Bisphosphonates are medications commonly used to prevent or treat osteoporosis (a thinning of the bones) or as part of cancer treatment. Some bisphosphonate medications (such as Fosamax, Actonel, Boniva) are taken orally (swallowed). Others, such as Aredia, Bonefos, Didronel or Zometa, are administered intravenously (injected into a vein).

In rare instances, some individuals receiving bisphosphonate therapy have developed Bisphosphonate-related osteonecrosis of the jaw (BRONJ), a serious condition that involves severe loss, or destruction, of the jawbone, and for which there is no known treatment. Necrosis refers to dead tissue, in this case bone, and the most common symptoms of BRONJ are areas of exposed bone in the upper or lower jaw that do not heal after more than 6 weeks. Most cases of osteonecrosis of the jaw associated with bisphosphonates have been diagnosed after dental procedures such as teeth extractions, however the condition can also occur spontaneously.

The actual incidence of BRONJ has not been accurately determined, but is reported from as low as 1 in 2,000 for certain oral medications to as high as 1 in 10 for those taking high bisphosphonate doses as part of cancer treatment. I have seen one case of BRONJ in my practice. It was after an extraction and the patient had not reported that he was taking bisphosphonates.

There are several important risk factors that can increase the possibility of developing BRONJ:

1. High doses
2. Continued use for more than 3 years
3. Corticosteroids being taken at the same time
4. Traumatic dental procedures such as teeth extractions
5. Alcohol or tobacco use
6. Diabetes
7. Poor oral hygiene

If you are considering the use of bisphosphonates for any reason, it is essential that you consult with your dentist and physician about the risks of BRONJ, and that you have any elective dental treatment completed prior to initiating therapy. If you are already using bisphosphonates you must inform your dentist so that he/she can help you make the best decisions about any future dental treatment.

Yours for excellent dental health,
Dr S