Osteonecrosis of the jaw and bisphosphonates

doi:10.1136/bmj.39037.696759.3A

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Editorial was confusing

Mark J Bolland (m.bolland@auckland.ac.nz),
Andrew Grey, associate professor of medicine,
Ian R Reid, professor of medicine

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

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 …