Evaluation of an ICD-10 algorithm to detect osteonecrosis of the jaw among cancer patients in the Danish National Registry of Patients

Abstract

The predefined algorithm is not adequate for monitoring ONJ in pharmacovigilance studies. Additional case-finding approaches, coupled with adjudication, are necessary to estimate ONJ incidence accurately.

Association of common comorbidities with osteonecrosis: a nationwide population-based case–control study in Denmark

“…In a recent report, of 83 jaw ON cases confirmed in medical records during a period of 5 years, only two cases were coded using M87.1 and 8 cases were coded using M87.8, while other ICD-10 codes than those used in our report were used for the rest of the cases (K04.6, K10.2 or K10.3). 30 Thus, our comorbidity results likely cannot be generalised to jaw ON, which has rather different risk factors and prognosis than other ON cases. Also, we lacked information on potential important confounders such as lifestyle factors including smoking and alcohol consumption, and prescription medication including corticosteroids and immunosuppressive drugs, which may lead to residual confounding and an overestimation of the risk conferred by comorbidities.…”

“… 7 Bisphosphonates used, for example, in the management of multiple myeloma 28 and bone metastases 29 have been related to ON of the jaw. 30 For haematological cancers, hyperviscosity-induced leukostasis and leukaemic infiltration have been suspected as underlying mechanisms. 31 Moreover, bone marrow transplantation is reportedly accompanied by a cumulative ON incidence after 10 years of 2.9%–15.5%.…”

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

“…In Denmark, there are 6 departments of oral and maxillofacial surgery managing ONJ patients (November 2013) and 23 private clinics/offices that may generally refer their ONJ patients to one of the six departments [14] and all used the disease codes. This referral procedure is known to dentist [15].…”

“…A previous study validating ICD-10 codes for identifying cases of ONJ in Danish registers have shown ICD-10 codes used alone to perform relatively poorly [37]. In the oncology setting [15], the ICD10 code K102, indicating inflammatory conditions of jaws, had a sensitivity of 60 and 63% for two validated ONJ populations while M878, 'unspecified osteonecrosis' had a sensitivity of 16.8% in both. For this reason, the current study did not rely on ICD-10 coding alone, but required the simultaneous presence of procedure codes for surgery to the oral cavity of jaws.…”

Osteonecrosis of the jaw among patients with cancer treated with denosumab or zoledronic acid: Results of a regulator‐mandated cohort postauthorization safety study in Denmark, Norway, and Sweden

“…In all 3 countries, ONJ treatment occurs at hospital‐based departments (all treatment is centralized to 6 clinics in Denmark); in Norway, ONJ also may be treated at free‐standing clinics; and in Sweden, ONJ also may be treated at departments of oral medicine, health care, or dental care. Clinics outside hospitals do not contribute records to the registries (Supporting Table 1), and even available hospital‐recorded International Classification of Diseases, Tenth Revision codes have low validity in capturing ONJ 16 . To maximize the completeness and validity of ONJ identification, we established the Scandinavian ONJ Cohort, which included ONJ cases diagnosed directly at treating clinics independently of treatment cohorts' identification.…”