Validity of an algorithm to identify osteonecrosis of the jaw in women with postmenopausal osteoporosis in the Danish National Registry of Patients

Figures & data

Table 1 PPV of an algorithm to identify ONJ based on ICD-10 codes and treatment at departments of oral and maxillofacial surgery, Central and North Denmark Regions, 2005–2010

	Total (n)	confirmed ONJ (n)	Not confirmed ONJ (n)	PPV, % (95% CI)
Overalla	60	19	41	32 (20–45)
Idiopathic aseptic necrosis of bone (M87.0)	0	0	0
Osteonecrosis due to drugs (M87.1)	1	1	0	100 (25–100)b
Osteonecrosis due to previous trauma (M87.2)	0	0	0
Other secondary osteonecrosis (M87.3)	0	0	0
Other osteonecrosis (M87.8)	3	2	1	67 (9–99)
Osteonecrosis, unspecified (M87.9)	0	0	0
Inflammatory conditions of the jaw (K10.2)	51	17	34	33 (21–48)
Alveolitis of the jaws (K10.3)	2	1	1	50 (13–99)
Periapical abscess with sinus (K04.6)	7	0	7	0 (0–41)b

Notes:

a Patients could have more than one ICD-10 code

b one-sided, 97.5% CI.

Abbreviations: CI, confidence interval; ICD, International Classification of Diseases; n, number; ONJ, osteonecrosis of the jaw; PPV, positive predictive value.

Table 2 Characteristics of the 19 women with postmenopausal osteoporosis with confirmed ONJ, North and Central Denmark Regions, June 1, 2005 through May 31, 2010

Characteristics	Number (%)a
Age at ONJ diagnosis, median (IQR)	72 (67–79)
Malignancies	10 (53%)
Use of bisphosphonatesb	18 (95%)
Oral	8 (42%)
Intravenous	10 (53%)
Dentoalveolar surgeryb	10 (53%)
Use of dentures	12 (63%)
Location of exposed bone
Mandible	14 (74%)
Maxilla	4 (21%)
Both jaws	1 (5%)

Notes:

a Values are expressed as number (percentage), unless otherwise indicated

b prior to ONJ occurrence.

Abbreviations: IQR, interquartile range; ONJ, osteonecrosis of the jaw.

Table S1 Case algorithm for osteoporosis

Osteoporosis diagnosis (ICD-10 codes)

– Osteoporosis with pathological fracture (M80x), osteoporosis without pathological fracture (M81x), or osteoporosis in diseases classified elsewhere (M82x)

or

Osteoporotic fracture diagnosis (ICD-10 codes)

– Fracture of forearm, humerus, spine, pelvis, or femur (ICD-10: S52x, S12.0, S12.1, S12.2, S12.7, S12.9, S22.0, S22.1, S32, T08, S42.2, S42.3, S42.4, S42.7, S42.8, and/or S72x)

– Without concurrent Nordic Medico-Statistical Committee code of external causes of injuries indicating major trauma (EUP2-EUP9 and/or EUM2-EUM9)

or

Osteoporosis medications

– Bisphosphonates (ATC: BM05BA, M05BB or Danish treatment code: BWHB40x), selective estrogen receptor modulators (ATC: G03XCx), ipriflavone (ATC: M05BX01), strontium ranelate (ATC: M05BX03), denosumab (ATC: M05BX04), parathyroid hormones (H05AA), and/or calcitonin H05BA

Abbreviations: ATC, Anatomical Therapeutic Chemical; ICD-10, International Classification of Diseases, 10th revision.