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Johan Bergdahl,1 Fredrik Jarnbring,2 Vera Ehrenstein,3 Henrik Gammelager,3 Fredrik Granath,1 Helle Kieler,1 Madeleine Svensson,1 Grethe S Tell,4 Ylva Trolle Lagerros11Centre for Pharmacoepidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; 2Department of Oral and Maxillofacial Surgery Solna, Karolinska University Hospital, Stockholm, Sweden; 3Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark; 4Department of Public Health and Primary Health Care, University of Bergen, Bergen, NorwayBackground: Osteonecrosis of the jaw (ONJ) is a medical condition associated with antiresorptive drugs, among others, used to treat osteoporosis and bone metastasis. Currently, there is no consensus regarding the definition of ONJ, and no ONJ-specific International Classification of Diseases-10 code exists. Therefore, register-based studies of this condition may be troublesome.Purpose: To evaluate an algorithm ascertaining ONJ cases in an attempt to facilitate future assessments of ONJ in clinical and epidemiological studies.Methods: By means of the Patient Register and the Prescribed Drug Register, we identified all postmenopausal female residents in Sweden from 2005 through 2009. To identify potential cases of ONJ, we employed an algorithm including the following conditions: periapical abscess with sinus, inflammatory conditions of jaws, alveolitis of jaws, idiopathic aseptic necrosis of bone, osteonecrosis due to drugs, osteonecrosis due to previous trauma, other secondary osteonecrosis, other osteonecrosis, and unspecified osteonecrosis. Women seen at departments of oral and maxillofacial surgery, with at least one of the conditions, were classified as potential cases of ONJ. Conditions in anatomic sites other than the jaw were excluded. Validation was performed through medical record review. Case confirmation was based on the ONJ definition by the American Association of Oral and Maxillofacial Surgeons. The algorithm was evaluated by positive predictive values (PPVs) stratified by diagnosis.Results: For the 87 potential cases identified through our algorithm, the medical records were obtained for 83. The overall PPV was 18% (95% confidence interval (CI) 10%–28%). The highest PPV was observed in osteonecrosis due to drugs (83%, 95% CI 36%–100%). Several diagnoses had a PPV of 0 or were not used at all (periapical abscess with sinus, alveolitis of jaws, idiopathic aseptic necrosis of bone, osteonecrosis due to previous trauma, other secondary osteonecrosis, other osteonecrosis, and unspecified osteonecrosis).Conclusion: It was possible to ascertain cases of ONJ from the Swedish registers using this algorithm; however, the PPV was low. Thus, further refinements of the algorithm are necessary.Keywords: bisphosphonate-associated osteonecrosis of the jaw, epidemiology, methods, ONJ, registries, validation

Sophie Norenstedt1,7, Fredrik Granath2, Anders Ekbom2, Jonas Bergh3, Mats Lambe4, Jan Adolfsson5, Fredrik Warnberg6, Jan Zedenius1,7, Inga-Lena Nilsson1,71Department of Molecular Medicine and Surgery, 2Department of Medicine, 3Department of Oncology and Pathology, Karolinska Institutet and Cancer Center Radiumhemmet, Karolinska University Hospital, Stockholm; 4Regional Oncology Centre, Uppsala; 5Oncologic Center, Karolinska University Hospital and CLINTEC Department, Karolinska Institutet, Stockholm; 6Department of Surgery, Uppsala Academic Hospital, Uppsala University; 7Endocrine Surgery Unit, Karolinska University Hospital, Stockholm, SwedenBackground: Primary hyperparathyroidism (pHPT) is associated with an increased risk of developing breast cancer, but little is known about the underlying factors. The aim of this study was to compare women with a history of pHPT and a reference population in terms of standard factors predictive of prognosis and response to therapy for breast cancer.Methods: We analyzed data collected from the National Swedish Cancer Register and from two regional oncologic center registries. Seventy-one women with breast cancer and a history of parathyroid adenomectomy were compared with 338 matched controls with breast cancer only. Tumor size, stage, hormone receptor status, lymph node status, cause of death, and cumulative survival were analyzed.Results: The mean age was 69 ± 11 years (95% confidence interval [CI]: 68–70) in both groups and the mean time interval between the parathyroid surgery and breast cancer diagnosis was 91 ± 68 months (95% CI: 72–111). There were no differences between the two groups regarding size, stage, lymph node metastases, or survival, but none of the cases with a history of pHPT were found in Stage III or IV.Conclusion: In conclusion, factors predictive of prognosis and response to therapy in women with a history of pHPT and breast cancer are similar to those in breast cancer patients without pHPT.Keywords: breast cancer, primary hyperparathyroidism, prognostic factors