Bisphosphonates and Bisphosphonate Induced Osteonecrosis

Oral and Maxillofacial Surgery Clinics of North America. 2007 Nov;19(4):487-498, Yoh Sawatari, Robert E. Marx

Bisphosphonate-induced osteonecrosis of the jaws is the correct term for this real drug complication that most dental practitioners face. All nitrogen-containing bisphosphonates pose a risk, which is related to the route of administration, the potency of the bisphosphonate, and the duration of use. Although intravenous bisphosphonate-induced osteonecrosis of the jaws is mostly permanent, most cases can be prevented or managed if they develop, with only a few cases requiring resection for resolution. Oral bisphosphonate-induced osteonecrosis of the jaws also can be prevented with knowledge of the risk level related to the duration of use and the C-terminal telopeptide blood test results. Most cases can be resolved with a drug holiday either spontaneously or via straightforward débridement.