To address this limitation, possible cases were assessed from a review of the text fields for ON cases with any mention of “jaw.” Another limitation is that prescriptions written by specialists may not have been recorded by the general practitioner. The study design was based on an a priori selection of risk factors that have been previously cited in the literature [1, 4–7, 15] with particular AZD8931 mouse focus on those that were highly correlated; therefore, this study may have excluded other potentially important risk factors. In conclusion, using data from the UK GPRD and THIN databases, we found that significant predictors of ON at any skeletal site included

use of systemic corticosteroids in the previous 2 years, hospitalization, referral or specialist

visit, bone fracture, any cancer, osteoporosis, connective tissue disease, and osteoarthritis within the past 5 years. Bisphosphonate use was not a significant predictor of ON. This Dinaciclib supplier study aimed to provide a broader perspective on the descriptive epidemiology of ON risk factors than previous published studies. Studies utilizing more recent data may further elucidate the understanding of key predictors of ON. Acknowledgments The authors gratefully acknowledge the following people for their statistical, editorial, and clinical expertise in the preparation of this manuscript: Karen Driver, Diane Vonderheide, Emma Hobbs, Andrea Klemes, Coridad Pontes and J. Michael Sprafka. Conflicts of interest Professor Cooper has undertaken consultancy and lecturing commitments for the Alliance for Better Bone Health, Eli Lilly, Novartis, GSK Roche, Servier, MSD, and Amgen. Dr. Steinbuch and Mr. Stevenson are employed by Procter & Gamble. PLEKHB2 Dr. Miday retains stock in Procter & Gamble. Dr. Watts has received honoraria for lectures from Amgen, Novartis, Procter & Gamble, and Sanofi-Aventis; consulting fees from Amgen, Eli Lilly, Novartis,

Novo Nordisk, Procter & Gamble, and Sanofi-Aventis; and research support from Amgen, Eli Lilly, Novartis, and Procter & Gamble. Open Access This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited. References 1. Assouline-Dayan Y, Chang C, Greenspan A, Shoenfeld Y, Gershwin ME (2002) Pathogenesis and natural history of osteonecrosis. Semin Arthritis Rheum 32(2):94–124PubMed 2. Tofferi JK, selleck Gilliland W (2008) Avascular Necrosis. Available via eMedicine. http://​emedicine.​medscape.​com/​article/​333364-overview. Accessed 20 Feb 2009. 3. Mont MA, Payman RK, Laporte DM, Petri M, Jones LC, Hungerford DS (2000) Atraumatic osteonecrosis of the humeral head. J Rheumatol 27(7):1766–73PubMed 4. Gladman DD, Urowitz MB, Chaudhry-Ahluwalia V, Hallet DC, Cook RJ (2001) Predictive factors for symptomatic osteonecrosis in patients with systemic lupus erythematosus.