Bisphosphonate induced osteonecrosis of the jaws: Unravelling uncertainty in disease causality

Bisphosphonates and Osteonecrosis of the Jaws

“…These data include the following: 1) the perceived higher prevalence of ONJ in bisphosphonate users versus nonusers; 2) a sequential relationship requiring bisphosphonate administration prior to the onset of clinical signs; 3) a reported dose response effect of the drug; 4) the consistency of numerous reports from a variety of investigators from different institutions regarding BON; and 5) biologically plausible explanations regarding the cause of a bisphosphonate-induced bone lesion. 21,22 To be sure, there are skeptics. These clinicians view the effects of bisphosphonates as stressors of bone health and argue that this particular agent is not very different from other drugs, such as glucocorticoids or estrogens, that have caused similar events in the jaw.…”