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Bisphosphonate Induced Osteonecrosis of the Jaw

Clinical Overview

Medicines called bisphosphonates (pronounced bis-FOS-fo-nates) have been used for many years to help prevent and treat osteoporosis. They appeared to have minimal side effects, but a new side effect has emerged called osteonecrosis (pronounced OSS-tee-oh-ne-KRO-sis) of the jaw. This is a rare but serious condition involving destruction of the jawbone. It is now being referred to as bisphosphonate-induced osteonecrosis, or BON. Recent media coverage on the subject has caused unnecessary public alarm and misunderstanding about this problem.
Osteonecrosis literally means “dead bone." Patients taking bisphosphonate medications who have developed osteonecrosis of the jaw have painful, exposed and necrotic (dead) areas of their jaw bone, which may have occurred following surgical dental procedures. These osteonecrosis lesions primarily involve the lower jaw (mandible), are non-healing or slow to heal, and are often complicated by secondary infection. Risk factors for the development of ONJ include corticosteroid therapy and chemotherapy, dental procedures such as tooth extraction, poor oral health, and bisphosphonate use. Of the millions of people who take bisphosphonate medication for osteoporosis, there have only been about 30 reported cases of bisphosphonate-induced osteonecrosis (BON) making this a rare, but very serious complication. Because bisphosphonate medications can reside in the bone tissues for many years, patients taking bisphosphonates for less than a year appear to have a very low risk of developing BON, while patients who have taken bisphosphonates for many years may be at a greater risk for BON. Currently there is no cure for BON, but treatment is available that can help reduce or eliminate pain, the major symptom of this condition. The most successful treatment involves using antibiotics and antibacterial mouth rinses such as chlorhexidine. Surgical treatment such as removal of the dead jaw bone has not been found to be successful, and often makes the condition worse. Stopping bisphosphonate use is not an effective treatment because these medicines remain in the bone for many years, even if the medication is no longer being taken. Although bisphosphonates have not been found to directly cause osteonecrosis of the jaw and the current number of cases of BON are extremely low, dentists and physicians are concerned about BON because millions of baby boomers are taking bisphosphonates for osteoporosis and are thus at greater risk for developing BON. Research is currently underway to better understand BON, identify the root cause of BON and develop more effective ways to prevent and treat the condition.

Last updated: Dec-22-06

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