Bisphosphonate associated osteonecrosis of the jaw

Aliya A. Khan, George K.B. Sándor, Edward Dore, Archibald D. Morrison, Mazen Alsahli, Faizan Amin, Edmund Peters, David A. Hanley, Sultan R. Chaudry, Brian Lentle, David W. Dempster, Francis H. Glorieux, Alan J. Neville, Reena M. Talwar, Cameron M. Clokie, Majd Al Mardini, Terri Paul, Sundeep Khosla, Robert G. Josse, Susan SutherlandDavid K. Lam, Robert P. Carmichael, Nick Blanas, David Kendler, Steven Petak, Louis Georges Ste-Marie, Jacques Brown, A. Wayne Evans, Lorena Rios, Juliet E. Compston

Research output: Contribution to journalReview articlepeer-review

151 Scopus citations


In 2003, the first reports describing osteonecrosis of the jaw (ONJ) in patients receiving bisphosphonates (BP) were published. These cases occurred in patients with cancer receiving high-dose intravenous BP; however, 5% of the cases were in patients with osteoporosis receiving low-dose bisphosphonate therapy. We present the results of a systematic review of the incidence, risk factors, diagnosis, prevention, and treatment of BP associated ONJ. We conducted a comprehensive literature search for relevant studies on BP associated ONJ in oncology and osteoporosis patients published before February 2008.All selected relevant articles were sorted by area of focus. Data for each area were abstracted by 2 independent reviewers. The results showed that the diagnosis is made clinically. Prospective data evaluating the incidence and etiologic factors are very limited. In oncology patients receiving high-dose intravenous BP, ONJ appears to be dependent on the dose and duration of therapy, with an estimated incidence of 1%-12% at 36 months of exposure. In osteoporosis patients, it is rare, with an estimated incidence < 1 case per 100,000 person-years of exposure. The incidence of ONJ in the general population is not known. Currently, there is insufficient evidence to confirm a causal link between low-dose BP use in the osteoporosis patient population and ONJ. We concluded BP associated ONJ is associated with high-dose BP therapy primarily in the oncology patient population. Prevention and treatment strategies are currently based on expert opinion and focus on maintaining good oral hygiene and conservative surgical intervention. The Journal of Rheumatology

Original languageEnglish (US)
Pages (from-to)478-490
Number of pages13
JournalJournal of Rheumatology
Issue number3
StatePublished - Mar 2009


  • Bisphosphonates
  • Epidemiology
  • Guidelines
  • Osteonecrosis of the jaw
  • Side effects

ASJC Scopus subject areas

  • Rheumatology
  • Immunology
  • Immunology and Allergy


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