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Bisphosphonates (BP) are a widely used class of drugs indicated for the prevention and treatment of postmenopausal and steroid-induced osteoporosis, Paget’s disease of bone, hypercalcemia of malignancy, multiple myeloma, and bone metastases associated with breast, prostate, lung, and other solid tumors1,2,3,4. In late 2003, a letter to The Journal of Oral and Maxillofacial Surgery described 36 patients who developed avascular necrosis of the jaw after receiving intravenous BP5. Twenty-four patients were taking pamidronate (90 mg monthly) and 12 patients were receiving zoledronate (4 mg monthly). Patients were receiving BP for multiple myeloma (18), metastatic breast cancer (17), and osteoporosis (1). All patients presented with painful, necrotic bone in the mandible (80%), maxilla (14%), or both (6%). In 78% of cases, the necrosis was associated with a history of tooth extraction. The remainder of cases appeared to arise spontaneously5. In late 2004, Ruggiero, et al 6 reported on 63 cases of BP-associated osteonecrosis accrued over a 26-month period from 2 medical centers. Twenty-eight of the 63 patients had multiple myeloma, 21 patients had breast cancer, 3 patients had prostate cancer, and 1 patient each had lung cancer, uterine leiomyosarcoma, plasmacytoma, and leukemia. All patients within the oncologic group were receiving chemotherapy and/or corticosteroids. Seven patients were diagnosed with osteoporosis and had no history of treatment with chemotherapeutic agents or corticosteroids. Fifty-four of 63 patients reported a recent extraction at the necrotic site while the remaining 9 patients had apparent spontaneous bone exposure. The reported length of BP therapy in this series ranged from 6 to 48 months although the treatment time for each individual patient was not specified. In a … Address correspondence to Dr. Landesberg. E-mail: rlandesberg{at}uchc.edu

Osteonecrosis of the Jaw and Rheumatoid Arthritis. Is It the Disease or the Drugs?