Osteonecrosis of the jaw after treatment with bisphosphonates: Is irreversible, so the focus must be on prevention

doi:10.1136/bmj.39024.647558.BE

BMJ 2006;333:982-983 (11 November), doi:10.1136/bmj.39024.647558.BE

Editorials

Osteonecrosis of the jaw after treatment with bisphosphonates

Is irreversible, so the focus must be on prevention

The first 150 words of the full text of this article appear below.

New generation bisphosphonates such as zolendronicacid, pamidronate, and alendronic acid have various indicationsin medicine. Initially, their use was restricted to patientswith metastatic bone malignancy secondary to breast cancer,lung cancer, prostate cancer, or multiple myeloma. Their benefitin these conditions led to wider application for other bonepathologies, such as osteoporosis and Paget's disease.¹ Theirmain effect is to inhibit osteoclast activity; however, theyalso seem to have antiangiogenic effects,² and once they areincorporated into the bony matrix, degradation is minimal.³

Reports from several hundred cases over thepast three years suggest that long term use of new generationbisphosphonates increases the risk of avascular osteonecrosisof the jaws.⁴ ⁵ ⁶ The meanonset time of osteonecrosis after the treatment is started isone to three years.⁶ The clinical picture consists of non-healingulcerated oral lesions and visible necrotic bone, which aresometimes associated with a diffuse jaw . . . [Full text of this article]

Basile Nicolas Landis, resident, Michel Richter, professor and head of department, Ivan Dojcinovic, senior resident, Max Hugentobler, associate professor

¹ Department of Oral and Maxillo-Facial Surgery, University Hospital of Geneva, 1211 Geneva, Switzerland

Basile.Landis@hcuge.ch

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Osteonecrosis of the jaw and bisphosphonates: Editorial was confusing: Mark J Bolland, Andrew Grey, and Ian R Reid
BMJ 2006 333: 1122-1123. [Extract] [Full Text] [PDF]

Osteonecrosis of the jaw and bisphosphonates: Historical lesson from occupational medicine: Eugene R Waclawski
BMJ 2006 333: 1123. [Extract] [Full Text] [PDF]

This article has been cited by other articles:

Waclawski, E. R (2006). Osteonecrosis of the jaw and bisphosphonates: Historical lesson from occupational medicine. BMJ 333: 1123-1123 [Full text]
Bolland, M. J, Grey, A., Reid, I. R (2006). Osteonecrosis of the jaw and bisphosphonates: Editorial was confusing. BMJ 333: 1122-1123 [Full text]

Rapid Responses:

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Osteonecrosis of the jaw: Prasanna Rao-Balakrishna
bmj.com, 11 Nov 2006 [Full text]
why the mandible?: Matthew N S Hunt
bmj.com, 12 Nov 2006 [Full text]
Historical Lesson from Occupational Medicine: Eugene R Waclawski
bmj.com, 13 Nov 2006 [Full text]
ONJ and bisphosphonates: Mark J Bolland, et al.
bmj.com, 16 Nov 2006 [Full text]
ONJ is not rare after bisphosphonate therapy: Jeffrey R Neilson
bmj.com, 20 Nov 2006 [Full text]
A re-newed need to promote awareness of bisphosphonate associated osteonecrosis of the jaw: Israa M Al-Shakarchi, et al.
bmj.com, 27 Sep 2007 [Full text]