Osteonecrosis of the jaw and bisphosphonates: Editorial was confusing

doi:10.1136/bmj.39037.696759.3A

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

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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 addedconfusion rather than clarity to the issue of osteonecrosisof the jaw (ONJ) in association with the use of bisphosphonates.¹They do not distinguish between the use of very high doses ofintravenous bisphosphonates (monthly pamidronate or zoledronate)to treat patients with malignancy, and the use of much lowerdoses of bisphosphonates (approximately 1/12 of the oncologydose) in the treatment of Paget's disease or osteoporosis. Thesetwo different uses of bisphosphonates have been associated withdifferent risks for ONJ. The authors quote an incidence of 1-10%for ONJ in association with bisphosphonates.¹ However, theyfail to indicate that this estimate relates to people with malignancytreated with high dose intravenous bisphosphonates. They alsorefer to ONJ as "avascular osteonecrosis of the jaw".¹ ONJ isnot usually termed "avascular" since reduced vascularity hasnot been proved to be an aetiological factor . . . [Full text of this article]

Mark J Bolland, Andrew Grey, associate professor of medicine, Ian R Reid, professor of medicine

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

m.bolland@auckland.ac.nz

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