| Position Statements ©
Osteonecrosis of the Jaw ©
Osteonecrosis of the jaw (ONJ) may occur in association
with bisphosphonate therapy. Most cases have been reported
following dental surgery in patients receiving high
dose intravenous bisphosphonates for malignant disease
but the condition has also been described in patients
receiving bisphosphonates for osteoporosis and Paget’s
disease.
Advice for Clinicians
Prior to starting bisphosphonate therapy
Dental examination and preventative dental surgery should
be completed whenever possible prior to starting bisphosphonate
therapy especially in patients with risk factors for
ONJ. These include:
- Malignant disease
- Chemotherapy
- Corticosteroids
- Diabetes
- Poor oral hygiene
- Invasive dental surgery
- Non-malignant disease treated with high dose bisphosphonate
therapy.
Dental Surgery in Patients on Bisphosphonates
It is not known whether treatment should be discontinued
in patients who are on bisphosphonate therapy and who
require invasive dental surgery. Clinical judgement
should be used to weight up the skeletal risk of temporarily
discontinuing the bisphosphonate against the risk of
developing ONJ, taking into account the known risk factors
for the condition. In patients with osteoporosis who
are being treated with bisphosphonates at the licensed
dose the risk of ONJ is very low. Accordingly, the benefit
of continuing bisphosphonate will almost invariably
outweigh the risk of ONJ in this situation.
Patients who develop ONJ whilst on bisphosphonates
There is no information on whether continued bisphosphonate
therapy interferes with the treatment of ONJ or prevents
healing of ONJ lesions. In view of the association between
bisphosphonate therapy and the development of ONJ however,
it is recommended that bisphosphonate therapy be discontinued
until healing has occurred unless the skeletal benefits
of continuing bisphosphonates are felt to clearly outweigh
the risks of exacerbating ONJ.
Further Information
Further information and guidance on the pathogenesis
and management of ONJ is available at the following
websites:
ASBMR task force on ONJ
http://www.jbmronline.org/doi/full/10.1359/jbmr.0707onj
American Dental Association
http://jada.ada.org/cgi/content/full/137/8/1144
http://jada.ada.org/cgi/content/full/136/12/1658
MHRA
http://www.mhra.gov.uk/home
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