Osteonecrosis of the jaw after treatment with bisphosphonates: Is irreversible, so the focus must be on prevention

doi:10.1136/bmj.39024.647558.BE

BMJ 2006;333:982-983 (11 November), doi:10.1136/bmj.39024.647558.BE

Editorials

Osteonecrosis of the jaw after treatment with bisphosphonates

Is irreversible, so the focus must be on prevention

The first 150 words of the full text of this article appear below.

New generation bisphosphonates such as zolendronicacid, pamidronate, and alendronic acid have various indicationsin medicine. Initially, their use was restricted to patientswith metastatic bone malignancy secondary to breast cancer,lung cancer, prostate cancer, or multiple myeloma. Their benefitin these conditions led to wider application for other bonepathologies, such as osteoporosis and Paget's disease.¹ Theirmain effect is to inhibit osteoclast activity; however, theyalso seem to have antiangiogenic effects,² and once they areincorporated into the bony matrix, degradation is minimal.³

Reports from several hundred cases over thepast three years suggest that long term use of new generationbisphosphonates increases the risk of avascular osteonecrosisof the jaws.⁴ ⁵ ⁶ The meanonset time of osteonecrosis after the treatment is started isone to three years.⁶ The clinical picture consists of non-healingulcerated oral lesions and visible necrotic bone, which aresometimes associated with a diffuse jaw . . . [Full text of this article]

Basile Nicolas Landis, resident, Michel Richter, professor and head of department, Ivan Dojcinovic, senior resident, Max Hugentobler, associate professor

¹ Department of Oral and Maxillo-Facial Surgery, University Hospital of Geneva, 1211 Geneva, Switzerland

Basile.Landis@hcuge.ch

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