Men's Osteoporosis Support Group

Two osteonecrosis of the jaws studies

J Oral Maxillofac Surg. 2008 Feb;66(2):223-30. Outcomes of placing dental implants in patients taking oral bisphosphonates: a review of 115 cases. Grant BT and others. PMID: 18201600. This study is a review of 115 female implant patients who were taking bisphosphonates such as alendronate (Fosamax) or risedronate (Actonel) at the time the implants were done between January 1999 and December 2006. The authors found, ". . . no evidence of bisphosphonate-associated osteonecrosis of the jaw in any of the patients evaluated in the clinic and those contacted by phone or e-mail reported no symptoms." Even with this outcome they concluded, "Nevertheless, sufficient evidence exists to suggest that all patients undergoing implant placement should be questioned about bisphosphonate therapy including the drug taken, the dosage, and length of treatment prior to surgery. For patients having a history of oral bisphosphonate treatment exceeding 3 years and those having concomitant treatment with prednisone, additional testing and alternate treatment options should be considered."

Editor's comments. There are other updates on this topic on this website, including this one which is a position paper from the American Association of Oral and Maxillofacial Surgeons (AAOMS) and this one regarding the risks of osteonecrosis of the jaws. And this one is a systemic review of the subject. Reading these pages will highlight that this can be a serious side effect associated with bisphosphonate therapy, especially when given to patients I.V. for bone problems associated with widespread bone lesions from cancer since this is very high-dose therapy. But there are also much rarer instances of jaw osteonecrosis occurring in individuals being treated for osteoporosis with oral bisphosphonates.

Dental implants can be a very beneficial treatment option to replace lost teeth, and the Grant and others study should give those seeking implants some comfort that the risk of jaw osteonecrosis from dental implants can be quite low. Still the AAOMS guidelines should be followed to keep the risk as low as possible.

Laryngoscope. 2009 Jan 26;119(2):323-329. [Epub ahead of print]. Bisphosphonate-related osteonecrosis of the jaw and its associated risk factors: A belgian case series. Saussez S and others. PMID: 191762621. This Belgian study cites important findings that can lead to greater success from analyzing 34 cases of bisphosphonate-related osteonecrosis of the jaw (BROJ). They found that 88.5% of the cases were in patients with disseminated cancer, and that 11.5% were in osteoporosis patients. Actinomyces infections or colonies were found in 72% of the 25 patients on whom they had microbiological data. The cure rate with surgery was only 20%, 4 of 20 patients so treated. Yet there was a 57% cure rate in those who received medical treatment only. A lesion smaller than 1 cm was associated with a statistically significantly better prognosis compared to larger lesions. And long-term antibiotics were also associated with a better outcome.

Editor's comments. Obviously prevention is the best treatment for BROJ. But when that is impossible, it appears quite beneficial to find the problem and treat it early with non-invasive methods and antibiotics if possible. A non-healing lesion in the soft tissue of the mouth on anyone taking bisphosphonates should be checked out by a dentist to verify it isn't BROJ. I define non-healing as anything lasting longer that 7-10 days. And if it appears to be BROJ you should get a referral to a qualified oral and maxillofacial surgeon so diagnosis and treatment can be done quickly.

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