BoneKEy-Osteovision | Perspective

Bisphosphonates: Sacrificing the jaw to save the skeleton?

Martha J Somerman
Laurie K McCauley

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DOI:10.1138/20060228

Abstract

Bisphosphonate-associated osteonecrosis of the jaw has drawn widespread attention and concern in the absence of evidence-based scientific information. There are hundreds of thousands of patients in the United States taking bisphosphonates for a variety of conditions including breast and prostate cancer, multiple myeloma, Paget's disease, and osteoporosis. Recent reviews in the Annals of Internal Medicine and Lancet Oncology have provided valuable summaries of this condition but also highlight the need for additional data. Bisphosphonate-associated osteonecrosis is, simply, exposed necrotic bone in the jaws of patients on bisphosphonates. Although the incidence is not yet clear, existing data suggest 6-10% of patients on intravenous bisphosphonates for cancer therapy will develop osteonecrosis of the jaw. This Perspective reassesses contributing factors that have been discussed in the literature, and also provides new thoughts regarding the targeted destruction of bones of the oral cavity versus other skeletal sites. Further research will help to identify individuals susceptible to osteonecrosis of the jaw and therefore facilitate prevention and effective treatment. Conditions such as osteonecrosis of the jaw highlight the need to consider oral-systemic links when treating patients and underscore the importance of communication between health care providers.

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