Complications Associated with Bisphosphonate Medications (Boniva, Fosamax, Actonel, and others) in the Dental Patient

What is Osteonecrosis of the Jaw (ONJ)?
ONJ is a condition characterized by loss of viability and eventual death of jawbone tissue.

What should I know about the use of biophosphonates and ONJ?
Recent studies have shown that the use of a popular class of drugs called bisphosphonates, often used to offset osteoporosis or to treat cancer, can harbor serious, detrimental effects for patients undergoing dental surgery. Oral bisphosphonates, such as Boniva, Fosamax, and Actonel, have been linked to incidences of ONJ. Also, intravenous bisphosphonates (Aredia, Bonefos, Didronel, Zometa) used as a part of cancer therapy to reduce bone pain and hypercalcemia of malignancy (abnormally high calcium levels in the blood) also have been associated with increased risk of ONJ development.

Dental experts believe that patients who have been taking these medications should carefully consider the potential risks associated with various types of dental surgeries. Dentists should discuss the potential for ONJ, as well as other treatment alternatives, available to their patients. Patients also may want to review this information with their physicians and be aware of any other treatments available to them. Also, individuals should understand that the risk for developing ONJ is considered to be very small and the vast majority of patients taking these medications do not develop any oral complications. Likewise, the incidence of ONJ developed by individuals being given intravenous bisphosphonates is also rare. However, this condition may result not only from dental surgery, but could occur spontaneously.

How is ONJ diagnosed?
Because ONJ is rare, experts can’t predict who among bisphosphonates users will develop it. Diagnosis of ONJ is usually determined by X-rays or from a culture test for infection.

How is ONJ treated?
The most common treatment for ONJ is the use of antibiotics and antimicrobial mouth rinses. Although surgery is typically avoided since it may worsen the condition, it may be necessary to remove injured tissue and reduce sharp edges of damaged bone. It is generally accepted that proper oral hygiene and regular dental care from your PDA member dentist is the best way to lower risk of developing ONJ.