Osteonecrosis of the Jaw: Weighing Your Risk
A troubling jaw disease that may be related to the use of some of the most commonly used osteoporosis medications has been the subject of many news stories and law firm commercials lately. The disease is “osteonecrosis of the jaw” (ONJ) and the medication in question is a family of drugs known as “bisphosphonates”. However, the risk of ONJ for osteoporosis patients taking these types of drugs is very low – much lower than the risk of breaking a bone. Most of the people who have gotten ONJ while taking bisphosphonates have been cancer patients taking large doses of the drugs intravenously (directly into the vein).
What is osteonecrosis of the jaw?
The word “osteonecrosis” literally means “bone death”. People with ONJ have areas of exposed bone usually in the lower jaw. They may also have painful ulcers in the tissue of the jaw.
What medications could be connected to osteonecrosis of the jaw?
A family of medications called “bisphosphonates” seems to be connected to some cases of ONJ. Some bisphosphonates are taken in pill form by mouth. Fosamax (Alendronate), Actonel (Risedronate), and Boniva (Ibandronate) are all this type of bisphosphonate.

Other bisphosphonates are given intravenously (directly into a vein). Zoledronic acid (Zometa) and pamidronate (Aredia) are this type of bisphosphonate. Boniva can also be given intravenously. Most of the ONJ cases connected to the use of bisphosphonates have involved zoledronic acid or pamidronate.

Can osteonecrosis of the jaw be prevented?
There is no known prevention of ONJ. However, to reduce the risk, all patients taking bisphosphonates should get regular dental checkups. Any infections in the mouth should be treated and any major oral surgery should be completed before starting bisphosphonates in people who are thinking about starting osteoporosis treatment.
Can osteonecrosis of the jaw be treated?
While there is no specific treatment for ONJ, it can heal on its own with the help of antibiotic rinses and avoiding any other dental surgery. But healing is not guaranteed.

If you’re on an osteoporosis drug like Fosamax, Actonel, or Boniva, how worried should you be about getting ONJ?

Take Home Messages:

American College of Rheumatology Hotline. June 1, 2006.