Bisphosphonate and osteonecrosis of the jaw

Abstract

Bisphosphonates are widely used in the treatment of bone metastases. Adverse effects associated with the use of these drugs are infrequent. Recently, osteonecrosis of the jaw (ONJ) associated with long-term intravenous bisphosponates treatment, has been reported. The overall risk of developing ONJ is low. Clinical features include exposed bone in the maxillofacial area that occurs in association with dental surgery or spontaneously. Treatment of patients with bisphosphonate-induced ONJ is difficult. Conservative management includes antiseptic oral rinse with agents containing chlorhexidine gluconate, systemic antibiotic therapy to control secondary infections, oral hygiene. Invasive procedure such as tooth extraction and bone biopsies should be avoided. It is recommended that patients should have a dental examination prior to treatment with bisphosphonates. We present a case of a 77-year-old woman with metastatic breast cancer and osteonecrosis of the jaw after a long-term intravenous treatment with bisphosphonate.