Osteonecrosis of the Jaw

See below for additional references.

Osteonecrosis of the Jaw is a rare condition affecting less than 1% of patients with bone cancer who are given high dose bisphosphonates intravenously. It presents as a painful or painless area of non-healing oral mucosa usually after a dental extraction or dental surgery. In most cases, though delayed for more than 8 weeks, the lesions heal with rinses and antibiotics.

Although it is theoretically possible that a similar problem could occur with tablet bisphosphonates (Fosamax, Alendronate, Actonel, etidronate, Didrocal), this has not yet been seen in clinical trials of osteoporosis patients. In over 100,000 patient-years of experience, there have not been more dental problems observed in bisphosphonate-treated patients (as compared with placebo). Therefore, if it is a problem at all, the frequency would be less than 1/300,000.

As always in medicine, we must carefully balance the risks and benefits of therapy. Bisphosphonates have provided safe, effective treatment for millions of women with osteoporosis and prevented many fractures. A theoretical unproven side-effect should not deter patients at risk of fragility fracture from taking proven effective treatment. Recommendations for patients on bisphosphonates are to maintain regular dental care. There is no evidence that stopping treatment before a dental surgery has any influence, though this would probably cause little harm.

If you would like to read more on this issue, please click on the link below:

• Osteonecrosis of the jaw (ONJ) and bisphosphonates
  Dr. Michael R. McClung, MD, FACP, Oregon Osteoporosis Center, Portland, OR

  North American Menopause Society (NAMS) Menopause e-Consult—Vol 3:2 (April 2007)

• The Impact of Osteonecrosis of the Jaw on Osteoporosis Management: Executive Summary of a European Society on Clinical and Economic Aspects of Osteoporosis and Foundation for Research on Osteoporosis and other Bone Diseases Working Group Meeting