Bisphosphonate-related osteonecrosis of the jaws.

Bisphosphonates are a class of agents whose efficacy in treating and preventing the skeletal complications associated with osteoporosis and malignant bone metastases has been well established. Despite this benefit, osteonecrosis of the jaws is a significant complication in a subset of patients receiving these drugs. Based on a growing number of case reports and institutional reviews, bisphosphonate therapy may cause bone to become exposed and necrotic. Currently, this phenomenon is isolated to the jaw. This complication usually presents following simple dentoalveolar surgery. The pathogenesis for this complication appears to be related to the profound inhibition of osteoclast function and bone remodeling. This article serves to alert ists and dental specialists about the potential complication of jaw necrosis in patients receiving bisphosphonate therapy, and proposes a guideline for diagnosis, staging and management.