Is diabetes a risk factor for bisphosphonate-associated osteonecrosis of the jaws? Systematic review and meta-analysis.

OBJECTIVE

This systematic review aimed to evaluate the risk of bisphosphonate-associated osteonecrosis of the jaws (BRONJ) in patients with diabetes mellitus (DM).

STUDY

DESIGN

A two-phase PROSPERO-registered systematic review (CRD420251101934) was conducted in accordance with the PRISMA guidelines. Search strategies were developed for central databases (PubMed, Scopus, Web of Science, COCHRANE, LILACS, and EBSCOhost) and Grey literature information sources (Google Scholar), and were searched up to February 2025. Newcastle-Ottawa was used to assess risk of bias (RoB), and the GRADE tool was used to determine the quality of evidence.

RESULTS

Of 251 articles, 15 were selected for systematic review and meta-analysis, including 9,469 patients. Low RoB was observed, and the DM group shows a 2.12-fold (95% CI = 1.39-3.23) increase in BRONJ prevalence (P = .0005). There was low heterogeneity (P = .03, I² = 44%) and no significant Risk of publication bias (P = .586), but GRADE-pro showed a very low certainty of evidence.

CONCLUSIONS

DM increased the risk of BRONJ; the heterogeneity is low, but the certainty of the evidence is low. The studies are not standardized regarding diagnostic criteria, nor do they differentiate between cases involving oral or intravenous BF and DM.