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VOLUME 9 , ISSUE 1 ( January, 2008 ) > List of Articles


Osteonecrosis of the Jaws Secondary to Bisphosphonate Therapy: A Case Series

Satish K. S. Kumar, Michael C. Meru, Parish P. Sedghizadeh

Citation Information : Kumar SK, Meru MC, Sedghizadeh PP. Osteonecrosis of the Jaws Secondary to Bisphosphonate Therapy: A Case Series. J Contemp Dent Pract 2008; 9 (1):63-69.

DOI: 10.5005/jcdp-9-1-63

License: CC BY-NC 3.0

Published Online: 01-03-2009

Copyright Statement:  Copyright © 2008; The Author(s).



The objective of this report is to present the clinical experiences of several patients affected with osteonecrosis (ONJ) secondary to bisphosphonate (BP) therapy and to provide a discussion of the specific BPs implicated in this condition.


ONJ secondary to BP therapy is becoming an increasingly reported complication following dental therapy. This is particularly true of surgical dental procedures such as extractions. BPs are a class of pharmaceuticals used in the treatment of numerous disorders affecting bone, including osteoporosis, cancer metastases to bone, hypercalcemia of malignancy, and multiple myeloma. Although ONJ is a more recently described phenomenon, it is an emerging problem that may be associated with significant morbidity such as oral dysfunction, impaired eating ability, pain, and compromised esthetics resulting in a poor quality of life in affected patients.

Case Report

This is a description of 13 patients affected with ONJ secondary to BP therapy managed at the Orofacial Pain & Oral Medicine Center, Special Patients Clinic, and Oral and Maxillofacial Surgery Clinic at the University of Southern California, School of Dentistry between October 2005 and April 2007, with a discussion of the specific BPs implicated in this condition, the clinical presentation, management, and follow-up.


Thorough reporting of every case of ONJ is important to help advance the understanding of this poorly understood condition. The authors’ approach to care represents a more conservative mode to management than previously described by many investigators.


Kumar SKS, Meru MC, Sedghizadeh PP. Osteonecrosis of the Jaws Secondary to Bisphosphonate Therapy: A Case Series. J Contemp Dent Pract 2008 January;(9)1:063-069.

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  1. Update of current therapeutic options for the treatment of postmenopausal osteoporosis. Clin Ther 2006;28(2):151-73.
  2. BPs for advanced prostate cancer. Cochrane Database Syst Rev 2006(4):CD006250.
  3. BPs in multiple myeloma. Cochrane Database Syst Rev 2002(3):CD003188.
  4. BPs for the relief of pain secondary to bone metastases. Cochrane Database Syst Rev 2002(2):CD002068.
  5. A metaanalysis on the use of BPs in corticosteroid induced osteoporosis. J Rheumatol 1999;26(5):1148-57.
  6. Emerging anti-cancer molecular mechanisms of amino BPs. Endocr Relat Cancer 2006;13(1):7-26.
  7. BPs for breast cancer. Cochrane Database Syst Rev 2005(3):CD003474.
  8. Discovery, clinical development, and therapeutic uses of BPs. Ann Pharmacother 2005;39(4):668-77.
  9. BP actions: physical chemistry revisited. Bone 2006;38(5):613-6.
  10. Ibandronate, an experimental intravenous BP for osteoporosis, bone metastases, and hypercalcemia of malignancy. Pharmacotherapy 2006;26(5):655-73.
  11. Narrative [corrected] review: BPs and osteonecrosis of the jaws. Ann Intern Med 2006;144(10):753-61.
  12. Once-monthly dosing: an effective step forward. Bone 2006;38(4 Suppl 1):S18-22.
  13. Pamidronate reduces bone loss after allogeneic stem cell transplantation. J Clin Endocrinol Metab 2006;91(10):3835-43.
  14. BP-induced avascular osteonecrosis of the jaws: a clinical report of 11 cases. Int J Oral Maxillofac Surg 2006;35(7):588-93.
  15. Reports of adverse events from bone drugs prompt caution. JAMA 2006;295(24):2833-6.
  16. Nature and frequency of BP-associated osteonecrosis of the jaws in Australia. J Oral Maxillofac Surg 2007;65(3):415-23.
  17. Osteonecrosis of the jaw--do BPs pose a risk? 2006;355(22):2278-81.
  18. BP-related osteonecrosis of the jaw: background and guidelines for diagnosis, staging and management. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006;102(4):433-41.
  19. Osteonecrosis of the jaws associated with the use of BPs: a review of 63 cases. J Oral Maxillofac Surg 2004;62(5):527-34.
  20. Effects of continuing or stopping alendronate after 5 years of treatment: the Fracture Intervention Trial Long-term Extension (FLEX): a randomized trial. JAMA 2006;296(24):2927-38.
  21. Use of BPs to improve the durability of total joint replacements. J Am Acad Orthop Surg 2006;14(4):215-25.
  22. BPs and osteonecrosis of the jaw: cause and effect or a post hoc fallacy? Ann Oncol 2006;17(8):1197-204.
  23. BP-induced exposed bone (osteonecrosis/ osteopetrosis) of the jaws: risk factors, recognition, prevention, and treatment. J Oral Maxillofac Surg 2005;63(11):1567-75.
  24. Current topics in pharmacological research on bone metabolism: inhibitory effects of BPs on the differentiation and activity of osteoclasts. J Pharmacol Sci 2006;100(3):189-94.
  25. BP-associated osteonecrosis of the auditory canal. Br J Haematol 2006;132(1):114.
  26. BPs and osteonecrosis of the jaw. Med J Aust 2005;182(8):417-8.
  27. BP osteochemonecrosis (bis-phossy jaw): is this phossy jaw of the 21st century? J Oral Maxillofac Surg 2005;63(5):682-9.
  28. BP-associated osteonecrosis: a long-term complication of BP treatment. Lancet Oncol 2006;7(6):508-14.
  29. American Association of Oral and Maxillofacial Surgeons position paper on bisphosphonate-related osteonecrosis of the jaws. J Oral Maxillofac Surg 2007;65(3):369-76.
  30. Dental management of patients receiving oral bisphosphonate therapy: expert panel recommendations. J Am Dent Assoc 2006;137(8):1144-50.
  31. Oral & Intravenous BP-Induced Osteonecrosis of the Jaws. Illinois: Quintessence Publishing Co, Inc; 2007.
  32. Jaw osteonecrosis related to bisphosphonate therapy: a severe secondary disorder. Bone 2007;40(4):828-34.
  33. Managing the care of patients with bisphosphonate-associated osteonecrosis: an American Academy of Oral Medicine position paper. J Am Dent Assoc 2005;136(12):1658-68.
  34. Bisphosphonates and avascular necrosis of the jaw: a possible association. Med J Aust 2005;182(8):413-5.
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