REVIEW - Bisphosphonates and osteonecrosis of the jaws

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REVIEW

Systematic Review: Bisphosphonates and Osteonecrosis of the Jaws

Sook-Bin Woo, DMD; W. Hellstein, DDS, MS; and R. Kalmar, DMD, PhD

16 May 2006 | Volume 144 Issue 10 | Pages 753-761

Osteonecrosis of the jaws is a recently described adverse side effect of

bisphosphonate therapy. Patients with multiple myeloma and metastatic

carcinoma to the skeleton who are receiving intravenous, nitrogen-containing

bisphosphonates are at greatest risk for osteonecrosis of the jaws; these

patients represent 94% of published cases. The mandible is more commonly

affected than the maxilla (2:1 ratio), and 60% of cases are preceded by a

dental surgical procedure. Oversuppression of bone turnover is probably the

primary mechanism for the development of this condition, although there may

be contributing comorbid factors. All sites of potential jaw infection

should be eliminated before bisphosphonate therapy is initiated in these

patients to reduce the necessity of subsequent dentoalveolar surgery.

Conservative débridement of necrotic bone, pain control, infection

management, use of antimicrobial oral rinses, and withdrawal of

bisphosphonates are preferable to aggressive surgical measures for treating

this condition. The degree of risk for osteonecrosis in patients taking oral

bisphosphonates, such as alendronate, for osteoporosis is uncertain and

warrants careful monitoring.

http://www.annals.org/cgi/content/abstract/144/10/753

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