Bisphosphonate-Related Osteonecrosis of the Jaw, Revisited

August 21, 2014

Bisphosphonate-Related Osteonecrosis of the Jaw, Revisited

  1. Allan S. Brett, MD

In a study from Taiwan, this condition developed in 1 of every 200 long-term users of oral alendronate.

  1. Allan S. Brett, MD

Bisphosphonate-related osteonecrosis of the jaw (ONJ) consists of exposed necrotic bone that persists for weeks or months; it can occur spontaneously or after invasive dental procedures. The condition was noted initially after high-dose intravenous bisphosphonate treatment for malignant conditions, but some evidence suggests that it can develop in users of oral bisphosphonate for osteoporosis (NEJM JW Gen Med Apr 8 2008). A report from Taiwan adds to the evidence.

Among 7332 patients who were taking oral alendronate (according to a hospital pharmacy database), 40 (0.55%) were diagnosed with ONJ an average of 4 years after initiating alendronate. Cases were verified by manual review of radiographic, operative, and pathology reports. In contrast, in a control group of 1882 patients who were treated for osteoporosis with raloxifene (a non-bisphosphonate), only 1 patient developed ONJ. After adjustment for potentially confounding factors, the incidence of ONJ was sevenfold higher with alendronate than with raloxifene. Risk factors for developing ONJ among users of alendronate included diabetes, rheumatoid arthritis, older age, and alendronate use for >3 years.


The possibility that oral bisphosphonate therapy might cause osteonecrosis of the jaw (ONJ) received quite a bit of attention about 5 years ago; more recently, the literature has focused on atypical femur fractures after long-term use of oral bisphosphonates (NEJM JW Gen Med Dec 29 2011). This new study provides additional support for jaw osteonecrosis as a likely — although uncommon — adverse effect of oral bisphosphonate therapy.

Editor Disclosures at Time of Publication

  • Disclosures for Allan S. Brett, MD at time of publication Nothing to disclose


Reader Comments (3)

ARIEF WIBOWO Physician, Internal Medicine, Jakarta

This a precaution for the patient who have biphosponate treatment when they want to undergo dental procedures. Does the patient with risk factors ( elderly, rematoid arthritis, and more 3 years on biphosponate) , have a contra indication to going dental procedure, some times, the dentist ask to us as preparation surgery procedures.

RITA BARROS Physician, Rheumatology, Lisbon, Portugal

Has the effect of pre bisphosponate dental evaluation been studied?

Douglas Tyler Physician, Internal Medicine, Santa Monica, Ca.

In the above mentioned study, how many of the 40 patients who developed jaw osteonecrosis had undergone a dental procedure, and, specifically, what dental procedure. On the same note, how many just spontaneously developed jaw osteonecrosis for no reason other than being on the biphosphonate? Thanks
Doug Tyler, M.D.

Your Comment

(will not be published)

Filtered HTML

  • Allowed HTML tags: <a> <em> <strong> <cite> <blockquote> <code> <ul> <ol> <li> <dl> <dt> <dd>
  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.

Plain text

  • No HTML tags allowed.
  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.
Do you have any conflict of interest to disclose?
This question is for testing whether you are a human visitor and to prevent automated spam submissions.

Vertical Tabs

* Required

Reader comments are intended to encourage lively discussion of clinical topics with your peers in the medical community. We ask that you keep your remarks to a reasonable length, and we reserve the right to withhold publication of remarks that do not meet this standard.

PRIVACY: We will not use your email address, submitted for a comment, for any other purpose nor sell, rent, or share your e-mail address with any third parties. Please see our Privacy Policy.