Jaw osteonecrosis associated with bisphosphonates: Multiple exposed areas and its relationship to teeth extractions. Study of 20 cases

Oral Bisphosphonate-Induced Osteonecrosis: Risk Factors, Prediction of Risk Using Serum CTX Testing, Prevention, and Treatment

“…Initial reports of bisphosphonate-induced osteonecrosis of the jaws focused on those cases caused by either Zometa or Aredia used to stabilize metastatic cancer deposits in bone. [1][2][3][4][5][6] Nevertheless, several of these publications also reported a smaller number of cases related to oral bisphosphonates used in the treatment of osteopenia and osteoporosis 2,3 and since then there have been more publications relating osteonecrosis in patients using oral bisphosphonates. [7][8][9] However, few details were provided and no distinctions concerning the incidence, severity, risks, prevention, or treatment outcomes between the intravenous bisphosphonate cases and the oral bisphosphonate cases were even attempted.…”

Reply

“…At present, most reported cases of ONJ have been in oncology patients, with the vast majority of these cases being reported in cancer patients receiving high-dose intravenous (IV) bisphosphonate therapy in association with chemotherapy, radiotherapy, poor dental hygiene, or after a dental procedure. Published series of cases in more than 300 oncology patients have been extensively reviewed (1,2), with additional cases reported in patients with metastatic bone disease or multiple myeloma (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)). In contrast, few cases of ONJ have been reported in patients receiving bisphosphonates for osteoporosis or osteopenia (1,2,13,18,(20)(21)(22), and the occurrence of ONJ in this population is thought to be very rare.…”

Experience with the treatment of bisphosphonate-related osteonecrosis of the jaw

“…Minor dentoalveolar surgery such as tooth extraction or chronic trauma of the oral mucosa caused by poorly fitting dentures are common triggering factors of bone exposure. However spontaneous development has also been reported 11,12 .…”