BMJ  2006;333:1122-1123 (25 November), doi:10.1136/bmj.39037.696759.3A

Letters

Osteonecrosis of the jaw and bisphosphonates

Editorial was confusing

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

The recent editorial by Landis et al has added confusion rather than clarity to the issue of osteonecrosis of the jaw (ONJ) in association with the use of bisphosphonates.¹ They do not distinguish between the use of very high doses of intravenous bisphosphonates (monthly pamidronate or zoledronate) to treat patients with malignancy, and the use of much lower doses of bisphosphonates (approximately 1/12 of the oncology dose) in the treatment of Paget's disease or osteoporosis. These two different uses of bisphosphonates have been associated with different risks for ONJ. The authors quote an incidence of 1-10% for ONJ in association with bisphosphonates.¹ However, they fail to indicate that this estimate relates to people with malignancy treated with high dose intravenous bisphosphonates. They also refer to ONJ as "avascular osteonecrosis of the jaw".¹ ONJ is not usually termed "avascular" since reduced vascularity has not been proved to be an aetiological factor . . . [Full text of this article]

¹ Department of Medicine, University of Auckland, Auckland, New Zealand

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Relevant Article

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

Basile Nicolas Landis, Michel Richter, Ivan Dojcinovic, and Max Hugentobler
BMJ 2006 333: 982-983. [Extract] [Full Text] [PDF]