In the News
Bisphosphonates and Osteonecrosis of the Jaw           [PDF format]

What is ONJ?
   A rare condition that can affect the bone of the upper or lower jaw and cause exposed bone in the mouth with pain and poor healing.

Who is at risk to get ONJ?
  • the answer to this question is still being worked out
  • it has been seen most often in people with a history of cancer who have received infusions of IV medicines to prevent the spread of cancer in the bone [zoledronic acid and pamidronate] who also had tooth extractions or extensive dental work
  • rare cases have been reported in postmenopausal women or men with osteoporosis who take medications called bisphosphonates for their bone health. [Bisphosphonates include: Fosamax, Actonel, Boniva, Didronel]

What is the relationship of medicines for bone health to ONJ?
  • A recent study looked at 368 cases of ONJ in patients on some type of bone health medicine between 1966 and 2006. [Woo, et al, AIM 2006;144:753-761]
  • 94% of these cases occurred in patients who had received the IV bisphosphonates [zoledronic acid or pamidronate]
  • 85% had bone cancer (multiple myeloma or breast cancer that had spread to the bones)
  • Of these 368 cases of ONJ, there were only 15 patients who developed ONJ who did not have a history of cancer.
  • 18 occurred in patients on oral alendronate (Fosamax), 1 with oral risedronate (Actonel) and one with oral ibandronate (Boniva). It is likely that more of these patients were on Fosamax because it has been available for use longer
  • The way these medicines might contribute to or cause ONJ is not known. Other health problems and other medicines may play a big part in increasing the risk.

Points to remember
  • ONJ is rare in postmenopausal women or men with osteoporosis who take medicines for their bone health.
  • ONJ may occur during treatment with any of the bisphosphonates
  • Many other factors may contribute to a person’s risk to develop ONJ (other health issues, other medicines)
  • If you have any dental problems, it is very important to have them addressed before beginning a bisphosphonate. Most experts agree that you should also probably interrupt treatment with bisphosphonates if you require some type of dental procedure in the future although it is unclear how long you would need to be off of your medication before undergoing a dental procedure
  • Aggressive dental surgery should generally be avoided if possible, if you are taking a bisphosphonate