Bisphosphonates and Osteonecrosis of the Jaw

Osteonecrosis of the jaw (ONJ) (a painful, refractory condition where a portion of the jaw bone dies and becomes exposed) has been linked to bisphosphonate therapy in the treatment of osteoporosis. Numerous studies over the past ten years have been unsatisfactory in demonstrating the actual incidence of oral bisphosphonate-related ONJ and therefore the level of risk remains controversial. A new study out of Australia may bring us closer to understanding this association. Gorromeo, et al. showed a "strong, significant association between oral bisphosphonate use and delayed dental healing and jaw osteonecrosis."*

"The most significant finding of this study was the 13-fold increased odds of developing delayed dental healing in individuals on oral bisphosphonate therapy (11.6-fold after adjusting for smoking)." "There was no association of bisphosphonate exposure with osteonecrosis risk independently of a predisposing dental intervention, thereby highlighting the importance of a thorough dental assessment at the outset of bisphosphonate therapy."

Other studies have shown smoking and diabetes to increase the risk for ONJ in patients being treated with bisphosphonates.

*Delayed dental healing is defined as a failure to heal within 6 weeks. This condition is considered a precursor to ONJ. ONJ is defined as exposed jaw bone of greater than 8 weeks duration. 

Borromeo, G.L. et al. 2014. A large case-control study reveals a positive association between bisphosphonate use and delayed dental healing and osteonecrosis of the jaw. J Bone and Mineral Res 29(6):1363-1368.