Osteonecrosis of the jaws associated with the use of bisphosphonates: a review of 63 cases

J Oral Maxillofac Surg. 2004 May;62(5):527-34. doi: 10.1016/j.joms.2004.02.004.


Purpose: Bisphosphonates are widely used in the management of metastatic disease to the bone and in the treatment of osteoporosis. We were struck in the past 3 years with a cluster of patients with necrotic lesions in the jaw who shared 1 common clinical feature, that they had all received chronic bisphosphonate therapy. The necrosis that was detected was otherwise typical of osteoradionecrosis, an entity that we rarely encountered at our center, with less than 2 patients presenting with a similar manifestation per year.

Patients and methods: We performed a retrospective chart review of patients who presented to our Oral Surgery service between February 2001 and November 2003 with the diagnosis of refractory osteomyelitis and a history of chronic bisphosphonate therapy.

Results: Sixty-three patients have been identified with such a diagnosis. Fifty-six patients had received intravenous bisphosphonates for at least 1 year and 7 patients were on chronic oral bisphosphonate therapy. The typical presenting lesions were either a nonhealing extraction socket or an exposed jawbone; both were refractory to conservative debridement and antibiotic therapy. Biopsy of these lesions showed no evidence of metastatic disease. The majority of these patients required surgical procedures to remove the involved bone.

Conclusions: In view of the current trend of increasing and widespread use of chronic bisphosphonate therapy, our observation of an associated risk of osteonecrosis of the jaw should alert practitioners to monitor for this previously unrecognized potential complication. An early diagnosis might prevent or reduce the morbidity resulting from advanced destructive lesions of the jaw bone.

MeSH terms

  • Administration, Oral
  • Adult
  • Aged
  • Aged, 80 and over
  • Alveolar Process / drug effects
  • Antineoplastic Agents / adverse effects*
  • Biopsy
  • Debridement
  • Diphosphonates / adverse effects*
  • Female
  • Humans
  • Injections, Intravenous
  • Male
  • Mandibular Diseases / chemically induced*
  • Maxillary Diseases / chemically induced*
  • Middle Aged
  • Osteomyelitis / chemically induced
  • Osteonecrosis / chemically induced*
  • Osteoporosis / drug therapy
  • Osteotomy
  • Retrospective Studies
  • Tooth Extraction
  • Tooth Socket / drug effects


  • Antineoplastic Agents
  • Diphosphonates