relation":{"has-review":[{"id-type":"doi","id":"10.3310\/nihropenres.14480.r30440","asserted-by":"subject"},{"id-type":"doi","id":"10.3310\/nihropenres.14480.r30001","asserted-by":"subject"},{"id-type":"doi","id":"10.3310\/nihropenres.14480.r30440","asserted-by":"object"},{"id-type":"doi","id":"10.3310\/nihropenres.14480.r30001","asserted-by":"object"}]},"ISSN":["2633-4402"],"issn-type":[{"value":"2633-4402","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,12,13]]},"assertion":[{"value":"Indexed","URL":"https:\/\/openresearch.nihr.ac.uk\/articles\/2-61\/v1#article-reports","order":0,"name":"referee-status","label":"Referee status","group":{"name":"current-referee-status","label":"Current Referee Status"}},{"value":"10.3310\/nihropenres.14480.r30001, Kara Anderson, Deakin University, Victoria, 28 Jul 2023, version 1, indexed","URL":"https:\/\/openresearch.nihr.ac.uk\/articles\/2-61\/v1#referee-response-30001","order":0,"name":"referee-response-30001","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"<b>Valeria Frighi<\/b>; \n<i>Posted: 12 Oct 2023<\/i>; Many thanks for your kind review. I will include some of the points you suggested in a minor revision of the manuscript in the near future.","URL":"https:\/\/openresearch.nihr.ac.uk\/articles\/2-61\/v1#referee-comment-3281","order":1,"name":"referee-comment-3281","label":"Referee Comment","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.3310\/nihropenres.14480.r30440, Zoe Paskins, Keele University, Keele, England, 10 Oct 2023, version 1, indexed","URL":"https:\/\/openresearch.nihr.ac.uk\/articles\/2-61\/v1#referee-response-30440","order":2,"name":"referee-response-30440","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"<b>Valeria Frighi<\/b>; \n<i>Posted: 12 Oct 2023<\/i>; Many thanks for your kind review. I will include some of the points you suggested in a minor revision of the manuscript in the near future.","URL":"https:\/\/openresearch.nihr.ac.uk\/articles\/2-61\/v1#referee-comment-3280","order":3,"name":"referee-comment-3280","label":"Referee Comment","group":{"name":"article-reports","label":"Article Reports"}},{"value":"The post-hoc analyses presented in this paper were funded by the small grant scheme of the Baily Thomas Charitable Fund (grant reference SG\/5354-8380)\nThe parent project was funded by the National Institute for Health Research (NIHR) under its Research for Patient Benefit (RfPB) Programme (Grant Reference Number PB-PG-1216-20017). The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. \nM Smith is supported by the National Institute for Health Research (NIHR) Oxford Biomedical Research Centre (BRC) and by the NIHR Applied Research Collaborative Oxford and Thames Valley. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.","order":4,"name":"grant-information","label":"Grant Information"},{"value":"This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs Licence, which only permits the download and sharing of the work, provided the original work is properly cited; the work cannot be changed or used commercially.","order":0,"name":"copyright-info","label":"Copyright"}]}}