Bisphosphonate Related Jaw Osteonecrosis

Widespread bisphosphonate (BP) use to treat various medical conditions led to increased recognition of their possible association with osteonecrosis (ON) of the jaw. BPs are synthetic pyrophosphate analogs used to treat hypercalcemia secondary to malignancy, osteoporosis, multiple myeloma, Paget disease, osteosclerosis, fibrous dysplasia, and other bone diseases in which bone resorption is involved. Infrequent side effects with BP use include pyrexia, renal function impairment, hypocalcemia, and recently recognized avascular ON of the jaw. The American Society of Bone and Mineral Research defined BP-related jaw ON as current or previous treatment with BPs that leads to exposed bone in the maxillofacial region that does not heal within 8 weeks of identification by a healthcare provider, and the patient has no history of radiation therapy in the craniofacial region. Eight weeks is considered because most surgical and infectious sites heal in this time frame even if complications such as postsurgical infection, chemotherapy, or systemic diseases are present.