According to research published early online in the Journal of Clinical Oncology, ibandronate and pamidronate appear to exhibit a safer drug profile concerning osteonecrosis of the jaw (ONJ) complication compared to zolendronic acid.
Researchers conducted a cohort study aimed at calculating the incidence of, and identifying the risk factors for osteonecrosis of the jaw (ONJ) in patients with cancer treated with intravenous zoledronate 4mg, ibandronate 6mg, and pamidronate 90mg.

The study included data obtained from 1,621 patients who received 29,006 intravenous doses of bisphosphonate. Data analysed included age, sex, smoking status, underlying disease, medical and dental history, bisphosphonates (BP) type, and doses administered. The relative risks, crude and adjusted odds ratios (aORs), and cumulative hazard ratios for ONJ development were calculated.

The following results were reported:
• Crude ONJ incidence was 8.5%, 3.1%, and 4.9% in patients with multiple myeloma, breast cancer, and prostate cancer, respectively.
• Multivariate analysis demonstrated that use of dentures (adjusted odds ratio aOR = 2.02; 95% CI, 1.03 to 3.96, p=0.042), history of dental extraction (aOR = 32.97; 18.02 to 60.31, p<0.001), having ever received zoledronate (aOR = 28.09; 5.74 to 137.43, p<0.001), and each zoledronate dose (aOR = 2.02; 1.15 to 3.56, p=0.015) were associated with increased risk for ONJ development.
• The aOR for patients having received zoledronate was 28.09 (5.74 to 137.43 p<0.001), for pamidronate 12.32 (2.04 to 74.47, p=0.006), and ibandronate 0.26 (0.07 to 0.95, p=0.042

The researchers concluded that although ibandronate and pamidronate at the doses used in this study appear to exhibit a safer profile, further randomised, controlled trials are needed to validate these results. Furthermore, they recommend that patients with a challenging dental situation should have dental care attended to before initiation of these drugs.