“Bis-phossy jaws” – High and low risk factors for bisphosphonate-induced osteonecrosis of the jaw

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Journal Article

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Interim status: Citation only.

Abu-Id, M. H., Warnke, P. H., Gottschalk, J., Springer, I. N., Wiltfang, J., Açil, Y., et al. (2008). “Bis-phossy jaws” – high and low risk factors for bisphosphonate-induced osteonecrosis of the jaw. Journal of cranio-maxillofacial surgery, 36(2), 95-103.

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2008 HERDC submission. FoR Code: 1115

© Copyright European Association for Cranio-Maxillofacial Surgery, 2007


Bisphosphonates (BPs) have transformed our ability to treat certain malignancies, osteoporosis and hypercalcaemia. This class of drug is assumed to be well tolerated by most. There are some important caveats to this assumption, however, one of the significances being the risk of osteonecrosis of the jaw (ONJ).

Material and methods
This multi-centre retrospective study examined the role of different BPs on the development of ONJ, its clinical presentation and the efficacy of various treatment modalities, comparing these findings with the available literature.

A total of 78 patients from 17 centres were identified with ONJ. A majority of patients identified with ONJ had used Pamidronate or Zoledronate (93.6%) intravenously. 94.9% of patients had received BP in the course of treatment for malignancies and a majority had also received prior chemotherapy or exogenous steroids. 82.1% of patients had received BP for more than 1 year. The mean time from the introduction of BP to the development of ONJ in 24 patients from our department was 31.8 months.

The most common intraoral manifestation was exposed necrotic jawbone. Tooth extractions and oral surgical intervention appear to place patients on BP therapy at risk of ONJ, especially after intravenous BP treatments. ONJ proved in this study to be remarkably refractory to treatment, with radical resection being the only curative approach. We recommend that all patients receive necessary dental treatment prior to commencing BP therapy.

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