Managing the care of patients receiving antiresorptive therapy for prevention and treatment of osteoporosis: executive summary of recommendations from the American Dental Association Council on Scientific Affairs

J Am Dent Assoc. 2011 Nov;142(11):1243-51. doi: 10.14219/jada.archive.2011.0108.


Background: This narrative review of osteonecrosis of the jaw in patients with low bone mass receiving treatment with antiresorptive agents is based on an appraisal of the literature by an advisory committee of the American Dental Association Council on Scientific Affairs. It updates the committee's 2008 advisory statement.

Methods: The authors searched MEDLINE for literature published between May 2008 (the end date of the last search) and February 2011.

Results: This report contains recommendations based on the findings of the literature search and on expert opinion that relate to general dentistry; periodontal disease management; implant placement and maintenance; oral and maxillofacial surgery; endodontics; restorative dentistry and prosthodontics; orthodontics; and C-terminal telopeptide testing and drug holidays.

Conclusions: The highest reliable estimate of antiresorptive agent-induced osteonecrosis of the jaw (ARONJ) prevalence is approximately 0.10 percent. Osteoporosis is responsible for considerable morbidity and mortality. Therefore, the benefit provided by antiresorptive therapy outweighs the low risk of developing osteonecrosis of the jaw.

Clinical implications: An oral health program consisting of sound hygiene practices and regular dental care may be the optimal approach for lowering ARONJ risk. No validated diagnostic technique exists to determine which patients are at increased risk of developing ARONJ. Discontinuing bisphosphonate therapy may not lower the risk but may have a negative effect on low-bone-mass-treatment outcomes.

Publication types

  • Practice Guideline
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Antibodies, Monoclonal / adverse effects
  • Antibodies, Monoclonal / therapeutic use
  • Antibodies, Monoclonal, Humanized
  • Biomarkers / blood
  • Bisphosphonate-Associated Osteonecrosis of the Jaw / prevention & control*
  • Bone Density Conservation Agents / adverse effects
  • Bone Density Conservation Agents / therapeutic use*
  • Collagen Type I / blood
  • Denosumab
  • Dental Care for Chronically Ill
  • Diphosphonates / adverse effects
  • Diphosphonates / therapeutic use
  • Humans
  • Oral Hygiene
  • Oral Surgical Procedures
  • Osteoporosis / drug therapy*
  • Osteoporosis / prevention & control
  • Patient Care Planning
  • Peptides / blood
  • RANK Ligand / antagonists & inhibitors
  • Risk Factors


  • Antibodies, Monoclonal
  • Antibodies, Monoclonal, Humanized
  • Biomarkers
  • Bone Density Conservation Agents
  • Collagen Type I
  • Diphosphonates
  • Peptides
  • RANK Ligand
  • collagen type I trimeric cross-linked peptide
  • Denosumab