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Osteonecrosis of the jaw and bisphosphonates

BMJ 2010; 340 doi: (Published 02 February 2010) Cite this as: BMJ 2010;340:c246
  1. Aliya Khan, professor of clinical medicine
  1. 1McMaster University, 331 #209 Sheddon Avenue, Oakville, ON, Canada, L6J 5T4
  1. aliya{at}

    Low doses for osteoporosis seem to be safe

    Bisphosphonate associated osteonecrosis of the jaw is defined as exposed bone in the maxillofacial region for more than eight weeks in the absence of radiotherapy but the presence of bisphosphonate use. The condition is diagnosed clinically with exclusion of local malignancy. Other conditions may present in a similar manner, and these include spontaneous sequestration or lingual mandibular sequestration and ulceration, which is characterised by exposed necrotic bone at the level of the mylohyoid ridge of the lingual mandible. This condition is self limiting and heals spontaneously within three days to 12 weeks.1

    Other important risk factors for the development of osteonecrosis include local infection, chemotherapy, steroid use, trauma, and periodontal disease.2 Bisphosphonates are commonly used in the management of skeletal complications of malignancy, and treatment with high dose bisphosphonates has been associated with an increased risk of osteonecrosis of the jaw in patients with cancer. …

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